Surgical · Other

Extracranial LeFort III midface reconstruction requiring bone grafts, performed without a simultaneous LeFort I osteotomy.

Verified May 8, 2026 · 4 sources ↓

Medicare: $1,673.72
Total RVUs: 50.11
Global, days: 90
Region: Other

Drawn from CMS

Documentation requirements

What must appear in the operative or office note to support the claim.

Source · Editorial brief grounded in 4 cited references ↓

Operative note must specify the extracranial approach and confirm LeFort I was NOT performed
Bone graft source documented — autograft site, allograft source, or both — since graft harvest is bundled
Medical necessity narrative linking the diagnosis (congenital deformity, post-traumatic defect, etc.) to the reconstruction
When co-surgeons bill modifier 62, each surgeon's operative note must describe their distinct intraoperative role
ICD-10 diagnosis code must appear on LCD L33428's supported-diagnosis list to survive medical necessity review
Pre-operative imaging (CT facial bones) confirming structural pathology and surgical planning basis

Applicable modifiers

Modifiers commonly billed with this code.

Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual

22 Increased complexity 51 Multiple procedures 59 Distinct service 62 Co-surgeons 80 Assistant surgeon AS PA/NP/CNS assistant

What this code covers

Source · Editorial summary grounded in 4 cited references ↓

CPT 21154 covers an extracranial LeFort III osteotomy with bone grafting to reposition the midface skeleton — orbital rims, zygomas, and nasal complex — without concurrent LeFort I (upper jaw) work. The procedure addresses congenital craniofacial deformities (e.g., Crouzon, Apert syndrome), post-traumatic midface collapse, or other structural midface pathology. Autograft harvest is included in the code; billing a separate graft-harvest code is not appropriate.

The 90-day global period covers all routine post-op care through day 90. Because this procedure involves multiple surgical disciplines — craniofacial surgery, neurosurgery, ophthalmology — document each surgeon's distinct role clearly when billing split/co-surgeon arrangements. When a co-surgeon arrangement applies, modifier 62 requires both surgeons to submit operative notes describing their individual contributions.

Medicare coverage is governed by LCD L33428 (Cosmetic and Reconstructive Surgery). Medical necessity must be clearly established — cosmetic intent triggers denial regardless of surgical complexity. ICD-10 diagnosis selection is the primary coverage gatekeeper; confirm the submitted diagnosis maps to the LCD's supported-diagnosis list before submission.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	30.51
Practice expense RVU	15.14
Malpractice RVU	4.46
Total RVU	50.11
Medicare national rate	$1,673.72
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	$1,673.72
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 21154 get rejected.

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

Cosmetic intent — diagnosis not on LCD L33428 supported list triggers automatic denial
Bundling with LeFort I code (21155) when only one level of osteotomy was performed
Missing or insufficient medical necessity documentation linking diagnosis to functional impairment
Co-surgeon claims lacking separate operative notes describing each surgeon's distinct contribution
Separate bone graft harvest code billed in addition to 21154 — graft harvest is included in the code

Frequently asked questions

Source · Generated from the editorial pipeline, verified against 4 cited references ↓

01What distinguishes 21154 from 21155?

21154 is LeFort III without LeFort I. 21155 adds a simultaneous LeFort I osteotomy. The distinction must be explicit in the operative note — the codes are not interchangeable and have different work values.

02Is autograft harvest separately billable with 21154?

No. Bone graft harvest is included in 21154 regardless of donor site. Billing a separate graft-harvest code alongside 21154 will be bundled and denied.

03How does Medicare decide if 21154 is reconstructive versus cosmetic?

LCD L33428 governs. The submitted ICD-10 code must appear on the supported-diagnosis list. Documented functional impairment — vision compromise, airway obstruction, post-traumatic deformity — supports medical necessity. Purely aesthetic motivation does not.

04Can two surgeons bill 21154 for the same case?

Yes, with modifier 62 (co-surgeons). Both surgeons must submit separate operative notes detailing their individual roles. Without distinct documentation, one claim will be denied as a duplicate.

05What global period applies to 21154, and what does it cover?

The global period is 90 days. It includes the day-before visit, the surgery itself, and all routine post-op care through day 90. Unrelated services billed during that window need modifier 24 (E/M) or 79 (unrelated procedure).

06Is modifier 22 ever justified for 21154?

Yes, when the case involves substantially greater work — severe scarring from prior surgery, revision after failed reconstruction, or unusually complex anatomy. Attach a cover letter quantifying the additional time and effort; modifier 22 without documentation is routinely ignored by payers.

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 level (LeFort III, extracranial), confirms absence of concurrent LeFort I work, documents bone graft source and harvest site, and flags each co-surgeon's distinct intraoperative contribution from dictation. This prevents the two most common denial triggers: miscoded LeFort level and insufficient co-surgeon documentation.

See how Mira captures CPT 21154 documentation