CPT 21142Surgery

Lefort i-2 piece w/o graft

CPT code 21142 covers a surgical procedure where the upper jaw (maxilla) is cut and repositioned in two pieces to correct facial abnormalities or bite problems, without using bone grafts. This is a complex facial reconstructive surgery performed by oral and maxillofacial surgeons.

Showing rates for

National Average

Base Medicare rate

$1,329.76

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

20.28

PE RVU (NF)

18.76

MP RVU

2.07

Total RVU

41.11

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

NCCI bundling edits

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Billing tips

Clearly document the two-piece segmentation approach and rationale for not using bone grafts in operative note
Impact: Prevents downcoding to 21141 (single piece) or upcoding confusion with 21145/21146 (with graft); protects full $1329.76 reimbursement
Bill separately for any additional procedures like septoplasty (30520) or genioplasty (21121/21123) performed during same session with modifier 51
Impact: Additional $300-800 revenue per procedure when medically necessary and documented; ensure separate incisions/approaches are noted
Obtain pre-authorization with complete treatment plan including orthodontic records, cephalometric analysis, and photographs showing functional impairment
Impact: Reduces denial rate by 60-80%; many payers require prior authorization for orthognathic procedures and may deny without it
Document medical necessity beyond cosmetic concerns by emphasizing functional deficits: mastication difficulty, speech impairment, TMJ dysfunction, or obstructive sleep apnea
Impact: Critical for coverage; purely cosmetic cases will be denied; functional documentation can mean difference between $0 and $1329.76
For revision cases or increased complexity, use modifier 22 with detailed documentation of additional time (benchmark: >1 hour beyond typical case) and specific anatomic challenges
Impact: Can increase payment 20-30% ($266-400 additional) but requires manual review; include time documentation and comparison to typical case
Verify facility vs non-facility status is correctly coded; this procedure should always be facility-based with both rates identical at $1329.76

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Frequently asked questions

What is the Medicare reimbursement for CPT code 21142 in 2025?

The 2025 Medicare national average reimbursement for CPT 21142 is $1329.76 for both facility and non-facility settings. This is based on 41.11 total RVUs multiplied by the 2025 conversion factor of 32.3465. Actual reimbursement may vary by geographic locality based on the GPCI adjustments for your area.

What is the difference between CPT 21142 and 21141?

CPT 21142 describes a LeFort I osteotomy performed in two pieces without bone grafting, allowing independent repositioning of two maxillary segments. CPT 21141 describes a single-piece LeFort I where the maxilla is repositioned as one unit. Code selection depends on whether the surgeon performs a midline or parasagittal vertical cut to create separate segments, which must be clearly documented in the operative report.

Is CPT 21142 covered by Medicare and commercial insurance?

CPT 21142 is covered by Medicare and most commercial payers when performed for reconstructive purposes with documented functional impairment such as severe malocclusion affecting mastication, speech problems, obstructive sleep apnea, or correction of congenital deformities. Coverage is typically denied for purely cosmetic indications. Prior authorization is usually required, and payers often mandate completion of orthodontic preparation before approving the surgery.

How many RVUs is CPT code 21142 worth?

CPT 21142 has a total of 41.11 RVUs for 2025, consisting of 20.28 work RVUs, 18.76 practice expense RVUs (both facility and non-facility), and 2.07 malpractice RVUs. This high RVU value reflects the complexity and surgical skill required for segmental maxillary osteotomy procedures.

What documentation is required to bill CPT 21142?

Documentation must include a detailed operative report describing the horizontal LeFort I osteotomy cut, specific documentation of the two-piece segmentation with location of the vertical split, explicit statement that no bone grafting was performed, fixation methods used, pre-operative cephalometric analysis, medical necessity justification emphasizing functional deficits, and coordination with orthodontic treatment. Pre-operative photographs and imaging studies should also be available in the medical record.

Can CPT 21142 be billed with a genioplasty or septoplasty on the same day?

Yes, CPT 21142 can be billed with genioplasty (21121 or 21123) or septoplasty (30520) when both procedures are medically necessary and performed during the same operative session. Use modifier 51 on the secondary procedure, and ensure the operative note documents separate incisions or distinct anatomic approaches. The combination is common in comprehensive orthognathic surgery cases, but each procedure must be independently justified.

What are common reasons for denial of CPT 21142 claims?

Common denial reasons include lack of prior authorization, medical necessity not established (procedure deemed cosmetic), insufficient documentation of functional impairment, incorrect code selection among LeFort variations, failure to complete required orthodontic preparation, and bundling with other procedures. To prevent denials, obtain pre-authorization with comprehensive documentation, clearly document functional deficits beyond aesthetics, and ensure the operative note explicitly describes the two-piece technique without grafting.