Closed treatment of a nasomaxillary complex (Le Fort II pattern) fracture, with application of an external splint or fixation device to stabilize the nasal and upper jaw bones without open surgical exposure.

Verified May 8, 2026 · 5 sources ↓

Medicare: $799.28
Total RVUs: 23.93
Global, days: 90
Region: Other

Drawn from CMSAaomsAAPC

Documentation requirements

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

Source · Editorial brief grounded in 5 cited references ↓

Imaging (CT or plain film) confirming nasomaxillary complex fracture pattern and displacement
Operative note specifying the fracture pattern as nasomaxillary (Le Fort II type), not isolated nasal or malar
Description of the closed reduction technique and the specific stabilization device applied (e.g., external splint, arch bars, intermaxillary fixation)
Documentation of pre- and post-reduction alignment and any complications encountered during the procedure
If modifier 22 is appended, a written narrative quantifying additional time, complexity, or intensity compared to a routine closed nasomaxillary reduction

Applicable modifiers

Modifiers commonly billed with this code.

Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual

22 Increased complexity 24 Unrelated E/M during global 25 Significant separate E/M 52 Reduced services 57 Decision for surgery 58 Staged or related 59 Distinct service 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 5 cited references ↓

CPT 21345 covers closed reduction and external stabilization of a nasomaxillary complex fracture — the pattern involving both the nasal bones and the maxilla, corresponding to the Le Fort II fracture zone. No incision is made; the surgeon manipulates the fragments into alignment and applies a splint, arch bar, or other fixation device to hold the reduction while healing occurs. This is distinct from open treatment codes (21346, 21347, 21348), which require surgical exposure of the fracture site.

The 90-day global period covers the procedure, the day-before visit if applicable, and all routine post-op management through day 90. Any E/M service during that window for an unrelated problem requires modifier 24; a separately identifiable E/M on the same day as the procedure requires modifier 25. Payers scrutinize these heavily — document medical necessity for each encounter explicitly.

When multiple facial fractures are treated at the same session, check NCCI procedure-to-procedure edits before billing 21345 alongside adjacent fracture codes (e.g., nasal fracture codes 21315–21337 or nasoethmoid codes 21338–21340). Where a modifier-59 bypass is not permitted, consider appending modifier 22 with a written narrative describing the additional complexity, time, and intensity involved.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	8.83
Practice expense RVU	13.81
Malpractice RVU	1.29
Total RVU	23.93
Medicare national rate	$799.28
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	$799.28
HOPD (APC 5163) Hospital outpatient department	$1,585.19
ASC (PI A2) Ambulatory surgical center (freestanding)	$659.17

Common denial reasons

The recurring reasons claims for CPT 21345 get rejected.

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

Fracture pattern not specified — claim coded as nasomaxillary (21345) but operative note only documents nasal fracture, triggering down-code to 21315–21325 range
Bundling denial when 21345 is billed same-session with nasal or nasoethmoid fracture codes without a valid modifier or NCCI edit bypass
E/M billed during the 90-day global period without modifier 24 or 25, causing automatic bundling by payer
Lack of imaging documentation to confirm displaced nasomaxillary fracture requiring active reduction, prompting medical necessity denial

Frequently asked questions

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

01What distinguishes 21345 from the nasal fracture codes 21315–21325?

21345 requires fracture involvement of both the nasal bones and the maxilla (nasomaxillary complex). Isolated nasal fractures — no maxillary component — belong in the 21315–21325 range. The operative note must explicitly establish the maxillary involvement to support 21345.

02Can 21345 and a nasal fracture code be billed together on the same date?

Only if NCCI edits allow it. Check the CMS NCCI procedure-to-procedure tables before billing both. Where a modifier bypass is not permitted, document the additional complexity and append modifier 22 to 21345 instead of billing the second fracture code separately.

03What is the global period for 21345, and what does it include?

The global period is 90 days. It covers the procedure, any day-before preoperative visit, and all routine post-op fracture management through day 90 — including splint checks, arch bar adjustments, and removal of fixation devices placed at the time of surgery.

04When is modifier 22 appropriate for 21345?

Use modifier 22 when the closed reduction required substantially more work than typical — for example, severe comminution, multiple simultaneous facial fractures treated at one session, or prolonged manipulation time. Attach a written narrative to the claim; payers won't approve the upward adjustment without it.

05Is 21345 payable in an ASC setting?

Yes. CMS assigns separate ASC payment status to 21345. The ASC rate differs significantly from the HOPD rate — see the Site of Service comparison on this page for current 2026 values.

06How does modifier 52 apply to 21345 in a bilateral fracture scenario?

If a bilateral nasomaxillary fracture is treated but only one set of arch bars or fixation hardware is applied instead of bilateral fixation, append modifier 52 (Reduced Services) to reflect that the full bilateral service was not completed. The AAOMS trauma coding guidance specifically flags this scenario for modifier 52 use.

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 fracture pattern (nasomaxillary complex, Le Fort II distribution), reduction technique, and the specific fixation device applied from surgeon dictation — preventing the most common audit flag: an operative note that documents 'nasal fracture' without establishing nasomaxillary involvement, which forces a down-code and triggers a medical necessity denial.

See how Mira captures CPT 21345 documentation