CPT 21145Surgery

Lefort i-1 piece w/ graft

CPT 21145 covers a LeFort I osteotomy, a surgical procedure where the upper jaw (maxilla) is cut, repositioned, and held in place with bone grafts to correct severe bite problems, facial deformities, or breathing issues.

Showing rates for

National Average

Base Medicare rate

$1,505.41

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

23.94

PE RVU (NF)

20.17

MP RVU

2.43

Total RVU

46.54

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

NCCI bundling edits

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Billing tips

Document medical necessity clearly, distinguishing from cosmetic correction by emphasizing functional impairment (OSA, mastication difficulty, TMJ pathology) with supporting diagnostic studies
Impact: Prevents denials; medical necessity denials represent 40-60% of rejections for orthognathic procedures
Bill bone graft separately using 20900-20902 series if source site requires separate incision and harvesting; 21145 includes only graft placement at osteotomy site
Impact: Additional $200-500 reimbursement for autogenous graft harvest depending on donor site complexity
Obtain predetermination/prior authorization with complete treatment plan, cephalometric analysis, and model surgery before scheduling to confirm coverage
Impact: Reduces denial rate by 70%; allows correction of documentation deficiencies before service delivery
Code multi-segment LeFort I (3+ pieces) with modifier 22 and detailed operative note specifying additional segments, increased operative time, and complexity
Impact: Potential 25-40% increase ($376-602 additional) with proper justification for increased physician work
Bundle rigid fixation plates and screws in 21145; do not separately bill hardware unless using modifier 22 for extensive fixation beyond typical LeFort I requirements
Impact: Prevents unbundling denials; standard fixation is included in base RVU calculation
When performing concurrent mandibular osteotomy (21196), bill 21145 as primary with 100% reimbursement and secondary procedure with modifier 51 at reduced rate
Ensures correct multiple procedure reduction; incorrect sequencing can reduce total reimbursement by $400-700

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Frequently asked questions

What is the Medicare reimbursement rate for CPT 21145 in 2025?

The 2025 Medicare national average reimbursement for CPT 21145 is $1505.41 for both facility and non-facility settings, based on 46.54 total RVUs and the conversion factor of $32.3465.

Does CPT 21145 include bone graft harvesting or just placement?

CPT 21145 includes bone graft placement at the osteotomy site but does not include harvesting from a separate donor site. If autogenous graft requires a separate incision (e.g., iliac crest, rib), bill harvest separately using codes 20900-20902.

Can I bill CPT 21145 with a mandibular osteotomy on the same day?

Yes, CPT 21145 can be billed with mandibular osteotomy codes (such as 21196 for bilateral sagittal split) using modifier 51 on the secondary procedure. The higher-valued procedure receives 100% reimbursement, the second receives 50% reduction.

What diagnoses support medical necessity for CPT 21145?

Medically necessary diagnoses include obstructive sleep apnea (G47.33) with maxillomandibular deficiency, skeletal Class III malocclusion (M26.12), maxillary hypoplasia (M26.02), cleft palate sequelae (Q35-Q37 series), and TMJ disorders secondary to skeletal discrepancy. Pure aesthetic concerns are typically excluded.

Is prior authorization required for CPT 21145?

Most commercial payers and Medicare Advantage plans require prior authorization for CPT 21145 due to high cost and medical necessity considerations. Obtain predetermination with complete treatment plan, cephalometric analysis, and supporting documentation before scheduling surgery to avoid denials.

What is the work RVU value for CPT 21145?

CPT 21145 has a work RVU of 23.94, reflecting the significant physician work involved in performing a LeFort I osteotomy with bone grafting. Total RVUs including practice expense and malpractice are 46.54.

How do I code a multi-segment LeFort I osteotomy?

For multi-segment LeFort I (three or more pieces), bill CPT 21145 with modifier 22 for increased procedural complexity. Submit detailed operative report documenting additional segments, extended operative time, and increased complexity. This may increase reimbursement by 20-50% with proper justification.