Closed treatment of craniofacial separation — repositioning and stabilizing the skull-to-facial-skeleton disjunction without open surgical exposure.
Verified May 8, 2026 · 5 sources ↓
- Medicare
- $646.98
- Total RVUs
- 19.37
- 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 5 cited references ↓
- Mechanism and energy of injury with clear description of craniofacial disjunction pattern (e.g., Le Fort III equivalent, naso-orbito-ethmoid involvement)
- Imaging confirmation — CT facial bones or craniofacial CT with reads documenting skull-to-facial-skeleton separation
- Description of closed reduction technique: specific manipulation maneuvers performed, force applied, and instruments or fixation devices used for stabilization
- Type of splint, arch bar, or intermaxillary fixation applied, including duration planned
- Pre- and post-reduction clinical findings including occlusion, facial projection, and orbital rim position
- Documentation of any concurrent specialist involvement (neurosurgery, ophthalmology) and whether those services are separately billed
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 5 cited references ↓
CPT 21431 covers closed (non-operative) management of a craniofacial separation, the traumatic disjunction between the cranial base and the facial skeleton. This injury pattern — historically classified within the Le Fort III or similar high-energy fracture spectrum — involves manipulating displaced segments back into anatomic alignment and maintaining that reduction through splinting, intermaxillary fixation, or external stabilization, without formal open reduction and internal fixation.
The 90-day global period means the treating physician's routine post-reduction visits, splint adjustments, and fracture-monitoring encounters are all bundled through day 90. Any unrelated E/M service in that window requires modifier 24. A separately identifiable same-day E/M needs modifier 25. Because this is a high-severity craniofacial injury, cases frequently involve co-management with neurosurgery or ophthalmology; document those concurrent services clearly to distinguish independently billable work.
Site of service matters: the HOPD and ASC payment rates differ substantially (see the Site of Service comparison table). Most high-energy craniofacial separations present through the ED and are managed in the inpatient or HOPD setting; confirm facility billing alignment before submitting. Verify NCCI bundles if additional facial fracture codes are reported on the same date — overlapping fracture management codes in the craniofacial region are common NCCI edit triggers.
RVU & reimbursement
Component RVUs and Medicare national rate. Actual payment varies by GPCI locality.
Source · CMS Physician Fee Schedule, RVU26A · January 2026
| Work RVU | 7.7 |
| Practice expense RVU | 10.79 |
| Malpractice RVU | 0.88 |
| Total RVU | 19.37 |
| Medicare national rate | $646.98 |
| 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 | $646.98 |
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 21431 get rejected.
Source · Editorial brief grounded in CMS NCCI edits, AAOS coding appeals, and cited references ↓
- Operative note describes open exposure or internal fixation — defaulting to 21431 when 21432 (open treatment) is the correct code
- NCCI bundling conflict when multiple craniofacial or midface fracture codes are billed on the same date without appropriate modifier 59 or XS to establish distinct anatomic sites
- Missing imaging documentation — payers deny without CT confirmation of craniofacial separation as distinct from isolated facial fracture
- Global period violation — post-reduction E/M visits billed without modifier 24 during the 90-day window
- Medical necessity not established — operative or clinical note lacks documentation of the degree of displacement or functional impairment justifying closed reduction
Frequently asked questions
Source · Generated from the editorial pipeline, verified against 5 cited references ↓
01What distinguishes 21431 (closed) from 21432 (open treatment) of craniofacial separation?
02Does 21431 cover the post-reduction visits?
03Can I bill concurrent facial fracture codes with 21431 on the same date?
04When is modifier 22 appropriate for 21431?
05Is prior authorization typically required for 21431?
06Can two surgeons bill modifier 62 for craniofacial separation treatment?
Sources & references
Editorial content was developed using the following public sources. Last verified May 8, 2026.
- 01CMS Physician Fee Schedule 2026
- 02aapc.comhttps://www.aapc.com/codes/cpt-codes/21431
- 03mdclarity.comhttps://www.mdclarity.com/cpt-code/21431
- 04billrazor.comhttps://billrazor.com/procedures/21431-cltx-craniofacial-separation
- 05aaos.orghttps://www.aaos.org/quality/coding-and-reimbursement/current_procedural_terminology/
Mira AI Scribe
Mira's AI scribe captures the injury classification (craniofacial separation vs. isolated midface fracture), the specific reduction maneuver and stabilization method used, pre- and post-reduction occlusal and orbital findings, and imaging correlation from dictation. That prevents the most common audit flag on 21431: operative notes that describe an open approach or internal fixation without a corresponding code change to 21432, and notes that omit the distinct craniofacial disjunction pattern required to distinguish this code from lower Le Fort levels.
See how Mira captures CPT 21431 documentation