Surgical · Other

Reconstruction of the midface using a modified LeFort III osteotomy with internal fixation, repositioning the midface skeleton to correct severe craniofacial deformities.

Verified May 8, 2026 · 5 sources ↓

Medicare: $1,851.41
Total RVUs: 55.43
Global, days: 90
Region: Other

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Documentation requirements

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

Source · Editorial brief grounded in 5 cited references ↓

Diagnosis driving reconstruction — syndromic craniosynostosis, post-traumatic midface deformity, or other specific craniofacial condition with ICD-10 code
Operative note naming the osteotomy level(s) performed and confirming the LeFort III or modified LeFort III approach by name
Quantified midface movement — advancement or repositioning distance in millimeters documented in the operative report
Type and placement of internal fixation — plates, screw sizes, and fixation sites must be explicitly described
Pre-operative imaging (CT or cephalometric studies) confirming the extent of deformity and surgical planning
Prior authorization documentation where required — mandatory for Arkansas Medicaid and variable across commercial payers

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 57 Decision for surgery 58 Staged or related 59 Distinct service 62 Co-surgeons 74 Discontinued post-anesthesia 78 Unplanned return — related 79 Unrelated during global 80 Assistant surgeon

What this code covers

Source · Editorial summary grounded in 5 cited references ↓

CPT 21155 covers a modified LeFort III midface reconstruction with internal fixation. This is a high-complexity craniofacial procedure involving osteotomies at or above the level of the zygomatic arches to mobilize and reposition the midface en bloc. Internal fixation — plates, screws, or wires — stabilizes the repositioned segment. The procedure addresses severe midface hypoplasia or retrusion, typically in patients with syndromic craniosynostosis (e.g., Crouzon, Apert) or significant post-traumatic deformity.

The 90-day global period covers all routine post-op management through day 90. Secondary procedures within that window require modifier 78 (related, unplanned return to OR) or 79 (unrelated procedure). NCCI edits bundle 21155 as a column-2 code against 21141 — the LeFort I osteotomy — meaning you cannot bill both for the same session without a modifier and strong documentation of distinct, separately performed procedures. Modifier 1 is allowed on that edit pair, but payer scrutiny is high.

Arkansas Medicaid requires prior authorization before performing 21155. Given the complexity and RVU load, payers across the board will audit operative notes closely. Document every osteotomy level, fixation method, and the specific movement vectors (advancement in mm) achieved. Vague operative notes are the fastest route to a post-payment audit clawback on this code.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	34.34
Practice expense RVU	16.08
Malpractice RVU	5.01
Total RVU	55.43
Medicare national rate	$1,851.41
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	$1,851.41
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 21155 get rejected.

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

Missing or inadequate prior authorization — required by Arkansas Medicaid and many commercial plans for this high-cost craniofacial procedure
Operative note lacks specificity on osteotomy level, defaulting reviewer to a lower-complexity LeFort code
NCCI bundling conflict with 21141 billed same session without a supporting modifier and distinct documentation
Medical necessity not established — absence of pre-op imaging or failure to link diagnosis to functional impairment
Global period billing errors — routine post-op visits billed separately without modifier 24 during the 90-day window

Frequently asked questions

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

01What distinguishes CPT 21155 from 21154?

21154 covers a standard LeFort III reconstruction without internal fixation. 21155 requires internal fixation — plates and screws stabilizing the osteotomized segment. If you placed hardware, bill 21155. If you didn't, bill 21154. Document the fixation explicitly by type and location.

02Can 21155 and 21141 be billed together for the same operative session?

NCCI bundles 21141 as the column-1 code over 21155 in the practitioner setting, with modifier indicator 1 — meaning a modifier may permit separate payment. You'll need clear operative documentation that distinct, separately performed osteotomies at different levels justify both codes. Expect scrutiny.

03Does 21155 require prior authorization?

Arkansas Medicaid requires prior authorization before performing 21155. Most commercial payers with craniofacial surgery carve-outs will also require it. Verify before scheduling — a missing auth on a procedure this size is a full-claim denial.

04What modifier applies if an unrelated procedure is performed during the 90-day global period?

Use modifier 79 for an unrelated procedure performed during the 90-day global. Reserve modifier 78 for an unplanned return to the OR for a complication or condition directly related to the original surgery. Inverting these two is a common audit flag.

05Is 21155 performed in an ASC setting?

It is payable in an ASC, though the HOPD rate is substantially higher than the ASC rate — see the Site of Service comparison table on this page. Given the complexity and monitoring requirements, most payers and facilities route this procedure to a hospital setting. Confirm facility credentialing and payer policy before scheduling in an ASC.

06How should modifier 22 be used with 21155?

Append modifier 22 when the procedure required substantially greater work than typical — for example, severe scarring from prior craniofacial surgery, unusual anatomy, or extended operative time well beyond the norm. Attach a cover letter quantifying the additional work and extra time. Without that letter, payers routinely ignore modifier 22 on craniofacial codes.

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 or modified variant), internal fixation details, measured midface advancement in millimeters, and the specific craniofacial diagnosis from dictation. That documentation directly supports medical necessity and distinguishes 21155 from lower-complexity LeFort codes — the most common audit trigger on this procedure.

See how Mira captures CPT 21155 documentation