Extraoral mandibular reconstruction using a transosteal bone plate — such as a mandibular staple bone plate — to restore structural integrity and function of the lower jaw.
Verified May 8, 2026 · 7 sources ↓
- Medicare
- $897.48
- Total RVUs
- 26.87
- Global, days
- 90
- Region
- Other
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 specify the extraoral surgical approach and confirm transosteal plate placement through the inferior mandibular border
- Indications must be documented: trauma, oncologic resection defect, severe mandibular atrophy, or congenital anomaly driving the reconstruction
- Hardware description: plate type, dimensions, and number of fixation points through the cortical bone
- Pre-op imaging (CT or panoramic radiograph) demonstrating the mandibular defect and confirming need for extraoral transosteal approach
- If modifier 22 is appended, the operative note must quantify increased time, complexity, or intraoperative findings that made the procedure substantially more difficult than typical
Applicable modifiers
Modifiers commonly billed with this code.
Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual
What this code covers
Source · Editorial summary grounded in 7 cited references ↓
CPT 21244 covers open, extraoral reconstruction of the mandible using a transosteal bone plate that passes through the full thickness of the jawbone. The procedure addresses mandibular defects caused by trauma, oncologic resection, or severe atrophy where intraoral approaches are insufficient. The transosteal hardware anchors through the inferior border of the mandible and provides rigid fixation to reestablish arch continuity and occlusal function.
This is a high-complexity craniofacial procedure carrying a 90-day global period. That window covers the operative day, any routine post-op visits, and management of normal healing through day 90. A return to the OR for hardware failure, wound breakdown, or plate revision during that window requires modifier 78 if the issue is related to the original procedure, or modifier 79 if unrelated. Staged reconstruction planned before the initial surgery bills with modifier 58.
Billing is predominantly driven by oral and maxillofacial surgeons and ENT/head-and-neck surgeons, not orthopedics — the PUF data reflects Otolaryngology as the top specialty. When performed in an HOPD or ASC, payment follows the site-of-service rate; see the site-of-service comparison table for 2026 values. Multiple procedure rules apply when 21244 is billed same-day with other surgical codes; modifier 51 signals the secondary procedure.
RVU & reimbursement
Component RVUs and Medicare national rate. Actual payment varies by GPCI locality.
Source · CMS Physician Fee Schedule, RVU26A · January 2026
| Work RVU | 13.28 |
| Practice expense RVU | 11.65 |
| Malpractice RVU | 1.94 |
| Total RVU | 26.87 |
| Medicare national rate | $897.48 |
| 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 | $897.48 |
HOPD (APC 5165) Hospital outpatient department | $6,048.05 |
ASC (PI J8) Ambulatory surgical center (freestanding) | $4,139.44 |
Common denial reasons
The recurring reasons claims for CPT 21244 get rejected.
Source · Editorial brief grounded in CMS NCCI edits, AAOS coding appeals, and cited references ↓
- Missing or vague indication: operative note states 'jaw reconstruction' without documenting the underlying diagnosis or severity driving the extraoral approach
- Incorrect approach documented — payers audit for explicit confirmation of extraoral access; notes that only describe intraoral work do not support 21244
- Global period conflicts: routine post-op visits billed separately without modifier 24 are automatically bundled into the 90-day global and denied
- Failure to link a supporting ICD-10-CM code that justifies the extent of reconstruction (e.g., mandibular fracture, jaw neoplasm, atrophy of edentulous mandible)
Frequently asked questions
Source · Generated from the editorial pipeline, verified against 7 cited references ↓
01What distinguishes 21244 from 21248 and 21249?
02Does 21244 cover the bone plate hardware separately?
03Can 21244 be billed for bilateral jaw reconstruction?
04Which ICD-10-CM categories most commonly support 21244?
05If the plate requires revision during the 90-day global, how do you bill?
06Is modifier 22 supportable for a particularly complex mandibular reconstruction?
Sources & references
Editorial content was developed using the following public sources. Last verified May 8, 2026.
- 01CMS Physician Fee Schedule 2026
- 02vsac.nlm.nih.govhttps://vsac.nlm.nih.gov/context/cs/codesystem/CPT/version/2020/code/21244/info
- 03aapc.comhttps://www.aapc.com/codes/cpt-codes/21244
- 04mdclarity.comhttps://www.mdclarity.com/cpt-code/21244
- 05axogeninc.comhttps://www.axogeninc.com/wp-content/uploads/2021/09/Oral-Maxillofacial-Coding-and-Billing-Guide.pdf
- 06aaoms.orghttps://aaoms.org/wp-content/uploads/2024/04/OralImplants_CodingPaper.pdf
- 07cms.govhttps://www.cms.gov/medicare/coding-billing/national-correct-coding-initiative-ncci-edits/medicare-ncci-policy-manual
Mira AI Scribe
Mira's AI scribe captures the surgical approach (extraoral vs. intraoral), confirmation of transosteal plate passage through the mandibular cortex, implant hardware details, and the specific diagnosis driving reconstruction — trauma, resection defect, severe atrophy, or congenital. That prevents the most common denial trigger for 21244: an operative note that documents hardware placement but omits the approach qualifier and clinical indication that distinguish this code from related mandibular procedures.
See how Mira captures CPT 21244 documentation