Surgical · Other

Excision of a benign tumor or cyst of the mandible requiring an intra-oral osteotomy, used for locally aggressive or destructive lesions that cannot be managed by simple enucleation or curettage alone.

Verified May 8, 2026 · 5 sources ↓

Medicare: $899.49
Total RVUs: 26.93
Global, days: 90
Region: Other

Drawn from CMSMdclarityEmedny

Documentation requirements

What must appear in the operative or office note to support the claim.

Source · Editorial brief grounded in 5 cited references ↓

Operative note must explicitly name the surgical approach and confirm an intra-oral osteotomy was performed, not merely enucleation or curettage
Pathology report or pre-op imaging (CT or panoramic radiograph) documenting the lesion's size, cortical involvement, and aggressive or destructive character
Lesion type specified by name (e.g., keratocystic odontogenic tumor, ameloblastoma) with ICD-10 diagnosis code matched to a benign classification
Documentation of proximity to adjacent anatomic structures such as the inferior alveolar nerve or tooth roots justifying the osteotomy approach
Pre-operative informed consent noting the complexity of the resection and risk of nerve involvement or mandibular continuity disruption
Postoperative specimen disposition confirming tissue was sent for histopathologic evaluation

Applicable modifiers

Modifiers commonly billed with this code.

Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual

22 Increased complexity 50 Bilateral procedure 51 Multiple procedures 52 Reduced services 59 Distinct service 76 Repeat, same physician 77 Repeat, another physician 78 Unplanned return — related 79 Unrelated during global 80 Assistant surgeon AS PA/NP/CNS assistant LT Left side RT Right side

What this code covers

Source · Editorial summary grounded in 5 cited references ↓

CPT 21046 covers surgical removal of a benign mandibular tumor or cyst when the lesion's size, location, or aggressive behavior requires an intra-oral osteotomy to achieve adequate access and complete excision. The key distinction from 21040 (enucleation/curettage only) is the osteotomy requirement — if the operative note doesn't document why bone cutting was necessary, expect a downcode. Locally aggressive lesions such as keratocystic odontogenic tumors or ameloblastomas are the classic indications.

The 90-day global period bundles the operative session, the day-before visit, and all routine postoperative care through day 90. Any E&M visit during that window for a reason unrelated to the mandibular procedure requires modifier 24. If a second jaw procedure becomes necessary during the global period — planned or unplanned — modifiers 78 or 79 apply depending on whether it's related or unrelated to the index surgery.

This code is billed almost exclusively by oral surgeons and maxillofacial surgeons. Payers scrutinize the distinction between 21046 and the less-complex 21040; the operative note must explicitly support the medical necessity of the osteotomy, including the lesion's characteristics (size, cortical involvement, proximity to the inferior alveolar nerve) and why simpler enucleation was insufficient.

RVU & reimbursement

Component RVUs and Medicare national rate. Actual payment varies by GPCI locality.

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	13.85
Practice expense RVU	11.32
Malpractice RVU	1.76
Total RVU	26.93
Medicare national rate	$899.49
Global period	90 days

Payment by site of service

Medicare pays different rates by setting. HOPD typically pays substantially more than ASC for the same procedure.

Source · CMS OPPS Addendum B·ASC HCPCS payment rates·2026

Setting	Medicare rate (national)
Office (PFS non-facility) Procedure performed in physician's office	$899.49
HOPD (APC 5165) Hospital outpatient department	$6,048.05
ASC (PI A2) Ambulatory surgical center (freestanding)	$3,025.62

Common denial reasons

The recurring reasons claims for CPT 21046 get rejected.

Source · Editorial brief grounded in CMS NCCI edits, AAOS coding appeals, and cited references ↓

Downcoded to 21040 when the operative note lacks explicit documentation of an osteotomy and the medical necessity for bone cutting
Medical necessity denial when imaging or pathology documentation does not support an aggressive or destructive lesion requiring osteotomy-level access
Bundling denial when 21046 is billed same-day with a related jaw procedure without a supporting modifier and distinct documentation for each procedure
Global period denial for postoperative E&M visits billed without modifier 24 when the visit is treated as unrelated but payer considers it routine recovery
Diagnosis mismatch denial when the ICD-10 code reflects a malignant lesion (which maps to 21044/21045) rather than a benign tumor or cyst

Frequently asked questions

Source · Generated from the editorial pipeline, verified against 5 cited references ↓

01What separates 21046 from 21040 in the operative note?

The osteotomy. 21040 covers enucleation and curettage only. 21046 requires documentation that bone was surgically cut to access or remove the lesion — and the note must explain why the lesion's size, location, or aggressive behavior made that necessary. If the note reads like a simple enucleation, payers will downcode to 21040.

02Can 21046 be billed bilaterally with modifier 50?

Technically modifier 50 applies if lesions are excised from both sides of the mandible in the same session, but this is extremely rare anatomically and clinically. If you're billing 50, your documentation needs to describe two distinct osteotomy sites on contralateral sides of the mandible, each with separate pathology.

03Is a concurrent E&M billable on the same day as 21046?

Only if it's a significant, separately identifiable service unrelated to the decision to perform the surgery. Append modifier 25 to the E&M. The visit must address a distinct clinical problem beyond the mandibular lesion, documented separately in the note. Payers routinely deny same-day E&M without modifier 25.

04What modifier applies if the patient returns to the OR during the 90-day global for a complication of the original excision?

Modifier 78 — unplanned return to the OR for a procedure related to the index surgery during the postoperative period. Do not use modifier 79, which is reserved for unrelated procedures performed during the global period.

05Does 21046 include imaging guidance?

No imaging guidance code is bundled into 21046 by the CPT descriptor. However, per NCCI policy, if radiologic guidance is considered integral to the technique used, it cannot be separately reported. Confirm against current NCCI edits before billing a separate imaging guidance code for the same session.

06Which diagnosis codes most commonly pair with 21046?

Benign odontogenic cysts and tumors are the correct ICD-10 territory — codes such as K09.0 (developmental odontogenic cysts) or D16.5 (benign neoplasm of lower jaw bone). Using a malignant diagnosis code will trigger a mismatch, since malignant mandibular tumors map to 21044 or 21045, not 21046.

Sources & references

Editorial content was developed using the following public sources. Last verified May 8, 2026.

Mira AI Scribe

Mira's AI scribe captures the lesion's name and characteristics, the specific intra-oral osteotomy technique performed, cortical involvement noted intraoperatively, proximity to the inferior alveolar nerve, and confirmation that tissue was sent to pathology. This prevents the most common audit trigger for 21046: an operative note that describes enucleation without clearly documenting why the osteotomy was required, which drives downcodes to 21040.

See how Mira captures CPT 21046 documentation