LeFort I single-piece maxillary osteotomy performed with bone grafting to reposition the upper jaw and correct midface skeletal deformity.
Verified May 8, 2026 · 5 sources ↓
- Medicare
- $1,390.81
- Total RVUs
- 41.64
- 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 ↓
- Cephalometric analysis and radiographic measurements documenting the degree of maxillary skeletal discrepancy
- Functional diagnosis (e.g., Class III malocclusion, obstructive sleep apnea contribution, masticatory dysfunction) establishing medical necessity beyond cosmetic correction
- Orthodontic or surgical treatment plan co-signed by the treating orthodontist, including pre-surgical dental records
- Operative note specifying the osteotomy design, direction and magnitude of movement, graft source and type (autograft iliac crest, allograft, etc.), and fixation method
- Intraoperative photos or diagrams documenting single-piece mobilization — distinguishes 21145 from multi-piece variants
- Pre-authorization documentation with supporting records submitted to payer prior to surgery
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 21145 describes a one-piece LeFort I osteotomy of the maxilla combined with bone grafting. The surgeon mobilizes the entire upper jaw as a single segment, advances or repositions it to correct the underlying skeletal malocclusion or midface deficiency, and stabilizes the repositioned maxilla with graft material. This is the baseline LeFort I descriptor — single-piece, with graft. Multi-piece variants and cases without graft are reported under adjacent codes in the 21145–21160 family.
The 90-day global period covers all routine follow-up. Any unrelated procedure performed during that window requires modifier 79; a return to the OR for a related complication (e.g., hardware failure, wound dehiscence requiring operative management) requires modifier 78. Concomitant mandibular procedures, orthognathic bone grafting at a separate site, or simultaneous rhinoplasty may be separately reportable with modifier 51 or 59 depending on NCCI edit status — confirm bundling pairs before billing.
This code sits in the Musculoskeletal Surgery section (Head). Oral and maxillofacial surgeons and craniofacial plastic surgeons are the primary billers. Most payors require pre-authorization and supporting records demonstrating functional impairment, not purely cosmetic indication. Document the cephalometric analysis, orthodontic records, and functional diagnosis to anchor medical necessity.
RVU & reimbursement
Component RVUs and Medicare national rate. Actual payment varies by GPCI locality.
Source · CMS Physician Fee Schedule, RVU26A · January 2026
| Work RVU | 23.34 |
| Practice expense RVU | 14.92 |
| Malpractice RVU | 3.38 |
| Total RVU | 41.64 |
| Medicare national rate | $1,390.81 |
| 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 | $1,390.81 |
HOPD (APC 5165) Hospital outpatient department | $6,048.05 |
ASC (PI J8) Ambulatory surgical center (freestanding) | $4,007.31 |
Common denial reasons
The recurring reasons claims for CPT 21145 get rejected.
Source · Editorial brief grounded in CMS NCCI edits, AAOS coding appeals, and cited references ↓
- Cosmetic exclusion: payer determines the procedure was performed for aesthetics rather than documented functional impairment
- Wrong code selected: multi-piece osteotomy or no-graft variant billed under 21145 instead of the correct adjacent code
- Missing pre-authorization or authorization obtained for a different procedure code
- Insufficient documentation of medical necessity — cephalometric records or functional diagnosis absent from the record
- Global period conflict: post-op service billed without required modifier 24, 78, or 79 during the 90-day global window
Frequently asked questions
Source · Generated from the editorial pipeline, verified against 5 cited references ↓
01What is the difference between CPT 21145 and the other LeFort I codes?
02Can a simultaneous mandibular osteotomy (e.g., BSSO) be billed on the same day as 21145?
03Does modifier 50 apply to this code?
04When does modifier 22 apply to 21145?
05What ICD-10 diagnoses best support medical necessity for 21145?
06What global period applies and what does it include?
Sources & references
Editorial content was developed using the following public sources. Last verified May 8, 2026.
- 01CMS Physician Fee Schedule 2026
- 02aapc.comhttps://www.aapc.com/codes/cpt-codes/21145
- 03mdclarity.comhttps://www.mdclarity.com/cpt-code/21145
- 04cms.govhttps://www.cms.gov/medicare/regulations-guidance/physician-self-referral/list-cpt-hcpcs-codes
- 05emedny.orghttps://www.emedny.org/providermanuals/physician/pdfs/physician%20procedure%20codes%20sect5.pdf
Mira AI Scribe
Mira's AI scribe captures the osteotomy design (single-piece vs. multi-piece), direction and magnitude of maxillary movement, graft source and type, and fixation construct directly from dictation. It also flags the functional diagnosis and links it to the cephalometric measurements documented in the note. This prevents the two most common audit flags: miscoding a multi-piece case as 21145 and submitting an operative note that lacks a documented functional indication.
See how Mira captures CPT 21145 documentation