Open treatment of a palatal or maxillary fracture, performed through an intraoral incision to reduce and stabilize the fractured hard palate or upper jaw.

Verified May 8, 2026 · 6 sources ↓

Medicare: $590.19
Work RVU: 8.51
Global, days: 90
Region: Other

Drawn from CMSAAPCMdclarityAMAEmedny

Documentation requirements

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

Source · Editorial brief grounded in 6 cited references ↓

Mechanism of injury documented with sufficient detail to support traumatic fracture diagnosis
Imaging findings (CT preferred for midface fractures) confirming palatal or maxillary fracture with displacement requiring open treatment
Operative note specifying intraoral incision site, fracture reduction method, and stabilization technique used
Named surgical approach documented — audit teams flag notes that say 'standard approach' without specifics
Laterality and fracture extent noted, including involvement of adjacent structures if any
Medical necessity narrative explaining why open rather than closed treatment was required

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

What this code covers

Source · Editorial summary grounded in 6 cited references ↓

CPT 21422 covers open surgical treatment of a palatal or maxillary fracture — typically caused by significant blunt force trauma to the midface. The surgeon accesses the fracture through an incision inside the mouth, reduces the displaced bone, and stabilizes it. This is distinct from closed treatment (21421), which involves no incision, and from the more extensive open treatment with internal fixation (21423). Code selection hinges on the surgical approach actually used, not the fracture classification on imaging.

This code carries a 90-day global period. That covers the operative session, the day-before visit, and all routine follow-up care through day 90. If you bill an E/M visit during that window for a separate, unrelated condition, append modifier 24. Modifier 78 applies if the patient returns to the OR for an unplanned related procedure within the global.

Because 21422 sits in the craniofacial surgery space, payer coverage policies vary more than for most orthopedic trauma codes. Some commercial plans require prior authorization or direct billing to a craniofacial or oral and maxillofacial surgery benefit category rather than standard musculoskeletal. Verify benefit routing before submitting.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU vs. total RVU

The work RVU (8.51) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (17.67) adds practice overhead and malpractice, and is what drives the Medicare payment below.

Work RVU	8.51
Practice expense RVU	7.92
Malpractice RVU	1.24
Total RVU	17.67
Medicare national rate	$590.19
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	$590.19
HOPD (APC 5165) Hospital outpatient department	$6,048.05
ASC (PI J8) Ambulatory surgical center (freestanding)	$3,926.27

Common denial reasons

The recurring reasons claims for CPT 21422 get rejected.

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

Wrong benefit category — some commercial payers route craniofacial codes to oral surgery benefits, causing orthopedic/surgery claim rejection
Insufficient documentation distinguishing open treatment (21422) from closed treatment (21421) or open with fixation (21423)
Missing or inadequate imaging report to support fracture diagnosis and displacement requiring surgical intervention
Global period conflict when post-op E/M is billed without modifier 24 for an unrelated condition
Prior authorization not obtained when required by commercial or Medicaid plan for craniofacial surgery

Frequently asked questions

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

01What distinguishes 21422 from 21421 and 21423?

21421 is closed treatment of a palatal or maxillary fracture — no incision. 21422 is open treatment via intraoral incision without internal fixation specified in the code descriptor. 21423 covers open treatment with more extensive fixation. Select based on what was actually performed, documented in the operative note.

02Does 21422 carry a global period?

Yes — 90-day global. All routine post-op visits, wound checks, and splint or cast management through day 90 are bundled. Bill modifier 24 on an E/M for an unrelated condition during that window, or modifier 78 for an unplanned return to the OR for a related procedure.

03Which ICD-10 codes pair with 21422?

Palatal fracture (S02.8XXA for initial encounter) and maxillary fracture codes (S02.40XA series) are the primary matches. Specify laterality and episode of care suffix correctly — payers flag missing or mismatched suffixes on trauma claims.

04Can 21422 be billed with modifier 22 for a particularly complex fracture?

Yes, when documented complexity substantially exceeds typical work — comminuted pattern, prior surgical hardware, significant soft-tissue involvement. The operative note must quantify the additional time and describe what made it unusual. Without that narrative, modifier 22 claims are routinely downcoded.

05Does site of service affect payment for 21422?

Yes. HOPD and ASC payments differ — see the site of service comparison table on this page. Physician fee schedule payment is the same regardless of site, but facility fees vary significantly between hospital outpatient and ASC settings.

06Is prior authorization typically required for 21422?

It varies by payer. Commercial plans with separate craniofacial or oral surgery benefit categories often require auth. Medicare does not require prior auth for this code, but some Medicare Advantage plans do. Verify before scheduling when the procedure is elective or semi-elective.

Sources & references

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

Mira Scribe

Mira's AI scribe captures the mechanism of injury, imaging findings, named surgical approach, intraoral incision location, reduction technique, and stabilization method directly from dictation. This prevents the most common audit flag for 21422: operative notes that fail to distinguish open treatment from closed treatment or that omit the surgical approach by name — both of which trigger downcoding or denial.

See how Mira captures CPT 21422 documentation