CPT 21044Surgery

Removal of jaw bone lesion

CPT code 21044 covers the surgical removal of a lesion (abnormal growth or tissue) from the jaw bone, including cysts, tumors, or other bony abnormalities that require excision.

Showing rates for

National Average

Base Medicare rate

$843.60

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

12.8

PE RVU (NF)

11.48

MP RVU

1.8

Total RVU

26.08

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

NCCI bundling edits

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Billing tips

Document exact lesion size, location (mandible vs maxilla), approach (intraoral vs extraoral), and extent of bone removal in operative report
Impact: Prevents denials and supports medical necessity; missing measurements cause 35-40% of initial claim rejections
Obtain and include pathology report confirming lesion type in claim submission or readily available for audit
Impact: Pathologic confirmation reduces denial rate by 60% and supports need for surgical vs non-surgical approach
Bill bone grafting separately (21210, 21215) when performed at same session for defect reconstruction after lesion removal
Impact: Can add $300-$800 in additional reimbursement; ensure separate documentation of graft source and placement
Verify whether procedure is performed in facility vs non-facility setting; 21044 has identical rates ($843.60) for both in 2025
Impact: Unlike most codes, place of service does not affect physician payment, but facility may have separate facility fee
Link appropriate diagnosis codes for specific lesion type (D16.5 for benign bone neoplasm, C41.0/C41.1 for malignant) to support medical necessity
Impact: Specific diagnosis coding reduces review rate by 45%; generic jaw lesion codes trigger higher audit frequency
When lesion removal is combined with tooth extraction, bill extraction separately (7140, 7210, 7220) only if teeth removed are not within the lesion margins
Impact: Prevents $75-$150 revenue loss but avoid unbundling violations for extractions integral to lesion access

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Frequently asked questions

What is the Medicare reimbursement rate for CPT code 21044 in 2025?

The 2025 Medicare national average reimbursement for CPT 21044 is $843.60 for both facility and non-facility settings. This rate is based on 26.08 total RVUs multiplied by the 2025 conversion factor of 32.3465. Local rates may vary based on geographic practice cost indices (GPCI).

Can CPT 21044 be billed with tooth extraction codes on the same date of service?

Yes, but only when the tooth extraction is separate and distinct from the lesion removal. If teeth are extracted solely to access the bone lesion or are within the lesion margins, extraction codes should not be billed separately. Use modifier 59 when billing separate, documented extractions outside the lesion site to prevent bundling denials.

What documentation is required to support medical necessity for CPT 21044?

Essential documentation includes preoperative imaging (panoramic x-ray, CT, or MRI) showing the bone lesion, clinical notes documenting symptoms or lesion characteristics requiring surgical removal, detailed operative report with lesion measurements and removal technique, and pathology report confirming the lesion diagnosis. Most payers require pathologic confirmation to support surgical intervention.

How many RVUs is CPT code 21044 worth in 2025?

CPT 21044 has 26.08 total RVUs in 2025, consisting of 12.8 work RVUs, 11.48 practice expense RVUs (both facility and non-facility), and 1.8 malpractice RVUs. This high RVU value reflects the complexity and risk associated with jaw bone lesion removal.

What is the difference between CPT 21044 and simple tooth extraction codes?

CPT 21044 specifically covers removal of pathologic bone lesions from the jaw, requiring excision of diseased bone tissue beyond the tooth socket. Simple extractions (D7140) or surgical extractions (D7210-D7240) involve tooth removal only. The key distinction is whether bone pathology exists that requires surgical excision separate from tooth removal.

Does CPT 21044 include bone grafting or is that billed separately?

Bone grafting is not included in CPT 21044 and should be billed separately using codes 21210 (graft, nasal, maxillary or malar areas) or 21215 (mandible) when documented as a distinct procedure for defect reconstruction. Documentation must clearly show the graft was placed after lesion removal to fill the resulting bony defect.

What are the most common diagnosis codes used with CPT 21044?

Common ICD-10 codes include D16.5 (benign neoplasm of lower jaw bone) or D16.4 (upper jaw), C41.1 (malignant neoplasm of mandible) or C41.0 (maxilla), M27.40 (unspecified cyst of jaw), and M27.49 (other cysts of jaw). The specific diagnosis code should match the pathology findings and support medical necessity for surgical excision.