Surgical · Other

Genioplasty performed via two or more sliding osteotomies — typically wedge excisions or bone wedge reversals — to reposition or reshape an asymmetrical chin.

Verified May 8, 2026 · 7 sources ↓

Medicare: $700.08
Total RVUs: 20.96
Global, days: 90
Region: Other

Drawn from CMSNIHFastrvuAAPCMdclarity

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 the number of osteotomies performed and their anatomical locations on the chin
Document the surgical technique by name (wedge excision, bone wedge reversal, or combined) for each cut
Record the functional or aesthetic indication — payers require clear distinction; cosmetic-only cases are non-covered by Medicare and most commercial plans
Include pre-operative imaging (cephalometric radiographs or CT) demonstrating the asymmetry or skeletal discrepancy being corrected
If modifier 22 is appended, the operative note must quantify increased complexity — time, anatomical difficulty, or prior surgical history that elevated risk
For functional indications such as OSA, include sleep study results and documentation linking chin repositioning to the treatment plan

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 59 Distinct service 78 Unplanned return — related 79 Unrelated during global 80 Assistant surgeon LT Left side RT Right side

What this code covers

Source · Editorial summary grounded in 7 cited references ↓

CPT 21122 covers a genioplasty in which the surgeon makes two or more cuts through the chin bone, then removes or repositions bone wedges to correct asymmetry or achieve the desired chin projection. The multi-osteotomy approach is more technically demanding than a single-cut sliding genioplasty (21121) because each additional osteotomy requires precise angulation, sequencing, and fixation to achieve a symmetric, stable result. This code sits in the 90-day global period, so all routine postoperative care through day 90 is bundled.

Indications span both functional and aesthetic presentations: correction of chin asymmetry, class II or III skeletal discrepancies in conjunction with orthognathic surgery, and, less commonly, adjunctive treatment for obstructive sleep apnea where chin advancement increases airway volume. Payer coverage policies diverge sharply here — cosmetic indications are uniformly non-covered, while functional indications tied to documented OSA or malocclusion may qualify under medical benefit. Confirm ICD-10 alignment and obtain prior authorization before scheduling.

When 21122 is performed at the same session as orthognathic procedures (e.g., Le Fort I, bilateral sagittal split), append modifier 51 to the lower-valued code(s). If the complexity of a given case substantially exceeds the typical work — unusually severe asymmetry, prior failed osteotomy, aberrant vascular anatomy — modifier 22 is appropriate, but submit the operative note with the claim via the PWK process; reviewers will not accept narrative field entries as justification.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	8.49
Practice expense RVU	10.9
Malpractice RVU	1.57
Total RVU	20.96
Medicare national rate	$700.08
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	$700.08
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 21122 get rejected.

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

Cosmetic-only ICD-10 codes trigger automatic non-covered-service denials from Medicare and most commercial payers
Missing prior authorization for elective jaw/chin reconstruction at facilities that require it
Modifier 51 omitted when 21122 is billed same-session with orthognathic or other craniofacial codes, causing bundling edits
Insufficient documentation to support modifier 22 — submitting without operative note via PWK results in claim rejection
ICD-10 diagnosis does not clearly support a functional indication, leading to medical-necessity denial even when prior auth was obtained

Frequently asked questions

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

01What separates 21122 from 21121?

The osteotomy count. 21121 is a single sliding osteotomy. 21122 requires two or more. The operative note must document each cut explicitly — one reference to 'a genioplasty' without specifying cut count will get the claim downcoded to 21121 on audit.

02Is 21122 covered by Medicare?

Only when the indication is functional — documented skeletal deformity, malocclusion requiring surgical correction, or, in some LCDs, adjunctive sleep apnea treatment. Purely cosmetic chin reshaping is a non-covered service under Medicare. Check your MAC's LCD for chin/jaw procedures before billing.

03Can 21122 be billed same-day with orthognathic surgery codes?

Yes. When performed at the same session as Le Fort I (21141–21160) or bilateral sagittal split osteotomy (21193–21196), append modifier 51 to the lower-valued procedure. Verify NCCI edits for the specific code pair before submitting.

04When does modifier 22 apply to 21122?

When the work is substantially greater than typical — for example, revision after a prior failed osteotomy, unusually severe asymmetry requiring complex wedge geometry, or aberrant anatomy. Submit the operative note via the PWK process on the same claim. Novitas and most MACs will reject modifier 22 claims that arrive without supporting documentation.

05What global period applies, and what does that mean for post-op billing?

90-day global. Routine office visits, wound checks, and hardware assessments through day 90 are bundled. Bill unrelated E/M services in the global window with modifier 24. Use modifier 79 for a return to the OR for an unrelated problem within the global; modifier 78 for an unplanned return for a complication related to the original procedure.

06Does 21122 require prior authorization?

Payer-variable. Most commercial plans require prior auth for elective craniofacial/orthognathic procedures. Functional indications (documented OSA, severe malocclusion) improve approval odds, but auth is not automatic. Cosmetic indications will not receive auth under any medical benefit plan.

Sources & references

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

Mira AI Scribe

The Mira AI Scribe captures the number of osteotomies made, the specific technique used at each cut (wedge excision vs. bone wedge reversal), fixation method, and the documented clinical indication (aesthetic vs. functional). That specificity prevents the most common 21122 denial: an operative note that says 'genioplasty performed' without confirming two or more discrete osteotomies — the detail that separates 21122 from 21121 and justifies the higher-complexity code on audit.

See how Mira captures CPT 21122 documentation