CPT 21045Surgery

Extensive jaw surgery

CPT code 21045 covers extensive jaw surgery, which involves major surgical procedures on the jaw bones (mandible or maxilla) to correct significant deformities, trauma, or disease. This is complex surgery that goes beyond simple fracture repair.

Showing rates for

National Average

Base Medicare rate

$1,169.33

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

18.37

PE RVU (NF)

15.21

MP RVU

2.57

Total RVU

36.15

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

NCCI bundling edits

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Billing tips

Ensure operative report specifically documents 'extensive' nature with detailed description of anatomic extent, bone segments involved, reconstruction performed, and time spent
Impact: Prevents downcoding to simpler jaw procedures (21040, 21044) which reimburse $400-600 less; proper documentation supports the full $1169.33 payment
Verify global period is 90 days and avoid billing E/M services during this period unless modifier 24 or 25 is appropriately applied for unrelated conditions
Impact: Prevents denials of legitimate postoperative visits; saves approximately $100-300 per denied E/M claim
When bone grafting is performed as integral part of the extensive jaw surgery, do not separately bill for simple bone grafts as they are bundled
Impact: Prevents unbundling denials and potential audit flags; focus documentation on the comprehensive nature of 21045 rather than splitting components
For tumor resections, link appropriate ICD-10 codes for neoplasm (C41.0, C41.1, D16.4, D16.5) to support medical necessity and potential modifier 22 consideration
Impact: Proper diagnosis linkage supports medical necessity and can justify additional reimbursement of 20-30% with modifier 22
Submit claims with facility type indicator aligned with actual location (inpatient vs outpatient); note that both facility and non-facility rates are identical at $1169.33 for this code
Impact: Ensures correct payment; while rates are equal for 21045, incorrect place of service can trigger audit flags and payment delays
When performed with dental extractions or alveolar procedures, ensure the jaw surgery component is clearly documented as separate and more extensive than routine dentoalveolar work

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Frequently asked questions

What is the Medicare reimbursement rate for CPT code 21045 in 2025?

The 2025 Medicare national average reimbursement for CPT 21045 is $1169.33 for both facility and non-facility settings. This rate is based on 36.15 total RVUs multiplied by the 2025 conversion factor of 32.3465. Actual payment may vary based on geographic adjustment and payer contracts.

What RVU value does CPT 21045 carry?

CPT 21045 has a total RVU of 36.15, comprised of 18.37 work RVUs, 15.21 practice expense RVUs (both facility and non-facility), and 2.57 malpractice RVUs. This high RVU value reflects the complexity and risk of extensive jaw surgery.

What is the difference between CPT 21045 and other jaw surgery codes?

CPT 21045 is specifically for extensive jaw surgery involving major reconstruction or resection, which is more comprehensive than simple fracture repairs (21440-21470) or limited jaw procedures (21040, 21044). The 'extensive' designation requires documentation of significant bone work, complex reconstruction, or major pathology beyond routine fracture fixation.

Does CPT 21045 require prior authorization from insurance?

Most commercial payers and Medicare Advantage plans require prior authorization for CPT 21045 due to its high cost and complexity. Traditional Medicare does not require prior authorization, but documentation supporting medical necessity must be available. Always verify specific payer requirements before scheduling.

Can CPT 21045 be billed with bone graft codes?

Simple bone grafts performed as an integral part of the extensive jaw surgery are typically bundled into 21045 and should not be separately billed. However, if substantial structural bone grafting from distant donor sites is performed as a distinct procedure, it may be separately billable with modifier 59 and appropriate documentation.

What is the global period for CPT 21045?

CPT 21045 has a 90-day global surgical period, meaning routine postoperative care for 90 days after surgery is included in the reimbursement. E/M services during this period are only separately billable if they are unrelated to the surgery (modifier 24) or if a decision for surgery occurs during the global period (modifier 57).

What diagnosis codes support medical necessity for CPT 21045?

Common supporting diagnosis codes include malignant jaw neoplasms (C41.0, C41.1), benign jaw tumors (D16.4, D16.5), jaw fractures with complications (S02.60-S02.69), osteomyelitis (M86.14, M86.15), medication-related osteonecrosis (M87.180), and dentofacial anomalies (M26.0-M26.9). The diagnosis must justify the extensive nature of the procedure.