Unlisted code for a maxillofacial prosthetic service, such as a custom facial or intraoral prosthesis, that no specific code in that section describes.
- Medicare
- $0.00
- Work RVU
- 0
- Global, days
- Region
- Other
Documentation requirements
What must appear in the operative or office note to support the claim.
Source · Editorial brief grounded in 2 cited references ↓
- Cause of the defect (trauma, tumor resection, congenital)
- Description of the prosthesis, materials, and fabrication steps
- Lab invoice or material cost
- Comparison code from the maxillofacial prosthetics section
- Number of visits for impressions, fittings, and delivery
What this code covers
Source · Editorial summary grounded in 2 cited references ↓
21089 covers maxillofacial prosthetics with no specific code: custom prostheses that restore missing facial or oral structures after trauma, tumor resection, or congenital defects. These are usually made by a maxillofacial prosthodontist, sometimes working with an oral surgeon or ENT team.
Orthopedic practices rarely touch it. It shows up in multispecialty groups or trauma centers where a facial fracture patient also has extremity injuries, and the billing office handles claims for several services. If your coders see it, confirm the rendering provider and specialty match what the payer expects for prosthetic work.
As an unlisted code it has no Medicare fee and no fixed global (YYY). The payer prices it from records. Send the clinical notes, a description of the prosthesis and how it was made, lab or material costs, and a comparison code. Many plans treat these under medical benefits only when the defect is from disease or trauma. Dental plans may claim it instead, so check which benefit applies before submitting.
RVU & reimbursement
Component RVUs and Medicare national rate. Actual payment varies by GPCI locality.
Source · CMS Physician Fee Schedule, RVU26A · January 2026
| Work RVU | 0 |
| Practice expense RVU | 0 |
| Malpractice RVU | 0 |
| Total RVU | 0 |
| Medicare national rate | $0.00 |
| Global period | 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 | $0.00 |
HOPD (APC 5161) Hospital outpatient department | $241.98 |
Common denial reasons
The recurring reasons claims for CPT 21089 get rejected.
Source · Editorial brief grounded in CMS NCCI edits, AAOS coding appeals, and cited references ↓
- Billed to medical when the plan routes it to dental benefits
- Missing description of the prosthesis
- No documentation linking the defect to disease or trauma
- A specific code in 21076-21088 describes the service
Frequently asked questions
Source · Generated from the editorial pipeline, verified against 2 cited references ↓
01Who usually bills CPT 21089?
02Does Medicare cover 21089?
03What should I send with a 21089 claim?
Sources & references
Editorial content was developed using the following public sources.
- 01CMS Physician Fee Schedule 2026
- 02cms.govhttps://www.cms.gov/regulations-and-guidance/guidance/manuals/downloads/clm104c12.pdf
Mira Scribe
Mira Scribe captures the cause of the defect and each fitting visit in plain language, which gives the payer what it needs to price an unlisted prosthetic.
See how Mira captures CPT 21089 documentation