Closed treatment of a mandibular fracture without manipulation — no surgical reduction or repositioning of fracture fragments performed.

Verified May 8, 2026 · 5 sources ↓

Medicare: $597.88
Work RVU: 3.62
Global, days: 90
Region: Other

Drawn from CMSAaomsCgsmedicare

Documentation requirements

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

Source · Editorial brief grounded in 5 cited references ↓

Imaging (X-ray, CT, or panoramic radiograph) confirming mandibular fracture with fracture location specified
Explicit statement that no manipulation was performed and clinical rationale for non-manipulative treatment
Description of any immobilization or stabilization applied (e.g., arch bars, elastic bands, soft diet instruction) at the time of service
ICD-10-CM fracture code from category S02 specifying fracture site, laterality, and encounter type (initial vs. subsequent)
Notation of associated injuries or complicating factors that influenced treatment decisions
Patient's occlusal status documented pre- and post-treatment to justify conservative approach

Applicable modifiers

Modifiers commonly billed with this code.

Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual

22 Increased complexity 24 Unrelated E/M during global 25 Significant separate E/M 50 Bilateral procedure 51 Multiple procedures 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 LT Left side RT Right side XS Separate structure

What this code covers

Source · Editorial summary grounded in 5 cited references ↓

CPT 21450 covers closed (non-operative) management of a mandibular fracture where the fracture fragments are left in their current position without any manual or mechanical manipulation. No incision is made, and no hardware is placed. The code sits within the 21450–21470 mandible fracture range; if manipulation is required, step up to 21451. If open treatment is needed, use codes in the 21452–21470 range depending on fixation method.

The 90-day global period applies. That window covers all routine post-fracture management visits, wire checks, dressing changes, and removal of any temporary fixation placed at the time of service. Bill unrelated E/M visits during the global with modifier 24. If a complication requires a return to treat the same fracture — wiring that loosens or displacement that demands intervention — modifier 78 applies. A new, unrelated surgical problem in the global period uses modifier 79.

When multiple facial fractures are present in the same operative session, report each separately to the extent NCCI edits allow. If a modifier cannot override a bundling edit, bill the highest-RVU fracture code and append modifier 22 with a supporting narrative documenting the additional work. Some payers apply bilateral modifier 50 rules differently for mandible fractures — verify eligibility before appending 50.

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 (3.62) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (17.9) adds practice overhead and malpractice, and is what drives the Medicare payment below.

Work RVU	3.62
Practice expense RVU	13.87
Malpractice RVU	0.41
Total RVU	17.9
Medicare national rate	$597.88
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	$597.88
HOPD (APC 5162) Hospital outpatient department	$551.01
ASC (PI G2) Ambulatory surgical center (freestanding)	$295.47

Common denial reasons

The recurring reasons claims for CPT 21450 get rejected.

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

Missing or inadequate imaging documentation to confirm fracture diagnosis at the time of treatment
Claim submitted without manipulation specified, triggering down-code or denial when payer cannot distinguish 21450 from 21451
Bundling denial when 21450 is billed with other facial fracture codes in the same session without modifier 59 or XS and supporting clinical documentation
Routine post-op visits billed separately during the 90-day global period without modifier 24 to indicate unrelated service
ICD-10 fracture code missing laterality or encounter type, causing medical necessity edit failure

Frequently asked questions

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

01What distinguishes 21450 from 21451?

21450 is closed treatment without manipulation — fragments are not repositioned. 21451 requires active manipulation to reduce the fracture. Document explicitly which occurred; the distinction drives code selection and reimbursement.

02Does 21450 carry a global period, and what does it cover?

Yes — 90-day global. It includes the day of service, all routine post-fracture follow-up visits, wire or fixation checks, and immobilization adjustments through day 90. Unrelated E/M visits in that window need modifier 24.

03Can 21450 be billed with other facial fracture codes on the same date?

Yes, but check NCCI Procedure-to-Procedure edits first. Report each fracture separately; use modifier 59 or XS when edits allow it. If a modifier cannot override the edit, bill the highest-RVU code and append modifier 22 with a narrative documenting the added complexity.

04When is modifier 22 appropriate with 21450?

Use modifier 22 when the clinical complexity significantly exceeds typical closed treatment — for example, multiple fracture lines in the same bone where a single code applies and NCCI prevents separate billing. Attach a written narrative quantifying the extra time and intensity.

05What ICD-10-CM codes pair with 21450?

Draw from S02 (Fracture of skull and facial bones). Specify the mandibular fracture site (symphysis, body, angle, ramus, condylar process, coronoid), laterality, and encounter type. A non-specific S02 code without site or laterality will trigger medical necessity edits at most payers.

06Is modifier 78 or 79 correct if the patient returns during the global period for additional fracture care?

Modifier 78 applies if the return procedure addresses a complication or progression of the same fracture — for example, displacement requiring manipulation or fixation. Modifier 79 applies only if the new procedure is entirely unrelated to the original fracture.

Sources & references

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

Mira Scribe

Mira's AI scribe captures the fracture site, laterality, imaging findings, and the explicit clinical decision not to manipulate fragments from the provider's dictation. It flags if the operative note lacks a statement confirming no manipulation occurred — the single most common reason 21450 is challenged on audit or confused with 21451. It also records any immobilization technique applied, which supports medical necessity and distinguishes this encounter from a routine E/M visit during a global period.

See how Mira captures CPT 21450 documentation