Open surgical treatment of a fractured mandibular or maxillary alveolar ridge, the tooth-bearing bone of the jaw.

Verified May 8, 2026 · 7 sources ↓

Medicare: $753.19
Work RVU: 6.1
Global, days: 90
Region: Other

Drawn from CMSAAPCFindacodeMdclarityPayerprice

Documentation requirements

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

Source · Editorial brief grounded in 7 cited references ↓

Explicitly state that open surgical access was used — do not just write 'fracture reduction performed'
Identify the specific jaw segment involved (mandibular alveolar ridge vs. maxillary alveolar ridge)
Document the mechanism and laterality of the fracture
Record internal fixation method if used (e.g., plates, screws, wire, splint) and whether teeth were involved in the fracture line
Note any complicating factors (e.g., tooth loss, infection, comminution) that might support modifier 22
Document anesthesia type and whether the procedure required general anesthesia, which supports hospital/ASC setting

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 62 Co-surgeons 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 7 cited references ↓

CPT 21445 covers open treatment of an alveolar ridge fracture — the bony crest of the mandible or maxilla that houses the tooth sockets. Open treatment means the surgeon accesses the fracture site directly, as opposed to closed reduction under 21440. The code carries a 90-day global period, so all routine post-op care, wound checks, and splint adjustments through day 90 are bundled.

This code sits in the Fracture and/or Dislocation Procedures on the Head section of CPT. It is most commonly billed by oral and maxillofacial surgeons, though craniofacial and general plastic surgeons perform it as well. The distinction between 21440 (closed) and 21445 (open) hinges entirely on surgical access — document the open approach explicitly or expect a downcode.

Site of service matters significantly here. The HOPD payment is roughly double the ASC payment, so facility selection drives revenue materially. If the procedure is performed in the office or ASC, confirm the fracture complexity justifies that setting and that your operative note supports the open-treatment descriptor.

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 (6.1) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (22.55) adds practice overhead and malpractice, and is what drives the Medicare payment below.

Work RVU	6.1
Practice expense RVU	15.76
Malpractice RVU	0.69
Total RVU	22.55
Medicare national rate	$753.19
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	$753.19
HOPD (APC 5165) Hospital outpatient department	$6,048.05
ASC (PI A2) Ambulatory surgical center (freestanding)	$3,025.62

Common denial reasons

The recurring reasons claims for CPT 21445 get rejected.

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

Claim billed as 21445 (open) but operative note only supports closed reduction — payer downcodes to 21440
Missing laterality or fracture-site specificity triggers medical necessity review
Post-op visits billed without modifier 24 during the 90-day global period
Site-of-service mismatch — code billed for facility but claim submitted on professional fee schedule without distinguishing components
ICD-10 fracture code not linked to a traumatic mechanism, raising cosmetic-exclusion flags with some commercial payers

Frequently asked questions

Source · Generated from the editorial pipeline, verified against 7 cited references ↓

01What separates 21445 from 21440?

21440 is closed reduction of an alveolar ridge fracture — no surgical opening of the site. 21445 requires direct open access to the fracture. The operative note must describe incision and exposure; if it doesn't, payers will downcode to 21440.

02Does 21445 include fixation hardware?

Yes. Open treatment of the alveolar ridge fracture encompasses the reduction and any stabilization performed at the same operative site. Do not separately bill plate or screw application — it is bundled into the open treatment code.

03Can 21445 be billed with other jaw fracture codes in the same session?

Yes, but modifier 51 is required on the lower-valued code when multiple fracture procedures are billed at the same session. Modifier 59 may also be needed if payer edits bundle the codes — document distinct fracture sites clearly.

04How does the 90-day global affect post-op billing?

All routine follow-up through day 90 is included. Bill unrelated E/M visits with modifier 24. If a new, unrelated surgical problem requires a procedure in the global window, use modifier 79. A related return to the OR uses modifier 78.

05Is modifier 22 ever justified for 21445?

Yes — comminuted fractures, infected wounds, significant displacement requiring extensive mobilization, or a patient with abnormal anatomy (e.g., prior reconstruction) can support modifier 22. You need a cover letter explaining the increased work and documentation quantifying operative time versus typical.

06Which ICD-10 codes typically pair with 21445?

Traumatic fracture codes from the S02 category (fractures of skull and facial bones) are the standard link. Specify the bone (mandible vs. maxilla), fracture type (displaced vs. nondisplaced), and laterality. Unspecified fracture codes increase audit risk.

Sources & references

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

Mira Scribe

Mira's AI scribe captures the surgical approach (open vs. closed), fracture location (mandibular or maxillary alveolar ridge), laterality, fixation method, and any complicating factors from dictation — the exact details auditors check when distinguishing 21445 from 21440. This prevents the most common denial: an open-treatment code with a note that only documents manipulation.

See how Mira captures CPT 21445 documentation