CPT 21146Surgery

Lefort i-2 piece w/ graft

CPT 21146 covers a complex jaw surgery (LeFort I osteotomy) where the upper jaw is surgically separated into two pieces and repositioned using bone graft material. This procedure corrects severe bite problems, facial asymmetry, or jaw deformities.

Showing rates for

National Average

Base Medicare rate

$1,572.36

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

24.87

PE RVU (NF)

21.21

MP RVU

2.53

Total RVU

48.61

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

NCCI bundling edits

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Billing tips

Clearly differentiate 2-piece segmentalization from single-piece LeFort I (21141-21145) in operative report with explicit description of midline or paramedian palatal cut and separate positioning of segments
Impact: Prevents downcoding to 21145 which reimburses approximately $200-300 less; documentation of distinct segmental cuts is essential
Document bone graft source, type, and volume explicitly (autograft harvest site, allograft specifications, or alloplastic material) as integral component distinguishing this from non-graft codes
Impact: Lack of graft documentation triggers denial or downcoding to codes without graft component (21145); specify cc volume and exact placement locations
Submit with diagnosis codes establishing medical necessity (M26.12 for maxillary asymmetry, M26.19 for other jaw anomalies, Q35-Q37 for cleft sequelae) rather than cosmetic indications
Impact: Functional and reconstructive diagnoses support medical necessity; purely cosmetic indications (Z41.1) result in automatic denial with zero reimbursement
Do not separately bill bone graft harvesting (20900-20902) when autograft is used, as graft procurement is included in 21146
Impact: Unbundling graft harvest results in denial of $150-400 and flags account for audit; CCI edits bundle these services
Verify prior authorization requirements with commercial payers 30-45 days pre-op, submitting cephalometric analysis, dental models, and treatment plan documentation
Impact: Lack of prior auth on $1572+ procedure results in 100% denial; authorization process takes 2-4 weeks with most commercial carriers
For revision cases, append modifier 22 with operative report comparison showing increased complexity, additional time (specific minutes), and complications addressed

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Frequently asked questions

What is the Medicare reimbursement for CPT code 21146 in 2025?

The 2025 Medicare national average reimbursement for CPT 21146 is $1572.36 for both facility and non-facility settings. This rate is based on 48.61 total RVUs (24.87 work RVU + 21.21 PE RVU + 2.53 MP RVU) multiplied by the 2025 conversion factor of 32.3465. Actual reimbursement may vary by geographic locality based on GPCI adjustments.

What is the difference between CPT 21146 and 21145?

CPT 21146 describes a LeFort I osteotomy with 2-piece segmentalization and bone graft, while 21145 is a single-piece LeFort I with bone graft. The key distinction is the number of maxillary segments created: 21146 requires a midline or paramedian cut separating the maxilla into two independently positioned pieces, whereas 21145 moves the maxilla as one complete unit. The segmentalization in 21146 adds complexity and allows correction of asymmetry or transverse deficiency.

Does CPT 21146 include bone graft harvesting?

Yes, CPT 21146 includes the bone graft material and its placement as part of the procedure. If autogenous bone is harvested from the patient (iliac crest, rib, chin), the harvesting is bundled and should not be separately coded with 20900-20902. Attempting to bill graft harvesting separately will result in denial due to CCI edits that bundle these services together.

Is prior authorization required for CPT 21146?

Most commercial insurance payers require prior authorization for CPT 21146 due to the high cost and potential for cosmetic indications. Medicare does not require pre-authorization but does require medical necessity documentation. Prior auth typically requires submission of cephalometric analysis, dental models, photographs, orthodontic records, and a detailed surgical treatment plan. Authorization should be obtained 30-45 days before surgery to avoid delays.

Can CPT 21146 be billed with a genioplasty on the same day?

Yes, CPT 21146 (LeFort I) and genioplasty codes (21120-21123) can be billed together as they address different anatomic structures (maxilla versus mandibular chin). However, some payers may require modifier 59 or XS to indicate these are distinct procedures. Both procedures must be medically necessary and documented separately in the operative report with distinct surgical approaches and functional indications.

What diagnosis codes support medical necessity for CPT 21146?

Appropriate diagnosis codes include M26.12 (maxillary asymmetry), M26.19 (other specified anomalies of jaw size), M26.4 (malocclusion), Q35-Q37 series (cleft palate/lip sequelae), M26.60-M26.69 (temporomandibular joint disorders), and G47.33 (obstructive sleep apnea when maxillary advancement is treatment). Cosmetic diagnosis codes like Z41.1 will result in denial. Documentation must link the skeletal deformity to functional impairment in chewing, breathing, or speech.

What are the RVU values for CPT code 21146 in 2025?

The 2025 RVU values for CPT 21146 are: Work RVU 24.87, Practice Expense (PE) RVU 21.21 for both facility and non-facility settings, and Malpractice (MP) RVU 2.53, totaling 48.61 RVUs. These values reflect the significant surgical complexity, operative time (typically 3-5 hours), and technical skill required for segmental maxillary osteotomy with bone grafting.