Surgical · Other

LeFort I osteotomy with segmentation into three or more pieces, repositioned in any direction, with bone grafting including autograft harvest

Verified May 8, 2026 · 5 sources ↓

Medicare: $1,525.42
Total RVUs: 45.67
Global, days: 90
Region: Other

Drawn from HiacodeEmednyCMS

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 specify the number of maxillary segments created by osteotomy — three or more required to support 21147 over 21143 or 21146
Document the direction and magnitude of each segment's movement (advancement, intrusion, elongation, transverse expansion, etc.)
Confirm and document graft type: autograft (harvest site must be named), allograft, or combination — autograft harvest is included in 21147 and not separately reportable
Identify the clinical indication driving segmentation, such as bilateral alveolar cleft, transverse discrepancy, or multiple osteotomy sites, and link to a corresponding ICD-10 diagnosis
Document intraoperative fixation method (titanium plates, wires, intermaxillary fixation) and whether interdental fixation was a distinct service
If co-surgery under modifier 62, each surgeon's operative note must describe their distinct intraoperative contributions

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 62 Co-surgeons 76 Repeat, same physician 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 21147 covers a LeFort I osteotomy in which the maxilla is divided into three or more segments via horizontal and vertical/segmental cuts, each segment repositioned independently, with bone grafts required to stabilize the construct. The parenthetical examples in the code description — ungrafted bilateral alveolar cleft or multiple osteotomies — signal the clinical scenarios that typically generate this level of segmentation. Graft harvest (autograft) is included in the code; do not separately report harvest when it's performed as part of this procedure.

The distinction between 21143 and 21147 is graft requirement, not complexity of movement. Three-or-more-piece LeFort I without graft goes to 21143; with graft, it's 21147. Similarly, two-piece with graft is 21146, single piece with graft is 21145. Count the number of osteotomy segments and confirm graft use before selecting.

This is a 90-day global procedure. Routine post-op visits, splint adjustments, and wound care within that window are bundled. If a concurrent procedure such as interdental fixation (21110 or 21497) is performed, check NCCI edits to determine bundling status before appending modifier 59. Co-surgery with a craniofacial or oral surgeon billed under modifier 62 is common given the complexity and operative time involved.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	25.81
Practice expense RVU	16.11
Malpractice RVU	3.75
Total RVU	45.67
Medicare national rate	$1,525.42
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	$1,525.42
HOPD (APC 5165) Hospital outpatient department	$6,048.05
ASC (PI J8) Ambulatory surgical center (freestanding)	$3,833.49

Common denial reasons

The recurring reasons claims for CPT 21147 get rejected.

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

Segment count not documented — payer downcodes to 21143 (no graft) or 21146 (two-piece with graft) when the operative note doesn't explicitly state three or more pieces
Graft harvest billed separately with a bone graft code — autograft harvest is bundled into 21147 and will be denied or recouped as duplicate billing
Medical necessity not established — missing or weak ICD-10 linkage to a documented maxillary deformity (e.g., cleft palate sequelae, skeletal malocclusion) triggers denial on cosmetic-exclusion grounds
Modifier 62 denied due to insufficient co-surgeon documentation — both surgeons' notes must independently describe distinct operative roles
Interdental fixation billed without checking NCCI bundling — 21110 and 21497 have known bundling questions with LeFort codes; unbundling without modifier support triggers edit denials

Frequently asked questions

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

01What separates 21147 from 21143?

Both involve three or more maxillary segments, but 21143 is performed without bone grafts and 21147 requires bone grafts. If grafts were used — including autograft harvest — bill 21147, not 21143.

02Is autograft harvest separately billable with 21147?

No. Autograft harvest is explicitly included in 21147. Billing a separate bone graft harvest code alongside 21147 will be denied as unbundling.

03Does demineralized bone matrix (DBM) qualify as the bone graft that triggers 21147 over 21143?

This is payer-variable and actively debated in coding forums. Some payers accept DBM or demineralized bone as satisfying the graft requirement; others require structural autograft or allograft. Get the payer's written policy before defaulting to 21147 based on DBM use alone.

04Can interdental fixation (21110 or 21497) be billed same-day with 21147?

Check NCCI edits before billing. Bundling between LeFort codes and interdental fixation codes is an active issue in coder forums and NCCI policy. If the fixation is distinct and separately documentable, modifier 59 may apply — but verify the edit status first.

05How should co-surgery with an oral and maxillofacial surgeon be billed?

Both surgeons bill 21147 with modifier 62. Each operative note must document that surgeon's distinct intraoperative contributions. Reimbursement is split at 62.5% of the fee schedule for each surgeon under Medicare rules.

06What is the global period for 21147 and what does it include?

The global period is 90 days. It bundles the day-of and day-before surgery visits, plus all routine post-op care through day 90. Unrelated E/M visits in that window need modifier 24; related new problems requiring a decision for surgery need modifier 25.

07How does site of service affect reimbursement for 21147?

There is a significant payment difference between HOPD and ASC settings. See the Site of Service comparison table on this page for current 2026 values under CMS Physician Fee Schedule 2026.

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 number of osteotomy segments, each segment's direction of movement, graft type and harvest site, fixation hardware used, and the clinical indication from dictation — the exact data points payers and audit teams use to validate 21147 over a lower-complexity LeFort I code. Missing any of these in the operative note is the primary driver of downcoding denials on this procedure.

See how Mira captures CPT 21147 documentation