CPT 21025Surgery

Excision of bone lower jaw

CPT code 21025 is used when a surgeon removes a piece of bone from the lower jaw (mandible), typically to treat infection, disease, or bony abnormalities. This is a surgical procedure that requires opening the jaw to access and excise the affected bone segment.

Showing rates for

National Average

Base Medicare rate

$785.37

This calculator gives a typical-case estimate using standard Medicare modifier rules. Actual payment depends on payer policies, documentation, code-specific CMS status indicators, and locality. Verify before billing.

RVU breakdown

Work RVU

10.03

PE RVU (NF)

13.18

MP RVU

1.07

Total RVU

24.28

Conversion factor: 32.3465 · Source: CMS MPFS RVU25A · Confidence: High

NCCI bundling edits

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Billing tips

Clearly document the extent and location of bone excision with measurements (mm or cm) and anatomical landmarks to differentiate from more extensive mandibulectomy codes
Impact: Prevents downcoding to less extensive procedures or upcoding denials; protects $785.37 base reimbursement
Bill in non-facility setting when performed in office-based surgical suite to capture the $129.38 higher reimbursement rate compared to facility setting
Impact: Increases revenue by 19.7% per case ($785.37 vs $655.99)
Verify medical necessity with supporting pathology reports or imaging studies showing bony lesion before submitting claim to avoid pre-payment audits
Impact: Reduces denial rate by approximately 40% based on payer medical necessity reviews for surgical mandibular procedures
When billing modifier 22, include detailed comparison of standard procedure time vs actual time and attach intraoperative photos if available
Impact: Successful modifier 22 claims can increase reimbursement by $157-$393 (20-50% of base rate)
Separately report pathology interpretation (88305 or 88307) as this is not bundled with 21025 and adds $50-150 per specimen
Impact: Captures additional revenue of $50-150 per case that is frequently overlooked
Document any bone grafting separately as this may warrant additional codes (21210, 21215) when performed beyond simple excision and closure
Impact: Bone grafting codes add $200-600 additional reimbursement when medically necessary and properly documented

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Frequently asked questions

What is the difference between CPT 21025 and 21040?

CPT 21025 is for excision of bone from the lower jaw (mandible), while 21040 is for excision of bone from the upper jaw (maxilla) or zygomatic arch. The anatomical location determines which code to use. Medicare pays $785.37 for 21025 (non-facility) versus different rates for 21040 based on its separate RVU values.

How much does Medicare pay for CPT 21025 in 2025?

Medicare pays $785.37 for CPT 21025 when performed in a non-facility setting and $655.99 in a facility setting in 2025, based on the national average. Actual payment varies by geographic locality using the Medicare Physician Fee Schedule with local adjustments applied to the base conversion factor of 32.3465.

Can CPT 21025 be billed bilaterally with modifier 50?

Yes, CPT 21025 can be billed with modifier 50 when bone excision is performed on both sides of the mandible during the same operative session. This typically increases reimbursement to 150% of the single-side allowable amount, resulting in approximately $1,178.06 for bilateral procedures under Medicare.

What diagnosis codes support medical necessity for CPT 21025?

Common supporting diagnosis codes include M86.171-M86.179 (osteomyelitis of mandible), D16.5 (benign neoplasm of mandible), M27.8 (other specified diseases of jaw), K10.8 (other specified diseases of jaws), and M85.00-M85.09 (fibrous dysplasia). The diagnosis must demonstrate pathology requiring surgical bone excision rather than conservative management.

Is CPT 21025 subject to the global surgical package?

Yes, CPT 21025 has a 90-day global surgical period, meaning the reimbursement includes preoperative evaluation (typically 1 day before), the surgical procedure itself, and routine postoperative care for 90 days after surgery. Separate E/M visits during this period are not separately billable unless unrelated to the surgery or complications requiring return to OR (modifier 78 or 79).

What documentation is needed to support modifier 22 with CPT 21025?

Modifier 22 requires documentation showing significantly increased complexity or time compared to standard procedure. Include operative report with total time, detailed description of complicating factors (extensive osteomyelitis, prior radiation, severe scarring), comparison to typical procedure duration and difficulty, and cover letter quantifying percentage increase in work (typically 25-50% minimum). Include intraoperative photos when available.

Can bone grafting be billed separately with CPT 21025?

Yes, bone grafting procedures (CPT 21210 for autogenous graft, 21215 for other graft types) can be billed separately with CPT 21025 when grafting is performed beyond simple closure of the excision site. Documentation must clearly indicate separate grafting procedure with different anatomical site or additional work beyond routine excision closure. Medical necessity for grafting must be independently established.