Open treatment of a nasomaxillary complex fracture with bone grafting

Verified May 8, 2026 · 5 sources ↓

Medicare: $947.92
Total RVUs: 28.38
Global, days: 90
Region: Other

Drawn from CMSEmednyAAOSAoassn

Documentation requirements

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

Source · Editorial brief grounded in 5 cited references ↓

Operative note must identify the fracture pattern and confirm open exposure of the nasomaxillary complex
Graft type, source (autograft donor site, allograft, or synthetic), and placement location must be explicitly documented
If autograft is harvested, document the donor site anatomy and harvest technique separately from the fracture repair narrative
Imaging (CT preferred) confirming nasomaxillary fracture with displacement or bone loss should be in the record
Document medical necessity for grafting — e.g., comminution, bone defect size, or inadequacy of primary fixation alone
Record any fixation hardware used (plates, screws, wires) with size and placement detail

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 76 Repeat, same physician 77 Repeat, another physician 78 Unplanned return — related 79 Unrelated during global 80 Assistant surgeon AS PA/NP/CNS assistant LT Left side RT Right side

What this code covers

Source · Editorial summary grounded in 5 cited references ↓

CPT 21348 covers open surgical repair of a nasomaxillary fracture that requires bone grafting as part of the reconstruction. The graft — autograft, allograft, or synthetic — is used to restore skeletal continuity or volume where comminution or bone loss makes primary fixation alone insufficient. The code is distinct from simpler nasomaxillary repair codes that do not involve grafting; if a graft is not harvested or placed, 21348 does not apply.

The 90-day global period means all routine post-op visits, wound checks, and splint or fixation adjustments are bundled through day 90. Unrelated E/M services in that window require modifier 24. A decision-for-surgery visit on the day before or day of the procedure needs modifier 57. If an autograft harvest is performed from a separate anatomic site, that harvest may be separately reportable — document the donor site explicitly in the operative note.

This procedure is almost always performed in a hospital or ASC setting given its complexity. Site-of-service payment differentials are significant; see the HOPD vs. ASC payment comparison on this page. Payers including Medicaid managed care plans frequently require prior authorization for nasomaxillary fracture repairs with grafting — confirm requirements before scheduling.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	17.08
Practice expense RVU	8.81
Malpractice RVU	2.49
Total RVU	28.38
Medicare national rate	$947.92
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	$947.92
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 21348 get rejected.

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

Graft not documented — payer downcodes to a non-graft nasomaxillary repair code when grafting is not explicitly confirmed in the operative note
Missing pre-op imaging or inadequate documentation of bone loss justifying graft use, triggering medical necessity denial
Prior authorization not obtained for elective or semi-elective repair in managed care or Medicaid plans
Separate graft harvest code billed without documentation of a distinct donor site procedure
Global period violation — post-op E/M billed within 90 days without modifier 24 for an unrelated condition

Frequently asked questions

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

01What distinguishes 21348 from other nasomaxillary fracture codes?

The defining element is bone grafting. If the repair is performed open but no graft is used, a different code applies. If it is closed treatment, a different code applies. 21348 is specifically open repair with graft — all three elements must be present.

02Can I separately bill for the autograft harvest?

Potentially yes, if the harvest is from a separate anatomic site and that work is distinctly documented. The donor site harvest has its own CPT codes. If the graft is allograft or synthetic, there is no harvest to bill separately, but the graft material cost may be separately billable as a supply depending on payer policy.

03Does the 90-day global period affect how I bill for hardware removal if needed later?

Yes. Hardware removal within the 90-day global is bundled unless it is unplanned and related, in which case modifier 78 applies for an unplanned return to the OR for a related procedure. If it falls outside the global or is for an unrelated reason, modifier 79 applies.

04Is modifier 22 appropriate if the reconstruction was significantly more complex than typical?

Yes, but document it carefully. Modifier 22 requires a written explanation of what made the work substantially greater — unusual comminution, prior failed repair, extensive scarring, or prolonged operative time compared to the typical case. Attach a cover letter to the claim; payers routinely request records before paying the upcharge.

05Do I need prior authorization for 21348?

Check each payer individually. Medicare does not require prior auth for most surgical procedures, but Medicaid managed care plans and many commercial payers require it for facial fracture repairs, especially those involving grafting. Failure to obtain auth when required is a leading cause of denial for this code.

06How should I handle billing when a plastic or ENT surgeon co-operates with the orthopedic or craniofacial surgeon?

If two surgeons of different specialties each perform distinct portions of the procedure, co-surgery modifier 62 may apply — both surgeons bill 21348 with modifier 62 and each submits their own operative report. If one surgeon assists rather than co-operates, modifier 80 or AS applies for the assistant.

Sources & references

Editorial content was developed using the following public sources. Last verified May 8, 2026.

Mira AI Scribe

The Mira AI Scribe captures the fracture pattern, confirmation of open exposure, graft type and donor site, fixation hardware details, and any concurrent procedures from dictation — structured into the operative note fields auditors check first. That prevents the most common downcoding scenario: a graft that was placed but never explicitly named in the note, which causes payers to reprocess the claim under a lower-value non-graft repair code.

See how Mira captures CPT 21348 documentation