Closed treatment of a mandibular or maxillary alveolar ridge fracture, performed by manipulation without surgical incision.
Verified May 8, 2026 · 4 sources ↓
- Medicare
- $794.27
- Work RVU
- 3.35
- 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 4 cited references ↓
- Mechanism of injury and clinical findings supporting fracture diagnosis (e.g., dental malocclusion, mobility of alveolar segment)
- Confirmation that treatment was closed — no incision made; manipulation technique described explicitly
- Specific anatomic site documented: mandibular alveolar ridge vs. maxillary alveolar ridge, with laterality
- Imaging (periapical, panoramic, or CT) referenced in the note to support fracture characterization
- Occlusal status assessed pre- and post-manipulation, including any splint or interdental wiring applied
- Post-reduction plan documented, including immobilization method and follow-up interval within the 90-day global
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 4 cited references ↓
CPT 21440 covers closed (non-surgical) treatment of fractures involving the alveolar ridge — the dense bone of the upper or lower jaw that anchors the tooth sockets. Treatment is accomplished through manual manipulation rather than an open incision. This distinguishes it from open treatment codes in the 21440s family, which require surgical exposure.
The 90-day global period means all routine fracture follow-up, including occlusal checks, splint adjustments, and related E/M visits, is bundled into the single procedure payment. Any visit unrelated to the fracture managed during that window requires modifier 24. A same-day E/M that drives the decision to treat requires modifier 57.
This code sits within the head fracture and dislocation subsection of the musculoskeletal CPT range. It is most commonly billed by oral and maxillofacial surgeons and ENT/head and neck specialists, though trauma-trained orthopedic surgeons may encounter it in polytrauma contexts. Correct ICD-10 diagnosis coding to the specific jaw segment and laterality is essential; nonspecific fracture codes are a common audit trigger.
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 (3.35) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (23.78) adds practice overhead and malpractice, and is what drives the Medicare payment below.
| Work RVU | 3.35 |
| Practice expense RVU | 19.95 |
| Malpractice RVU | 0.48 |
| Total RVU | 23.78 |
| Medicare national rate | $794.27 |
| 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 | $794.27 |
HOPD (APC 5164) Hospital outpatient department | $3,387.27 |
ASC (PI P3) Ambulatory surgical center (freestanding) | $670.01 |
Common denial reasons
The recurring reasons claims for CPT 21440 get rejected.
Source · Editorial brief grounded in CMS NCCI edits, AAOS coding appeals, and cited references ↓
- ICD-10 fracture code too nonspecific — missing laterality or jaw segment specificity triggers medical necessity edits
- Same-day E/M billed without modifier 57, resulting in bundling denial under the global package rules
- Operative note describes incision or open exposure, contradicting the closed-treatment code and triggering downcoding or denial
- Claim submitted without adequate imaging documentation on file, causing medical necessity denial on pre-payment review
- Modifier 24 omitted on follow-up E/M visits within the 90-day global, causing those visits to be denied as included services
Frequently asked questions
Source · Generated from the editorial pipeline, verified against 4 cited references ↓
01What distinguishes 21440 from open alveolar ridge fracture codes?
02How long is the global period for 21440, and what does it include?
03Can 21440 be billed for both mandibular and maxillary alveolar ridge fractures treated at the same encounter?
04What modifier applies if the same-day E/M drove the decision to perform closed treatment?
05Is 21440 appropriate when the patient requires sedation or anesthesia for manipulation?
06What ICD-10 codes pair with 21440?
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, the specific alveolar ridge segment (mandibular vs. maxillary, with laterality), confirmation that no incision was made, manipulation technique, pre- and post-reduction occlusal status, and any splint or wiring applied. That documentation directly prevents downcoding to an unspecified fracture code and shields against closed-vs-open treatment disputes on audit.
See how Mira captures CPT 21440 documentation