Surgical · Other

Surgical reconstruction of the mandibular rami and/or body using a sagittal split osteotomy technique, performed without internal rigid fixation hardware.

Verified May 8, 2026 · 7 sources ↓

Medicare: $1,217.46
Total RVUs: 36.45
Global, days: 90
Region: Other

Drawn from CMSAAPCFindacodeEmednyCgsmedicare

Documentation requirements

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

Source · Editorial brief grounded in 7 cited references ↓

Preoperative photographs and cephalometric radiographs demonstrating the jaw deformity or misalignment being corrected
Operative note specifying sagittal split technique, anatomic extent (rami, body, or both), and explicit statement that no internal rigid fixation was placed
Documentation of the method of post-operative stabilization used (e.g., intermaxillary fixation wires or elastics)
Diagnosis supported by ICD-10 code identifying the underlying condition — traumatic deformity, congenital anomaly, or acquired malocclusion
If modifier 22 is appended, a separate addendum quantifying the additional time, complexity, or unusual anatomic findings that increased physician work
If two surgeons bill modifier 62, each operative note must independently describe the distinct portion of the procedure that surgeon performed

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 62 Co-surgeons 76 Repeat, same physician 77 Repeat, another physician 78 Unplanned return — related 79 Unrelated during global 80 Assistant surgeon

What this code covers

Source · Editorial summary grounded in 7 cited references ↓

CPT 21195 describes a sagittal split osteotomy of the mandible — rami, body, or both — where the bone is repositioned to correct jaw misalignment or deformity without securing the segments with internal rigid fixation (plates, screws). The absence of fixation distinguishes it from 21196, which covers the same osteotomy with internal rigid fixation. Indications include skeletal Class II or Class III malocclusion, traumatic deformity, and congenital jaw asymmetry. The procedure typically involves intermaxillary fixation (wiring the jaws) post-operatively to stabilize the repositioned segments during healing.

The 90-day global period covers all routine post-operative visits, wound checks, and fixation removal through day 90. Any visit addressing a new problem unrelated to the jaw reconstruction requires modifier 24. If a complication drives an unplanned return to the OR within the global window for a related procedure, bill with modifier 78 — not 79. Modifier 79 is reserved for a genuinely unrelated procedure during that same global period.

This code is performed primarily by oral and maxillofacial surgeons and, less commonly, by craniofacial plastic surgeons. When two surgeons co-operate distinct portions of a complex reconstruction — for example, one managing the osteotomy while another addresses a simultaneous orthognathic procedure — modifier 62 applies to both claims. Verify co-surgeon eligibility on the Medicare Physician Fee Schedule database before billing; not all codes allow it.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	18.68
Practice expense RVU	15.06
Malpractice RVU	2.71
Total RVU	36.45
Medicare national rate	$1,217.46
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	$1,217.46
HOPD (APC 5165) Hospital outpatient department	$6,048.05
ASC (PI J8) Ambulatory surgical center (freestanding)	$4,052.92

Common denial reasons

The recurring reasons claims for CPT 21195 get rejected.

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

Upcoding to 21195 when internal fixation was actually placed — payers audit operative notes and flag absence of a 'no fixation' statement
Missing or insufficient documentation of the sagittal split technique; notes that describe only 'jaw osteotomy' without specifying the sagittal split approach trigger medical review
ICD-10 diagnosis code mismatch — billing a congenital deformity code when the record supports only occlusal correction or vice versa
Billing modifier 62 (co-surgeons) without verifying CMS co-surgeon eligibility indicator for this code on the Physician Fee Schedule database
Global period violations — routine post-op visits billed without modifier 24 during the 90-day window are automatically denied

Frequently asked questions

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

01What is the difference between 21195 and 21196?

Both describe a sagittal split osteotomy of the mandibular rami and/or body. 21195 is used when no internal rigid fixation (plates or screws) is placed; 21196 covers the same procedure when internal rigid fixation secures the osteotomy segments. The operative note must affirmatively state which was done — auditors do not give benefit of the doubt.

02Does CPT 21195 carry a global period?

Yes — 90-day global. All routine post-op visits, wound checks, and hardware monitoring through day 90 are bundled. Bill unrelated E/M visits in that window with modifier 24; unplanned related OR returns with modifier 78.

03Can 21195 be billed bilaterally with modifier 50?

Sagittal split osteotomy is typically performed on both sides of the mandible in the same session. When that occurs, modifier 50 applies. Some payers instead require two line items with LT and RT. Confirm the specific payer's bilateral billing requirement before submitting, because the reimbursement methodology differs.

04When does modifier 62 apply to 21195?

Modifier 62 applies when two surgeons operate as co-primary surgeons on distinct portions of the reconstruction in the same session — for example, one performing the osteotomy while a second addresses a concurrent craniofacial component. Each surgeon reports 21195-62 with documentation of their distinct work. Verify CMS co-surgeon eligibility for this code on the Physician Fee Schedule database first; payment is 62.5% of allowable to each surgeon when specialties differ.

05What ICD-10 codes are typically paired with 21195?

Common diagnoses include mandibular prognathism (M26.11), mandibular retrognathism (M26.02), jaw asymmetry (M26.13), malocclusion (M26.4–), and post-traumatic deformity of the mandible (M27.6-range or S02.6x-sequela). The ICD-10 code must match the documented indication — mixing a congenital code with a purely acquired deformity is a top denial trigger.

06Is 21195 performed in an ASC or hospital setting?

Both settings are used. The procedure is typically performed in a hospital OR, but ASC billing is permissible and the site of service affects payment — see the Site of Service comparison for HOPD versus ASC payment rates. The clinical complexity and need for post-operative airway monitoring often drives surgeons toward hospital-based settings.

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 surgical approach by name (sagittal split), the anatomic extent (rami, body, or both), and the explicit absence of internal rigid fixation — the single most important documentation element separating 21195 from 21196. It also records the post-operative stabilization method and the indication driving the reconstruction. This prevents the most common audit flag: an operative note that fails to affirmatively state no plates or screws were placed, which auditors treat as an ambiguous record supporting the higher-paying 21196.

See how Mira captures CPT 21195 documentation