Surgical · Other

Excision of a benign tumor or cyst of the maxilla requiring extra-oral osteotomy and partial maxillectomy — used for locally aggressive or destructive lesions.

Verified May 8, 2026 · 7 sources ↓

Medicare: $1,021.07
Total RVUs: 30.57
Global, days: 90
Region: Other

Drawn from MdclarityAAPCFindacodePayerpriceAaoms

Documentation requirements

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

Source · Editorial brief grounded in 7 cited references ↓

Operative note must specify extra-oral approach and confirm osteotomy was performed through the maxillary bone
Document extent of partial maxillectomy, including anatomical boundaries of bone removed
Pathology report confirming benign diagnosis (K04, K09, or M27 category) — required before claim submission
Lesion description justifying aggressive approach: size, location, evidence of local destruction or aggressive behavior
Pre-operative imaging (CT or panoramic radiograph) referenced in the operative note to establish lesion characteristics
Anesthesia type documented — local anesthesia is inherent and not separately billable

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 62 Co-surgeons 76 Repeat, same physician 77 Repeat, another physician 78 Unplanned return — related 79 Unrelated during global LT Left side RT Right side XS Separate structure

What this code covers

Source · Editorial summary grounded in 7 cited references ↓

CPT 21049 covers open surgical removal of a benign tumor or cyst from the maxilla (upper jaw) when the lesion is locally aggressive or destructive enough to require an extra-oral osteotomy and partial maxillectomy. This is the highest-complexity code in the maxillary cyst/tumor excision family — step it up from 21030 (enucleation/curettage) and 21048 (intra-oral osteotomy only) when the surgical access demands a cut through the maxillary bone from outside the mouth and removal of a portion of the maxilla itself.

The 90-day global period covers all routine post-op care through day 90. Wound closure is bundled per NCCI — do not separately bill repair codes 12001–13153 for closure of the surgical incision. If a separately identifiable procedure is performed the same day, modifier 51 signals multiple procedures; modifier 59 or XS addresses distinct anatomical structures when NCCI edits are triggered.

Delay claim submission until the pathology report confirms a benign diagnosis — billing before pathology returns is a common audit flag, and a malignant finding shifts coding to a different code family entirely (e.g., 21034). ICD-10-CM categories K04, K09, and M27 cover the most common diagnoses paired with this code.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	18.84
Practice expense RVU	9.27
Malpractice RVU	2.46
Total RVU	30.57
Medicare national rate	$1,021.07
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	$1,021.07
HOPD (APC 5165) Hospital outpatient department	$6,048.05
ASC (PI G2) Ambulatory surgical center (freestanding)	$3,025.62

Common denial reasons

The recurring reasons claims for CPT 21049 get rejected.

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

Claim submitted before pathology report received, leaving diagnosis unconfirmed at time of billing
Operative note fails to document extra-oral osteotomy — payer downcodes to 21030 or 21048
Wound closure billed separately with repair codes 12001–13153, triggering NCCI bundle denial
Missing or insufficient documentation of lesion aggression or destruction to justify partial maxillectomy
Incorrect site modifier when bilateral procedures are billed — payer requires LT/RT split or modifier 50 per their specific policy

Frequently asked questions

Source · Generated from the editorial pipeline, verified against 7 cited references ↓

01What distinguishes 21049 from 21048 and 21030?

21030 is enucleation or curettage only — no osteotomy. 21048 adds an intra-oral osteotomy. 21049 requires an extra-oral osteotomy and partial maxillectomy, reserved for locally aggressive or destructive lesions. Use the highest code supported by what was actually performed and documented.

02Should I wait for pathology before billing 21049?

Yes. AAOMS coding guidance and standard audit practice recommend holding the claim until pathology confirms a benign diagnosis. A malignant finding requires a different code set entirely, and submitting before results return invites take-back risk.

03Can wound closure be billed separately with 21049?

No. NCCI policy bundles closure of surgical incisions into procedures with a 090 global period. Repair codes 12001–13153 are not separately reportable for closing the operative site.

04Is modifier 50 appropriate if the procedure is bilateral?

Bilateral maxillary cyst excision at this level is rare, but if performed, modifier 50 applies. ASC billing requires two claim lines with LT and RT modifiers. Verify your specific payer's bilateral reporting requirement before submitting — some want modifier 50 on a single line, others want two lines.

05What ICD-10-CM codes pair with 21049?

The primary categories are K04 (pulp and periapical diseases), K09 (cysts of oral region), and M27 (other diseases of the jaws). The specific code depends on lesion type confirmed by pathology — K09.0 for developmental odontogenic cysts is a common pairing.

06Is local anesthesia separately billable with 21049?

No. Local anesthesia is an inherent component of this — and all — surgical procedures under both CPT and CDT coding frameworks. Do not bill it separately.

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 (extra-oral vs. intra-oral), confirmation of osteotomy through the maxillary bone, extent of partial maxillectomy, and lesion characteristics (size, destruction pattern) directly from dictation. This prevents downcoding to 21030 or 21048 when the operative note lacks explicit approach documentation — the most common reason payers reduce this claim.

See how Mira captures CPT 21049 documentation