Closed treatment of a mandibular fracture with manual repositioning of the fractured bone segments — no incision required.

Verified May 8, 2026 · 5 sources ↓

Medicare: $779.91
Total RVUs: 23.35
Global, days: 90
Region: Other

Drawn from CMSEntnetAaomsAAPCFindacode

Documentation requirements

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

Source · Editorial brief grounded in 5 cited references ↓

Explicit statement that no surgical incision was made (closed approach confirmed)
Description of the manipulation technique used to reposition fracture fragments
Fracture location on the mandible (e.g., symphysis, body, angle, subcondylar, condyle)
Imaging confirmation of fracture (X-ray, CT) with pre- and post-reduction alignment noted
Any stabilization devices applied (arch bars, splints, elastic bands) with description of method
Mechanism of injury and clinical findings supporting fracture diagnosis
Documentation that interdental fixation was NOT used if distinguishing from 21453

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 58 Staged or related 59 Distinct service 73 Discontinued pre-anesthesia 74 Discontinued post-anesthesia 76 Repeat, same physician 77 Repeat, another physician 78 Unplanned return — related 79 Unrelated during global 80 Assistant surgeon 24 Unrelated E/M during global 25 Significant separate E/M

What this code covers

Source · Editorial summary grounded in 5 cited references ↓

CPT 21451 covers closed (non-surgical) realignment of a mandibular fracture where the surgeon manually manipulates the fractured segments back into anatomic position without making an incision. The key distinction from 21450 is the manipulation: bone fragments are physically repositioned, not simply immobilized in place. From 21453, which involves interdental fixation (wiring or banding the teeth together), 21451 does not require that additional stabilization step, though arch bars or other external devices may still be placed at the surgeon's discretion.

The 90-day global period means all routine post-treatment management — follow-up visits, splint or arch bar adjustments, and related care — is bundled. Any service unrelated to the mandible fracture during that window requires modifier 24 (E/M) or 79 (unrelated procedure). If the fracture subsequently requires open treatment due to inadequate closed reduction, report the open code with modifier 58 (staged or related procedure by same surgeon).

This code sits in the fracture and dislocation procedures section of the head. It is commonly billed by oral and maxillofacial surgeons, ENT surgeons, and plastic surgeons. Payers occasionally scrutinize the closed vs. open distinction — operative notes that don't clearly document the absence of an incision and the manual manipulation technique create unnecessary audit exposure.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	5.51
Practice expense RVU	17.22
Malpractice RVU	0.62
Total RVU	23.35
Medicare national rate	$779.91
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	$779.91
HOPD (APC 5163) Hospital outpatient department	$1,585.19
ASC (PI A2) Ambulatory surgical center (freestanding)	$659.17

Common denial reasons

The recurring reasons claims for CPT 21451 get rejected.

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

Operative note fails to confirm closed approach, triggering a query for open treatment upcoding
Missing post-reduction imaging or documentation of fragment alignment after manipulation
Global period conflict — follow-up E/M billed without modifier 24 during the 90-day window
Upcoding concern when manipulation is not distinctly documented, causing downcode to 21450
Payer requires prior authorization for fracture care in the outpatient or ASC setting and none was obtained

Frequently asked questions

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

01What is the difference between CPT 21450 and 21451?

21450 is closed treatment without manipulation — the fracture is immobilized as-is. 21451 requires active manual repositioning of the displaced fragments. If you manipulated the fracture, bill 21451. If you only stabilized an undisplaced fracture, bill 21450.

02When should I use 21453 instead of 21451?

Use 21453 when closed treatment is performed with interdental fixation — meaning the teeth are wired or banded together (intermaxillary fixation) as the primary stabilization method. 21451 covers manipulation without that interdental fixation component.

03If closed reduction fails and I need to proceed to open treatment, how do I code the second procedure?

Report the appropriate open treatment code (e.g., 21462 with interdental fixation, 21461 without) with modifier 58 — staged or related procedure by the same surgeon during the global period.

04Does the 90-day global period cover arch bar removal?

Yes. Arch bar or splint removal during the 90-day global is bundled into 21451 when it's routine post-fracture care. Removal under general anesthesia for a complicated patient may support modifier 22 on the original claim or a separate discussion with the payer, but routine removal does not generate a separate billable service.

05Can 21451 be billed with TMJ codes on the same date?

It depends on the clinical scenario. If a condylar fracture is being treated and a separate, distinct TMJ procedure is performed, modifier 59 may support separate billing — but document the distinct anatomical sites and indications clearly. NCCI edits and payer policy govern what's separately payable.

06Is 21451 covered by Medicare in the ASC setting?

Yes. The code has an ASC payment rate under CMS Physician Fee Schedule 2026. Confirm the procedure is on your ASC's covered procedures list and that the site-of-service documentation matches the place of service code billed.

Sources & references

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

Mira AI Scribe

Mira's AI scribe captures the manipulation technique, fracture location on the mandible, confirmation of closed (no-incision) approach, pre- and post-reduction alignment, and any stabilization devices applied during dictation. That specificity prevents downcoding to 21450 (no manipulation) and audit flags from operative notes that only state 'fracture reduced in standard fashion' without technique detail.

See how Mira captures CPT 21451 documentation