Surgical · Other

Excision of a benign cyst or tumor of the mandible (lower jaw) using an extraoral approach with osteotomy and partial mandibulectomy, including repair.

Verified May 8, 2026 · 8 sources ↓

Medicare: $1,076.51
Total RVUs: 32.23
Global, days: 90
Region: Other

Drawn from CMSAaomsMedicaidBedrockbillingFastrvu

Documentation requirements

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

Source · Editorial brief grounded in 8 cited references ↓

Specify that the approach was extraoral (skin incision of face or neck), not intraoral — payers use approach to distinguish 21047 from 21046
Document the nature of the lesion (benign cyst or tumor type, e.g., odontogenic keratocyst, ameloblastoma) with pathology confirmation or clinical diagnosis supporting benign classification
Record the extent of mandible resected, including osteotomy details and description of partial mandibulectomy performed
Document the repair performed — type of reconstruction, bone graft, plate fixation, or soft tissue closure — as repair is integral to code selection
Include preoperative imaging (CT or panoramic radiograph) demonstrating lesion size, location, and cortical involvement to justify the extraoral approach and extent of resection
If modifier 22 is appended, provide a separate cover letter quantifying the additional work — operative time, complexity, or unusual anatomy — beyond the typical procedure

Applicable modifiers

Modifiers commonly billed with this code.

Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual

22 Increased complexity 51 Multiple procedures 52 Reduced services 57 Decision for surgery 58 Staged or related 59 Distinct service 62 Co-surgeons 76 Repeat, same physician 78 Unplanned return — related 79 Unrelated during global 80 Assistant surgeon

What this code covers

Source · Editorial summary grounded in 8 cited references ↓

CPT 21047 covers removal of a benign mandibular cyst or tumor that has grown aggressively enough to require an extraoral osteotomy and partial mandibulectomy. The surgeon accesses the jaw through a skin incision on the face or neck — not intraorally — removes the offending lesion along with a portion of the mandible, and performs repair. This is the most extensive of the benign mandibular excision codes; 21040 covers simple enucleation/curettage, and 21046 covers intraoral osteotomy cases. If the lesion is malignant, report 21044 or 21045 instead.

The 90-day global period covers all routine postoperative care through day 90. An E&M on the day of surgery to decide whether to proceed is separately reportable with modifier 57. Unrelated procedures during the global window need modifier 79; a related return to the OR needs modifier 78. AAOMS notes that CPT codes 21046–21049 are priced for the facility setting and may not be reimbursed in a non-facility (office) setting — verify with each payer before scheduling in-office.

This code is billed almost exclusively by oral surgeons and maxillofacial surgeons. NCCI bundling edits apply: 21047 as the Column 1 code bundles several less-extensive jaw excision codes as components. Do not separately report 21040 or 21046 on the same encounter for the same lesion.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	19.57
Practice expense RVU	10.05
Malpractice RVU	2.61
Total RVU	32.23
Medicare national rate	$1,076.51
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	$1,076.51
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 21047 get rejected.

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

Insufficient documentation of extraoral approach — payers downcode to 21046 (intraoral osteotomy) or 21040 (enucleation) without explicit operative note language confirming skin incision access
Lesion coded as malignant on ICD-10 — 21047 is a benign excision code; malignant mandibular tumors require 21044 or 21045, and mismatched diagnosis codes trigger automatic denial
Bundling with less-extensive mandibular excision codes (e.g., 21040, 21046) billed same-day for the same anatomic site — NCCI edits bundle these as components of 21047
Non-facility setting claim rejection — AAOMS guidance states 21046–21049 are priced for facility settings; payers routinely deny or dramatically reduce payment when billed from an office place of service
Missing or non-confirmatory pathology report — payers may recoup payment if post-operative pathology returns malignancy and the benign excision code was billed without amendment

Frequently asked questions

Source · Generated from the editorial pipeline, verified against 8 cited references ↓

01What distinguishes 21047 from 21046?

Approach and extent. CPT 21046 uses an intraoral osteotomy. CPT 21047 requires an extraoral osteotomy — through a skin incision on the face or neck — plus a partial mandibulectomy. If you didn't go through skin and didn't remove a portion of the mandible, 21047 is not the right code.

02Can 21047 be billed from an office (place of service 11)?

Generally no. AAOMS coding guidance explicitly states that CPT codes 21046–21049 are priced for the facility setting and may not be reimbursed in a non-facility setting. Verify with individual payers, but plan to perform this procedure in a hospital or ASC.

03What ICD-10 codes support 21047?

Benign mandibular lesion diagnoses drive this code — common examples include odontogenic cysts (K09.0, K09.1), other jaw cysts (K09.2), and benign neoplasms of the mandible (D16.5). A malignant diagnosis code paired with 21047 will trigger denial; use 21044 or 21045 for malignant tumors.

04Is modifier 50 applicable if bilateral jaw cysts are excised?

Bilateral mandibular excisions at the same encounter are uncommon, but if two distinct anatomic sites on the mandible require separate extraoral osteotomies, report with modifier 59 to distinguish the distinct procedural services rather than modifier 50, which applies to true bilateral paired structures. Confirm with the specific payer.

05How does the 90-day global period affect post-op coding?

All routine follow-up, wound checks, suture removal, and post-op visits through day 90 are bundled into 21047's global. An unrelated procedure during that window uses modifier 79. A return to the OR for a complication related to the original excision uses modifier 78. A new decision for surgery at a separate site uses modifier 57 on the E&M.

06Can 21047 and 21040 be billed together on the same day?

Not for the same lesion or site. NCCI edits bundle 21040 (enucleation/curettage) as a component of 21047 when performed at the same anatomic location. If a genuinely separate, distinct cyst at a different mandibular site is also enucleated, modifier 59 documents the distinct service — but document the separate anatomy clearly.

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 surgical approach (extraoral vs. intraoral), osteotomy details, extent of mandible resected, repair method, and the lesion's clinical classification as benign from dictation. That structured capture prevents the most common denial path for 21047: an operative note that omits the extraoral access or the partial mandibulectomy, which auditors use to downcode to 21046 or 21040.

See how Mira captures CPT 21047 documentation