Closed treatment of a mandibular (lower jaw) fracture using interdental fixation — teeth-based hardware stabilizes the fracture without open surgical exposure.

Verified May 8, 2026 · 5 sources ↓

Medicare: $1,120.60
Total RVUs: 33.55
Global, days: 90
Region: Other

Drawn from CMSAAPCEmednyFindacode

Documentation requirements

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

Source · Editorial brief grounded in 5 cited references ↓

Fracture site within the mandible (body, ramus, parasymphysis, symphysis, angle) — vague references to 'mandible fracture' without anatomical specificity invite audits
Confirmation that treatment was closed — no surgical exposure of the fracture site; document approach explicitly
Type of interdental fixation applied (arch bars, Ivy loops, Ernst ligatures, splints, or combination) with placement details
Pre- and post-reduction occlusal status — document dental occlusion alignment achieved after fixation
Imaging (panorex, CT maxillofacial, or plain films) confirming fracture and post-reduction alignment cited in the operative note
Mechanism of injury and relevant trauma history to support the fracture diagnosis code
If additional fracture sites treated at same encounter, document each site separately with distinct treatment method to support multiple code reporting with modifier 59

Applicable modifiers

Modifiers commonly billed with this code.

Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual

22 Increased complexity 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 AS PA/NP/CNS assistant XS Separate structure

What this code covers

Source · Editorial summary grounded in 5 cited references ↓

CPT 21453 covers closed management of a mandibular fracture where the treating surgeon stabilizes the fracture using interdental fixation — wires, arch bars, or similar devices anchored to the teeth — without surgically opening the fracture site. The mandible is reduced and immobilized through the dental occlusion rather than direct bony exposure. This distinguishes it from open treatment codes (21461, 21462, 21470) and from closed treatment without interdental fixation.

The 90-day global period means the operative session, any day-before visit, and all routine post-op management through day 90 are bundled. Separate billing for fixation adjustments, wire checks, or arch bar maintenance during that window requires modifier 24 or 25 if the visit is genuinely unrelated, or modifier 78 if you're returning to the OR for a related complication. Modifier 79 applies only if the return OR visit is truly unrelated to the mandible fracture.

When multiple mandibular fracture sites are treated at the same encounter — for example, a closed fracture at one site addressed with 21453 alongside an open fracture at a distinct anatomical site addressed with 21462 — NCCI bundling edits apply. The modifier indicator for many of these pairs is '1', meaning modifier 59 (or XS for a distinct structural location) on the column 2 code can bypass the edit when documentation supports distinct sites and distinct procedures. Append modifier 51 as a secondary modifier on the additional procedure to flag multiple procedures in the same session.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	6.47
Practice expense RVU	26.1
Malpractice RVU	0.98
Total RVU	33.55
Medicare national rate	$1,120.60
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	$1,120.60
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 21453 get rejected.

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

Bundling edit triggered when 21453 is reported same-day with 21462 or other mandibular fracture codes without modifier 59 on the column 2 code
Global period violations — billing for routine post-op wire checks or arch bar adjustments within the 90-day global without appropriate modifier 24, 25, or 78
Insufficient documentation of interdental fixation type — payers deny when the note says 'fixation applied' without specifying the device or technique used
ICD-10 diagnosis code mismatch — using a closed fracture diagnosis (S02.6XXA series) inconsistently with the procedure code or failing to specify fracture site
Missing imaging documentation — claims lacking reference to confirming radiographs are flagged for lack of medical necessity support

Frequently asked questions

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

01What separates 21453 from 21462?

21453 is closed treatment — no surgical opening of the fracture site — with interdental fixation. 21462 is open treatment with interdental fixation, meaning the surgeon directly exposes and reduces the fracture. If both are performed at the same encounter for different fracture sites, append modifier 59 to the column 2 code and document each site distinctly.

02Can 21453 and 21462 be billed together at the same encounter?

Yes, when they address distinct anatomical fracture sites (e.g., closed treatment at the body and open treatment at the condyle). NCCI bundling edits apply, but the modifier indicator is '1' — append modifier 59 to the column 2 code and modifier 51 as a secondary modifier. ICD-10 codes must reflect separate fracture locations.

03What does the 90-day global period include for 21453?

It covers the surgical session, the day-before visit, and all routine post-op management through day 90 — including arch bar checks, wire adjustments, and fixation maintenance related to the fracture. Use modifier 24 or 25 for unrelated E&M services, modifier 78 for a related unplanned return to the OR, and modifier 79 for an unrelated return to the OR within that window.

04When is modifier 22 appropriate with 21453?

Use modifier 22 when the procedure required substantially more work than typical — for example, severely comminuted fractures, extreme patient anatomy, or significant patient instability that prolonged fixation time. Documentation must clearly quantify the added work; attach a cover letter explaining the circumstances. Payers will request the operative note.

05Is assistant surgeon billing supported for 21453?

Yes — 21453 allows assistant surgeon billing (modifier 80 for MD assistant, modifier AS for PA/NP/CRNA first assist). Confirm the specific payer's assistant surgeon policy; some commercial payers restrict assistant surgeon reimbursement for fracture cases classified as not requiring an assistant based on their internal guidelines.

06What ICD-10 codes are typically paired with 21453?

Use codes from the S02.6 series (mandible fracture) with the appropriate 7th character — 'A' for initial encounter, 'D' for subsequent encounter, 'S' for sequela. Specify fracture site when possible (e.g., S02.600A for unspecified mandible fracture, or site-specific subcategories). Mismatch between a closed-fracture diagnosis and open-treatment code is a common denial trigger.

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 mandibular fracture site (symphysis, parasymphysis, body, angle, ramus), confirms the treatment was closed without surgical exposure, documents the specific interdental fixation device applied (arch bars, Ivy loops, splints), and records pre- and post-reduction occlusal alignment. That specificity prevents bundling denials when multiple fracture sites are treated at the same encounter and blocks audit flags for underdocumented fixation technique.

See how Mira captures CPT 21453 documentation