Surgical · Other

Surgical reconstruction of the maxilla (upper jaw) via osteotomy — cutting and repositioning the bone to correct deformity from trauma, congenital defect, or disease.

Verified May 8, 2026 · 6 sources ↓

Medicare: $873.43
Total RVUs: 26.15
Global, days: 90
Region: Other

Drawn from CMSAAPC

Documentation requirements

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

Source · Editorial brief grounded in 6 cited references ↓

Operative report must name the specific osteotomy technique and segment(s) mobilized — vague references to 'jaw surgery' or 'standard approach' invite audit flags.
Document the clinical indication explicitly: congenital deformity, post-traumatic deformity, tumor resection sequela, osteonecrosis, or other reconstructive rationale — not aesthetic improvement.
Include preoperative imaging (CT or panoramic radiographs) and any surgical planning records demonstrating skeletal deformity requiring reconstruction.
If two surgeons participated under modifier 62, each must file a separate operative note describing their distinct surgical role.
For Medicare claims, link a covered ICD-10 code from LCD L33428 Group 7 (e.g., M27.0, M27.2, M87.180) to establish medical necessity and avoid cosmetic-exclusion denial.
Document any intraoperative fixation hardware used; plating and fixation are included in the procedure and not separately billable.

Applicable modifiers

Modifiers commonly billed with this code.

Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual

22 Increased complexity 52 Reduced services 59 Distinct service 62 Co-surgeons 80 Assistant surgeon

What this code covers

Source · Editorial summary grounded in 6 cited references ↓

CPT 21206 covers a maxillary osteotomy performed to reconstruct the upper jaw. The surgeon incises the maxilla, mobilizes one or more bony segments, repositions them to correct skeletal deformity, and stabilizes the construct. Indications include congenital dentofacial deformities, post-traumatic malocclusion, jaw tumors, osteonecrosis (including medication-related), and developmental jaw disorders. The 90-day global period encompasses all routine pre- and post-operative care, including splint adjustments and wound checks through day 90.

Distinguish 21206 from 21248/21249, which describe partial or complete mandible or maxilla reconstruction using endosteal implants — a different procedure class. When an osteotomy is performed solely to gain surgical access for another procedure (e.g., orbital fracture repair), it is not separately billable; the access step is bundled into the primary code. Documentation must make clear that the osteotomy itself was a therapeutic reconstructive procedure, not merely an approach.

Coverage under Medicare hinges on the distinction between reconstructive and cosmetic intent. LCD L33428 (Cosmetic and Reconstructive Surgery) governs this determination for Medicare beneficiaries. Supported ICD-10 diagnoses include M27.0 (developmental jaw disorders), M87.180 (osteonecrosis of the jaw due to drugs), M27.2 (inflammatory conditions of jaws), and related codes. Without a mapped, covered diagnosis, expect a cosmetic-exclusion denial.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	15.2
Practice expense RVU	9.19
Malpractice RVU	1.76
Total RVU	26.15
Medicare national rate	$873.43
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	$873.43
HOPD (APC 5165) Hospital outpatient department	$6,048.05
ASC (PI A2) Ambulatory surgical center (freestanding)	$3,025.62

Common denial reasons

The recurring reasons claims for CPT 21206 get rejected.

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

Cosmetic exclusion: Medicare and many commercial payers deny 21206 when documentation fails to establish reconstructive medical necessity versus aesthetic improvement.
Bundling into primary procedure: when the osteotomy was performed only to gain access for a separate surgery (e.g., orbital fracture repair), payers bundle it into the primary code and deny separate billing.
Insufficient documentation: operative notes that lack the specific osteotomy technique, segment detail, or clinical indication are routinely denied for inadequate support of the procedure billed.
Diagnosis mismatch: claims submitted with ICD-10 codes not listed in the payer's covered-diagnosis policy (e.g., cosmetic malocclusion codes) result in medical-necessity denials.
Scope of practice issues: some payers scrutinize claims from non-oral-surgery or non-dental specialties and may request additional credentialing documentation.

Frequently asked questions

Source · Generated from the editorial pipeline, verified against 6 cited references ↓

01Is 21206 covered by Medicare?

Medicare covers 21206 when the procedure is reconstructive, not cosmetic. LCD L33428 governs coverage. The claim must be linked to a supported ICD-10 diagnosis — for example, M27.0, M27.2, or M87.180. A purely aesthetic indication is excluded under Medicare's cosmetic surgery exclusion.

02Can I bill 21206 separately when the osteotomy was done to access another surgical site?

No. An osteotomy performed solely as a surgical approach to another procedure (e.g., orbital fracture repair) is bundled into the primary code. Separate billing requires that the osteotomy itself was a distinct therapeutic reconstructive procedure, documented as such in the operative note.

03What is the global period for 21206?

CPT 21206 carries a 90-day global period. All routine post-operative care — including wound checks, splint management, and suture removal — is bundled through day 90. Services unrelated to the jaw reconstruction billed during that window require modifier 24 (E/M) or modifier 79 (unrelated procedure).

04When should modifier 62 be used with 21206?

Use modifier 62 when two surgeons perform distinct, required portions of the maxillary reconstruction together — for example, a craniofacial surgeon and an oral surgeon each managing separate anatomic components. Both surgeons append modifier 62 and file separate operative notes describing their individual roles.

05How does 21206 differ from 21248 and 21249?

CPT 21248 and 21249 describe partial or complete maxilla or mandible reconstruction using endosteal implants — the unit of service is the reconstruction, not the implant. CPT 21206 is an osteotomy-based reconstruction without the endosteal implant component. Do not substitute or stack these codes for the same anatomic reconstruction.

06What ICD-10 codes support medical necessity for 21206?

CMS Article A56658 (LCD L33428) lists covered diagnoses including M27.0 (developmental jaw disorders), M27.2 (inflammatory conditions of jaws), M27.40/M27.49 (jaw cysts), M87.180 (osteonecrosis of jaw due to drugs), and selected neoplasm codes. Map the claim to the most specific covered code. Unlisted or cosmetic-only diagnoses will trigger denial.

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 technique, specific maxillary segments mobilized, fixation method, and the reconstructive indication (trauma, congenital, osteonecrosis, tumor sequela) directly from dictation. That prevents the most common denial for 21206: an operative note that documents a jaw procedure without making the reconstructive — not cosmetic — intent explicit for payer review.

See how Mira captures CPT 21206 documentation