Surgical · Other

Midface reconstruction via LeFort II osteotomy, movement in any direction, with bone grafting including autograft harvest

Verified May 8, 2026 · 7 sources ↓

Medicare: $1,553.81
Total RVUs: 46.52
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 7 cited references ↓

Operative note must identify the specific osteotomy level as LeFort II, not generic 'midface osteotomy'
Document the direction of segment movement (anterior, posterior, superior, inferior, or combination)
Record bone graft source — autograft site, quantity harvested, and method of fixation at recipient site
If freeze-dried or synthetic graft is used instead of autograft, document explicitly so modifier 52 is supported
Identify each surgeon's distinct operative role if co-surgeon (modifier 62) billing is used
Indications and diagnosis supporting medical necessity — e.g., traumatic midface deformity, congenital anomaly, or post-oncologic reconstruction
Pre- and post-operative imaging supporting the planned skeletal movement and graft need

Applicable modifiers

Modifiers commonly billed with this code.

Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual

22 Increased complexity 52 Reduced services 62 Co-surgeons 74 Discontinued post-anesthesia 79 Unrelated during global 80 Assistant surgeon AS PA/NP/CNS assistant LT Left side RT Right side

What this code covers

Source · Editorial summary grounded in 7 cited references ↓

CPT 21151 covers LeFort II midface reconstruction where the midface segment is mobilized in any direction and bone grafts are required to stabilize the repositioned skeletal unit. The code includes autograft harvest — no separate bone graft code is needed when autogenous bone is taken as part of this procedure. LeFort II osteotomy cuts involve the nasal bones and medial orbital walls, distinguishing it from the lower-level LeFort I family (21145–21147) and the more extensive LeFort III codes (21154–21155).

This is a 90-day global procedure. All routine post-op management through day 90 is included in the surgical payment. Interdental fixation or splint placement performed as a component of the reconstruction does not warrant a separate code unless it is a distinct, separately documented service unrelated to the osteotomy. When two surgeons operate together — common in craniofacial cases — co-surgeon billing with modifier 62 requires each surgeon to document their distinct, non-overlapping roles in the operative note.

If freeze-dried or synthetic (non-autogenous) bone material is substituted and no surgical harvest is performed, the bone graft component described by the code is not fully executed. In that scenario, modifier 52 is appropriate to signal reduced service. Confirm this approach with the payer before submission, as commercial carriers vary on how they handle modifier 52 reductions for this code family.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	28.29
Practice expense RVU	14.1
Malpractice RVU	4.13
Total RVU	46.52
Medicare national rate	$1,553.81
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	$1,553.81
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 21151 get rejected.

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

Operative note uses non-specific language like 'midface osteotomy' without confirming LeFort II level, triggering downcoding to a less complex code
Bone graft harvest not documented, causing payer to question whether the graft component of the code was actually performed
Co-surgeon claims denied when each surgeon's operative note does not independently describe distinct, non-overlapping surgical roles
Medical necessity denial when diagnosis codes reflect cosmetic indication rather than reconstructive or congenital basis
Modifier 52 omitted on claims where synthetic bone substitute was used and no autograft harvest occurred, flagged on audit

Frequently asked questions

Source · Generated from the editorial pipeline, verified against 7 cited references ↓

01Does 21151 include the bone graft harvest, or do I bill a separate graft code?

Autograft harvest is included in 21151 — no separate graft harvest code is appropriate when the graft is taken as part of this procedure. If a separately identifiable graft from a distinct donor site is harvested under distinctly different circumstances, document that clearly, but standard autograft harvest is bundled.

02When is modifier 52 appropriate for 21151?

Use modifier 52 when freeze-dried or synthetic bone substitute replaces autograft and no surgical harvest is performed. The graft-harvest component of the code descriptor was not executed, so the service is reduced. Per AAOMS guidance, append modifier 52 and reduce the fee accordingly, and confirm the approach with the payer in advance.

03Can two surgeons each bill 21151 with modifier 62 for the same case?

Yes, if both surgeons perform distinct, non-overlapping portions of the procedure and each documents their individual role in a separate operative note. Many commercial carriers follow CMS rules for co-surgeon billing — verify indicator status on the Medicare Physician Fee Schedule Look-Up Tool and confirm with each payer before submitting.

04What distinguishes 21151 from 21150 and 21154?

CPT 21150 is LeFort II anterior intrusion only, no bone graft required. CPT 21151 is LeFort II movement in any direction requiring bone grafts. CPT 21154 steps up to LeFort III extracranial reconstruction with bone grafts, without a concurrent LeFort I. Select based on the specific osteotomy level and whether grafting was required.

05Is 21151 on the inpatient-only list?

No. CMS removed 21151 and the related LeFort code family from the inpatient-only list effective CY 2021. It can be performed in the HOPD setting and is assigned to APC 5165 under OPPS. ASC performance is also possible — see the site-of-service payment comparison for the applicable rates.

06What global period applies to 21151?

90-day global. The day before surgery, the operative day, and all routine post-op care through day 90 are included in the surgical payment. Unrelated E/M services during the global window need modifier 24; a significant separately identifiable same-day E/M needs modifier 25.

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 LeFort II osteotomy level, direction of midface movement, bone graft source and harvest site, method of fixation, and each surgeon's distinct operative contribution from dictation. This prevents the most common audit flag for 21151 — an operative note that confirms a midface reconstruction occurred but fails to document the specific osteotomy level or graft harvest, which reviewers use to downcode or deny the claim.

See how Mira captures CPT 21151 documentation