Surgical · Other

LeFort I midface reconstruction performed in two separate maxillary segments, repositioning the upper jaw in any direction, without bone grafting.

Verified May 8, 2026 · 5 sources ↓

Medicare: $1,238.17
Total RVUs: 37.07
Global, days: 90
Region: Other

Drawn from CMSAaomsAAOS

Documentation requirements

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

Source · Editorial brief grounded in 5 cited references ↓

Operative note must state the number of osteotomy segments explicitly — 'two-piece' — not just 'LeFort I' or 'segmented maxillary osteotomy'.
Document the direction of segment movement (anterior, posterior, superior, inferior, or multidirectional) for each piece.
Confirm no bone graft was placed; if autograft was obtained and used, 21146 is the correct code.
Record the underlying diagnosis (congenital deformity, acquired deficiency, post-traumatic malocclusion, obstructive sleep apnea, etc.) tied to a supporting ICD-10 code to establish medical necessity.
If modifier 22 is appended, include a separate written justification describing the specific factors — prior surgery scarring, abnormal anatomy, extended operative time — that made the work substantially greater than typical.
For same-session concurrent procedures (e.g., mandibular osteotomy, genioplasty), each must have its own documented operative description distinct enough to withstand NCCI unbundling review.

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 78 Unplanned return — related 79 Unrelated during global 80 Assistant surgeon AS PA/NP/CNS assistant

What this code covers

Source · Editorial summary grounded in 5 cited references ↓

CPT 21142 describes a LeFort I osteotomy of the midface in which the maxilla is mobilized and repositioned as two distinct pieces, moving each segment independently in any direction — anteriorly, posteriorly, superiorly, inferiorly, or in combination. No bone graft is harvested or placed; the code family steps up to 21146 when autograft is required. The two-piece segmentation distinguishes this code from 21141 (single piece) and 21143 (three or more pieces), so the operative note must explicitly document the number of osteotomy segments.

This procedure is performed for congenital dentofacial deformities, acquired midface deficiencies, and post-traumatic malocclusion. It is typically coordinated with orthodontic treatment and frequently billed alongside mandibular procedures (e.g., 21193–21196) or genioplasty (21121–21122) in the same operative session. When additional procedures are performed, report the highest-RVU code first and apply modifier 51 to secondaries — but verify NCCI edits for each combination before billing.

The 90-day global period covers the surgery date, the pre-op day-before visit, and all routine follow-up through day 90. Use modifier 57 on a same-day or day-before E/M if that visit is when the surgical decision was made. Any unrelated procedure performed by the same surgeon during the global window requires modifier 79; a related, unplanned return to the OR for a complication requires modifier 78.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	19.77
Practice expense RVU	14.43
Malpractice RVU	2.87
Total RVU	37.07
Medicare national rate	$1,238.17
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	$1,238.17
HOPD (APC 5165) Hospital outpatient department	$6,048.05
ASC (PI J8) Ambulatory surgical center (freestanding)	$3,881.44

Common denial reasons

The recurring reasons claims for CPT 21142 get rejected.

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

Cosmetic vs. reconstructive determination: payer denies without documentation of functional impairment, prior orthodontic records, or prior authorization where required.
Wrong code selected within the LeFort I family — billing 21141 (single piece) when two segments are documented, or 21142 when a bone graft was used (should be 21146).
Missing or inadequate medical necessity documentation — no ICD-10 linking the deformity to a functional deficit such as malocclusion, airway compromise, or dysphagia.
Global period conflict — separate E/M billed within the 90-day global without modifier 24 (unrelated) or 25 (significant, separately identifiable on day of procedure).
Modifier 62 (co-surgery) submitted without a second surgeon's distinct operative note documenting their separate surgical work.

Frequently asked questions

Source · Generated from the editorial pipeline, verified against 5 cited references ↓

01What is the difference between CPT 21141, 21142, and 21143?

The number of maxillary segments is the only differentiator: 21141 is a single-piece LeFort I, 21142 is two pieces, and 21143 is three or more pieces. Direction of movement does not change the code — all three cover movement in any direction. The operative note must state the segment count explicitly.

02When should I use 21146 instead of 21142?

Use 21146 any time a bone graft is harvested and placed during the two-piece LeFort I. CPT 21142 is specifically for procedures performed without bone grafting. Billing 21142 when graft documentation exists creates an undercoding risk on audit.

03Can 21142 and a mandibular osteotomy code be billed together on the same date?

Yes, bimaxillary cases routinely combine 21142 with a mandibular procedure. List the highest-RVU code first and append modifier 51 to the secondary code. Verify NCCI edits for the specific combination — some mandibular codes carry column 2 edits against LeFort codes that require modifier 59 to override when both are clearly documented as distinct procedures.

04How does the 90-day global period affect billing for this procedure?

The 90-day global covers the day before surgery, the operative day, and all routine postoperative visits through day 90. Routine follow-up within that window is not separately billable. Use modifier 24 for unrelated E/M visits, modifier 79 for unrelated procedures, and modifier 78 for an unplanned return to the OR for a related complication. A planned staged return — such as hardware removal — uses modifier 58, which also resets the global clock.

05Does Medicare routinely cover CPT 21142?

Medicare coverage depends on medical necessity documentation showing a functional deficit — not cosmetic motivation. Prior authorization policies vary by MAC and commercial payer. Submit supporting records including orthodontic workup, imaging, and a diagnosis-linked letter of medical necessity with the initial claim when your payer requires it. CMS Article A56658 addresses cosmetic versus reconstructive distinctions directly.

06When is modifier 62 appropriate for this procedure?

Modifier 62 applies when two surgeons — for example, an oral and maxillofacial surgeon and a plastic surgeon — each perform distinct portions of the LeFort I reconstruction and both bill for the same CPT code. Each surgeon must submit a separate operative report documenting their individual work. Both claims are reimbursed at a reduced co-surgery rate.

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 segment count, direction of movement for each piece, absence of bone graft, and the underlying diagnosis from dictation — the three data points that determine whether 21142, 21141, 21143, 21146, or a different LeFort variant is correct. It also flags when concurrent procedures are dictated so the coder can sequence by RVU and apply modifier 51 before the claim drops, preventing the most common upcoding and downcoding audit flags for this code family.

See how Mira captures CPT 21142 documentation