CPT 21147Surgery

Lefort i-3/> piece w/ graft

CPT 21147 covers a complex jaw surgery called LeFort I osteotomy where the surgeon cuts the upper jaw into three or more pieces and uses bone grafts to reshape it. This procedure corrects severe jaw deformities, bite problems, or facial asymmetry.

Showing rates for

National Average

Base Medicare rate

$1,653.23

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

26.47

PE RVU (NF)

21.96

MP RVU

2.68

Total RVU

51.11

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

NCCI bundling edits

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Billing tips

Document exact number of maxillary segments clearly in operative report title and body (must be 3 or more pieces). If only 2 segments performed, must bill 21146 instead, which has significantly lower reimbursement.
Impact: Incorrect code selection between 21146 (2 pieces) and 21147 (3+ pieces) results in underpayment or overpayment; difference of approximately 5-8 RVUs affects reimbursement by $160-260
Separately document bone graft source, type (autogenous vs allogenic), and harvest site if autogenous. Iliac crest harvest is separately billable (20900-20902) and adds significant reimbursement.
Impact: Bone graft harvest codes add $300-800 to total reimbursement; failure to document and bill separately leaves significant revenue on table
Ensure pre-authorization obtained before surgery with clear documentation of medical necessity. Submit cephalometric radiographs, dental models, and treatment plan showing skeletal discrepancy measurements exceeding payer thresholds.
Impact: Pre-authorization prevents denials on $1653+ procedure; appeal success rate drops below 40% without pre-operative imaging documentation
Bill facility versus non-facility based on actual site of service. Both rates are identical ($1653.23) for 21147, so no reimbursement difference, but coding location correctly prevents claim rejections.
Impact: Incorrect place of service code triggers auto-denial; correction requires claim resubmission delaying payment 30-60 days
When performed with other orthognathic procedures (mandibular osteotomy, genioplasty), sequence 21147 first as primary procedure due to highest RVU value (51.11) to maximize reimbursement before multiple procedure reduction.
Impact: Proper sequencing prevents unnecessary 50% reduction on highest-value procedure; can preserve $800+ in reimbursement

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Common denials

Medical necessity not established - payer considers procedure cosmetic rather than reconstructive. Common when skeletal discrepancy measurements not documented or don't meet payer thresholds (typically <4mm overjet/overbite).

How to appeal: Submit appeal with cephalometric analysis showing ANB angle discrepancy >4 degrees, overjet/overbite measurements >5mm, airway obstruction documentation, functional deficits (chewing, speech), photographs showing facial asymmetry, and orthodontist letter confirming non-orthodontic correction possible. Include payer's own medical policy showing criteria met.

Incorrect code selection - auditor determines only 2 segments performed based on operative report, requiring downcode to 21146. Vague documentation like 'segmental osteotomy' without specifying piece count triggers this.

How to appeal: Request operative report review with highlighted sections explicitly stating '3-piece LeFort I' or describing three distinct segments. If truly only 2 pieces, accept recoupment and adjust future documentation. If 3+ pieces, provide amended operative note with surgeon attestation clarifying segment count.

Bundling denial - bone graft code denied as included in 21147. Payers may incorrectly bundle graft harvest codes (20900-20902) claiming graft included in primary procedure.

How to appeal: Cite CPT guidelines and NCCI edits showing graft harvest from separate site (iliac crest, tibia) is separately reportable. Include operative note documentation of separate incision, harvest time, and closure. Reference CMS policy that autogenous graft harvest is not bundled when from distant donor site.

Missing or inadequate prior authorization. Many payers require pre-authorization with specific documentation submitted 30+ days before surgery; procedure performed without approval triggers automatic denial.

How to appeal: If authorization obtained but not referenced, resubmit claim with authorization number prominently displayed. If no authorization obtained, file retroactive authorization request with documentation of emergency circumstances or payer error in communication. Success rate low without genuine extenuating circumstances; may need to adjust patient financial responsibility.

Frequently asked questions

What is the Medicare reimbursement rate for CPT 21147 in 2025?

The 2025 Medicare national average reimbursement rate for CPT 21147 is $1653.23 for both facility and non-facility settings. This is based on 51.11 total RVUs multiplied by the 2025 conversion factor of 32.3465. Actual payment may vary by geographic locality and MAC jurisdiction.

What is the difference between CPT 21147 and 21146?

CPT 21146 is for LeFort I osteotomy with 2 pieces, while 21147 is for 3 or more pieces. The number of maxillary segments directly determines code selection. The operative report must clearly document whether 2 pieces (21146) or 3+ pieces (21147) were created. Using 21147 when only 2 segments were performed constitutes upcoding.

Can I bill bone graft harvest separately with CPT 21147?

Yes, autogenous bone graft harvest from a separate donor site (iliac crest, tibia) is separately billable using codes 20900-20902. The harvest site must be different from the surgical site, require a separate incision, and be clearly documented. Allogenic bone graft material is typically included in facility charges and not separately billable by the surgeon.

Does CPT 21147 require prior authorization from insurance?

Most commercial payers and Medicare Advantage plans require prior authorization for CPT 21147 due to the high cost and potential cosmetic versus reconstructive determination. Authorization typically requires submission of cephalometric x-rays, photographs, dental models, functional assessment, and documented failed conservative treatment. Medicare traditional does not require pre-authorization but may conduct post-payment review.

How many RVUs is CPT code 21147 worth?

CPT 21147 has 51.11 total RVUs in 2025, consisting of 26.47 work RVUs, 21.96 practice expense RVUs (both facility and non-facility), and 2.68 malpractice RVUs. This is considered a high-value surgical procedure reflecting the complexity and time required for segmental maxillary osteotomy.

What diagnosis codes support medical necessity for CPT 21147?

Common supporting ICD-10 codes include M26.4 (malocclusion), M26.12 (maxillary hyperplasia), M26.02 (maxillary hypoplasia), Q35-Q37 (cleft palate/lip), G47.33 (obstructive sleep apnea), and M26.89 (other dentofacial anomalies). Documentation must demonstrate functional impairment (chewing, breathing, speech) or significant skeletal discrepancy beyond cosmetic concerns.

Can CPT 21147 be billed with other orthognathic surgery codes?

Yes, 21147 can be billed with other distinct orthognathic procedures such as mandibular osteotomy (21196), genioplasty (21121-21123), or nasal procedures when performed together. Use modifier 51 on secondary procedures and sequence codes by RVU value (highest first). Ensure each procedure addresses a distinct anatomic issue documented in the operative report. Do not bill multiple LeFort codes together.