Reconstruction of the midface via a modified Le Fort II osteotomy pattern that advances the nasal-orbital complex anteriorly without mobilizing the zygoma.
Verified May 8, 2026 · 4 sources ↓
- Medicare
- $1,415.20
- Total RVUs
- 42.37
- 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 4 cited references ↓
- Specify osteotomy pattern by name (Le Fort II) and confirm zygomatic arches were NOT mobilized — distinguishes 21150 from 21154/21155/21160
- Document the underlying diagnosis driving midface retrusion (e.g., Crouzon syndrome, Apert syndrome, post-traumatic deformity) with ICD-10 linkage
- Describe functional impairment: obstructive sleep apnea, exorbitism, malocclusion, or airway obstruction — required for medical necessity under most payers
- Record bone graft harvest site and graft type separately if an interpositional or onlay graft was placed (may support add-on coding)
- Document fixation hardware used (plates, screws) and their placement locations in the operative note
- Note intraoperative imaging or navigation use if applicable — fluoroscopy bundled per NCCI general policy unless a separate identifiable service
- Anesthesia type and any monitored parameters supporting general anesthesia medical necessity
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 4 cited references ↓
CPT 21150 describes a Le Fort II-type midface reconstruction — an osteotomy pattern that cuts through the nasal bones, medial orbital walls, and across the maxilla to mobilize the central midface (nose, orbital floor, and upper jaw) as a single unit. Unlike Le Fort III, the zygomatic arches are not included. The procedure corrects midface retrusion affecting the nasomaxillary complex, most often in patients with craniofacial dysostoses (Crouzon, Apert) or post-traumatic midface collapse where the zygomas are adequately positioned.
The 90-day global period covers all routine postoperative management through day 90, including wound checks, suture removal, and standard imaging reviews. Any new problem unrelated to the reconstruction — or a staged secondary procedure — requires modifier 79. An unplanned return to the OR for a complication (e.g., hardware failure, airway compromise) is billed with modifier 78.
Site of service matters significantly here. The HOPD and ASC payment differentials are substantial; see the site-of-service comparison rendered on this page. Most payers require prior authorization given the high RVU value (42.37 total) and the elective-reconstructive nature of the procedure. Commercial carriers frequently scrutinize medical necessity documentation distinguishing functional impairment from purely aesthetic correction.
RVU & reimbursement
Component RVUs and Medicare national rate. Actual payment varies by GPCI locality.
Source · CMS Physician Fee Schedule, RVU26A · January 2026
| Work RVU | 25.31 |
| Practice expense RVU | 13.37 |
| Malpractice RVU | 3.69 |
| Total RVU | 42.37 |
| Medicare national rate | $1,415.20 |
| 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 | $1,415.20 |
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 21150 get rejected.
Source · Editorial brief grounded in CMS NCCI edits, AAOS coding appeals, and cited references ↓
- Wrong code level selected — payers downcode to 21141 or 21145 when operative note does not explicitly confirm a Le Fort II cut pattern
- Medical necessity not established — cosmetic vs. functional distinction is absent or ambiguous in the clinical record
- Missing or inadequate prior authorization — high-RVU craniofacial codes are routinely flagged for preauthorization by commercial payers
- Global period conflict — E/M or follow-up services billed within the 90-day window without modifier 24 (unrelated) attached
- Bundling edit triggered when bone graft harvest (e.g., 20900–20902) is billed without appropriate modifier demonstrating a distinct surgical site or service
Frequently asked questions
Source · Generated from the editorial pipeline, verified against 4 cited references ↓
01What distinguishes CPT 21150 from 21154 and 21155?
02Can you bill a bone graft harvest separately with 21150?
03Is modifier 22 defensible for this procedure?
04How does the 90-day global period affect E/M billing postoperatively?
05Which payers require prior authorization for 21150?
06Can 21150 and orthognathic procedures (e.g., 21195–21199) be billed on the same date?
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 osteotomy pattern name, cut boundaries (nasal bones, medial orbital walls, pterygoid plates), structures mobilized, fixation method, graft harvest site if applicable, and the functional indication driving the procedure. That detail prevents downcoding to a less complex Le Fort level and supplies the medical necessity language payers require to clear prior-authorization and clinical review denials.
See how Mira captures CPT 21150 documentation