Midface reconstruction via LeFort I osteotomy, single-piece maxillary segment moved in any direction, performed without bone graft.
Verified May 8, 2026 · 6 sources ↓
- Medicare
- $1,208.44
- Total RVUs
- 36.18
- Global, days
- 90
- Region
- Other
Documentation requirements
What must appear in the operative or office note to support the claim.
Source · Editorial brief grounded in 6 cited references ↓
- Operative note must explicitly state the number of maxillary pieces created and confirm no segmental vertical osteotomies were performed
- Direction and magnitude of segment movement (advancement, impaction, elongation, or retrusion) documented in millimeters
- Confirmation that no bone graft was used — if graft becomes necessary intraoperatively, code switches to 21145
- Pre-operative cephalometric analysis and occlusal records demonstrating skeletal deformity contributing to functional impairment
- Documentation of failed or inadequate orthodontic treatment establishing surgical necessity
- Precertification approval reference number from payer's oral and maxillofacial surgery review unit, where required
Applicable modifiers
Modifiers commonly billed with this code.
Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual
What this code covers
Source · Editorial summary grounded in 6 cited references ↓
CPT 21141 covers a single-piece LeFort I osteotomy in which the entire maxilla is mobilized as one unit and repositioned — advancement, retrusion, impaction, or elongation — without bone graft. The horizontal cut separates the maxilla from the midface skeleton; no vertical segmental cuts divide it into multiple pieces. That single-piece, no-graft distinction is what separates 21141 from 21142 (2-piece), 21143 (3+ pieces), and 21145 (single-piece with graft). Pick the wrong code in that family and you've either underbilled or created an audit flag for upcoding.
The 90-day global period covers the day-before visit, the surgery itself, and all routine post-op care through day 90. Office visits during that window for orthodontic adjustments, occlusal checks, or routine healing are bundled. Bill modifier 24 for unrelated E/M visits and modifier 78 for an unplanned return to the OR for a related complication within the global. A new global period does not open when modifier 78 is used.
Most payers, including Aetna, require precertification for orthognathic surgery and want documented functional impairment — typically masticatory dysfunction with skeletal discrepancies that cannot be corrected by orthodontics alone. Cosmetic intent alone will not satisfy medical necessity criteria. Pre-auth denials on 21141 almost always trace back to missing functional documentation or failure to route through the payer's oral and maxillofacial surgery review unit.
RVU & reimbursement
Component RVUs and Medicare national rate. Actual payment varies by GPCI locality.
Source · CMS Physician Fee Schedule, RVU26A · January 2026
| Work RVU | 19.08 |
| Practice expense RVU | 14.34 |
| Malpractice RVU | 2.76 |
| Total RVU | 36.18 |
| Medicare national rate | $1,208.44 |
| 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 | $1,208.44 |
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 21141 get rejected.
Source · Editorial brief grounded in CMS NCCI edits, AAOS coding appeals, and cited references ↓
- Medical necessity denial when documentation reflects cosmetic goals without recorded masticatory dysfunction or functional impairment
- Wrong code selection — biller uses 21141 when operative note describes vertical segmental cuts creating 2+ pieces (should be 21142 or 21143)
- Missing precertification or failure to route through the payer's OMS review unit before surgery
- Bundling denial when assistant surgeon services are billed without modifier 80 or AS, or without confirming the procedure is assistant-eligible under the payer's policy
- Global period violation — routine orthodontic or post-op follow-up billed separately within the 90-day global without modifier 24
Frequently asked questions
Source · Generated from the editorial pipeline, verified against 6 cited references ↓
01What is the difference between 21141 and 21145?
02When should I use 21142 or 21143 instead of 21141?
03Does 21141 require precertification?
04Can modifier 22 be used with 21141?
05How does the 90-day global period affect billing for concurrent orthodontic management?
06Is an assistant surgeon reimbursable for 21141?
07What ICD-10 diagnoses support medical necessity for 21141?
Sources & references
Editorial content was developed using the following public sources. Last verified May 8, 2026.
- 01hiacode.comhttps://hiacode.com/blog/cpt-coding-for-lefort-i-procedures
- 02aaoms.orghttps://aaoms.org/publications/coding-and-billing-papers/coding-for-orthognathic-surgery-and-or-obstructive-sleep-apnea/
- 03aetna.comhttps://www.aetna.com/cpb/medical/data/1_99/0095.html
- 04sgo.orghttps://www.sgo.org/wp-content/uploads/2012/09/Medicare-Global-Surgery-Modifiers.pdf
- 05cms.govhttps://www.cms.gov/files/document/2025nccimedicarepolicymanualcompletepdf.pdf
- 06CMS Physician Fee Schedule 2026
Mira AI Scribe
Mira's AI scribe captures the number of maxillary pieces created, the direction and millimeter magnitude of segment movement, graft status, and the functional indication from dictation — preventing the most common 21141 audit flag, which is an operative note that documents the osteotomy technique but omits the piece count or graft decision that determines the correct code in the 21141–21147 family.
See how Mira captures CPT 21141 documentation