LeFort I osteotomy of the maxilla performed in three or more bone segments, without bone grafting, for midface reconstruction.
Verified May 8, 2026 · 5 sources ↓
- Medicare
- $1,273.58
- Total RVUs
- 38.13
- 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 5 cited references ↓
- Operative note must explicitly state the number of maxillary segments created (three or more) to distinguish 21143 from 21141 or 21142.
- Confirm absence of bone graft use — if autograft or allograft is harvested and placed, 21147 is the correct code.
- Document the direction and magnitude of segment movement (anterior, posterior, superior, inferior, or rotational) and the clinical indication driving multi-piece design.
- Preoperative imaging (CT, panoramic radiograph, or cephalometric X-ray) demonstrating the deformity and surgical planning must be in the record.
- Fixation hardware type and placement should be described; plate and screw fixation is integral and not separately reportable.
- Record the surgical approach, soft tissue management, and any intraoperative complications or circumstances that would support modifier 22.
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 5 cited references ↓
CPT 21143 describes a LeFort I level midface reconstruction in which the maxilla is divided into three or more separate bony pieces and repositioned — without the use of bone grafts. This is among the most technically complex iterations of the LeFort I family (21141–21143), used when a single or two-piece osteotomy cannot adequately correct severe maxillary deformity, transverse discrepancies, or segmental alveolar irregularities. The 90-day global period applies, covering all routine postoperative management through day 90.
The code sits in the craniofacial/midface reconstruction section and is almost exclusively performed by oral and maxillofacial surgeons or plastic surgeons with craniofacial fellowship training. Because no graft harvest is involved, codes for autograft procurement are not separately reportable. When a bone graft is added, step up to 21147. If the procedure also includes a LeFort III component, consider 21155. Confirm the segment count and graft status in the operative note — these are the two variables that determine which LeFort I variant is correct.
RVU & reimbursement
Component RVUs and Medicare national rate. Actual payment varies by GPCI locality.
Source · CMS Physician Fee Schedule, RVU26A · January 2026
| Work RVU | 20.52 |
| Practice expense RVU | 14.63 |
| Malpractice RVU | 2.98 |
| Total RVU | 38.13 |
| Medicare national rate | $1,273.58 |
| 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 | $1,273.58 |
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 21143 get rejected.
Source · Editorial brief grounded in CMS NCCI edits, AAOS coding appeals, and cited references ↓
- Segment count not documented: payer downcodes to 21141 or 21142 when the operative note does not specify three or more pieces.
- Medical necessity not established: absence of preoperative imaging, cephalometric analysis, or a documented failed conservative treatment course triggers denial for non-trauma cases.
- Incorrect code when bone graft was used: billing 21143 for a case involving graft harvest results in denial or audit finding; 21147 is required.
- Global period conflicts: E/M or minor procedures billed during the 90-day postoperative window without modifier 24 or 79 are denied as included services.
- Facility vs. professional fee mismatch: HOPD and ASC claims submitted without matching place-of-service codes generate technical denials.
Frequently asked questions
Source · Generated from the editorial pipeline, verified against 5 cited references ↓
01What is the difference between 21141, 21142, and 21143?
02When should I use 21147 instead of 21143?
03Can 21143 be billed with a LeFort II or LeFort III code on the same date?
04Is an assistant surgeon reimbursable for 21143?
05What triggers modifier 22 on 21143?
06Does the 90-day global period include postoperative orthodontic coordination visits?
Sources & references
Editorial content was developed using the following public sources. Last verified May 8, 2026.
- 01CMS Physician Fee Schedule 2026
- 02emedny.orghttps://www.emedny.org/providermanuals/physician/pdfs/physician%20procedure%20codes%20sect5.pdf
- 03cms.govhttps://www.cms.gov/files/document/02-chapter2-ncci-medicare-policy-manual-2025finalcleanpdf.pdf
- 04aaos.orghttps://www.aaos.org/globalassets/quality-and-practice-resources/coding-and-reimbursement/resident-guide/resident-guide_modifiers.pdf
- 05aaos.orghttps://www.aaos.org/globalassets/quality-and-practice-resources/coding-and-reimbursement/resident-guide/resident-guide-coding-reference-tools_what-is-ncci-ptp.pdf
Mira AI Scribe
Mira's AI scribe captures the segment count (three or more), confirmation that no bone graft was harvested, direction of segment movement, fixation method, and the underlying diagnosis driving the multi-piece design — directly from surgeon dictation. This prevents the single most common downcode on LeFort I claims: an operative note that describes the reconstruction without specifying the piece count, which auditors use to default the claim to the lower-valued 21141.
See how Mira captures CPT 21143 documentation