CPT 21155Surgery

Lefort iii w/ lefort i

CPT 21155 covers a complex facial reconstructive surgery that combines two different levels of bone cuts in the face (LeFort III and LeFort I) to correct severe facial deformities. This advanced procedure repositions the upper and middle portions of the facial skeleton.

Showing rates for

National Average

Base Medicare rate

$2,093.47

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

35.22

PE RVU (NF)

24.41

MP RVU

5.09

Total RVU

64.72

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

NCCI bundling edits

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Billing tips

Document the medical necessity for combining both LeFort III and LeFort I levels in the operative note, including specific anatomic measurements and functional deficits
Impact: Prevents denials for experimental/investigational procedure codes; essential for authorization approval and post-service payment
Pre-authorization is mandatory for nearly all payers - submit detailed surgical plan with cephalometric analysis, 3D CT imaging, and treatment objectives at least 30-45 days before surgery
Impact: Failure to obtain pre-authorization typically results in complete denial; retrospective appeals rarely successful given high cost
Use modifier 62 when neurosurgeon assists with cranial base work during LeFort III portion - each surgeon must document their distinct role in separate operative notes
Impact: Maximizes reimbursement by allowing both surgeons to bill ($1308.42 each vs $2093.47 split informally)
Bill facility charges separately with appropriate revenue codes for OR time (typically 6-10 hours), specialized instrumentation, surgical navigation systems, and ICU admission
Impact: Facility charges often exceed $100,000-150,000 for this procedure; proper revenue code mapping critical for hospital reimbursement
Consider modifier 22 when patient has had prior failed LeFort procedures, severe scarring, or concurrent bone grafting from distant sites that significantly increases complexity
Impact: Additional 20-30% payment possible ($418.69-$628.04 more) with comparative documentation showing increased time/difficulty
Code separately for bone grafts using 20900 series codes if autogenous bone is harvested from iliac crest or calvarium - these are not bundled with 21155

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Frequently asked questions

What is the Medicare reimbursement rate for CPT 21155 in 2025?

The 2025 Medicare national average reimbursement for CPT 21155 is $2093.47 for both facility and non-facility settings. This is based on 64.72 total RVUs multiplied by the 2025 conversion factor of 32.3465. Actual payment may vary by geographic locality and carrier.

How many RVUs is CPT code 21155 worth?

CPT 21155 has 64.72 total RVUs in 2025, consisting of 35.22 work RVUs, 24.41 practice expense RVUs, and 5.09 malpractice RVUs. This makes it one of the highest-valued procedures in oral and maxillofacial surgery.

Can CPT 21155 be billed with modifier 62 for co-surgeons?

Yes, modifier 62 is commonly appropriate for CPT 21155 when two surgeons of different specialties work together as co-surgeons, such as a craniofacial surgeon and neurosurgeon. Each surgeon receives 62.5% of the allowed amount ($1308.42 each for Medicare) and must document their distinct, simultaneous role in separate operative notes.

What is the difference between CPT 21155 and separate LeFort codes?

CPT 21155 specifically describes a combined LeFort III with LeFort I osteotomy performed together. This differs from billing separate codes for single-level procedures (21150 for LeFort III alone or 21141-21147 for LeFort I variations). The combination code should only be used when both surgical levels are performed in the same operative session.

Is pre-authorization required for CPT 21155?

Yes, virtually all commercial and government payers require pre-authorization for CPT 21155 due to the complexity and cost of the procedure. Pre-authorization requests should be submitted 30-45 days before surgery with comprehensive documentation including imaging, cephalometric analysis, and functional assessment. Failure to obtain pre-authorization typically results in complete claim denial.

What diagnosis codes support medical necessity for CPT 21155?

Common supporting ICD-10 codes include Q75.0 (craniosynostosis), Q75.1 (craniofacial dysostosis including Crouzon and Apert syndromes), Q75.4 (mandibulofacial dysostosis), Q67.4 (congenital deformities of skull, face and jaw), and M26.4 series (malocclusion codes). The diagnosis must demonstrate severe functional or structural impairment requiring multi-level correction.

How long is the global period for CPT 21155?

CPT 21155 has a 90-day global surgical period. This means pre-operative visits within 1 day of surgery and all post-operative care for 90 days after the procedure are included in the payment. Any unrelated E/M services during this period require modifier 24, and related returns to the OR require modifier 78 or 79 as appropriate.