CPT 21270Surgery

Augmentation cheek bone

CPT code 21270 covers surgical augmentation of the cheekbone, a procedure where a surgeon enhances or builds up the cheek area using implants or bone grafts to improve facial contour and structure.

Showing rates for

National Average

Base Medicare rate

$999.51

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

10.63

PE RVU (NF)

18.32

MP RVU

1.95

Total RVU

30.9

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

NCCI bundling edits

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Billing tips

Verify place of service accuracy: facility (POS 22/24) versus non-facility (POS 11) before submission
Impact: $264.27 payment difference between settings; incorrect POS coding triggers recoupment and delays
Document medical necessity with pre-operative photos, measurements, and functional deficits when billing for reconstructive rather than cosmetic indication
Impact: Determines coverage eligibility; cosmetic augmentation typically results in patient responsibility denials with zero reimbursement
For bilateral procedures, bill with modifier 50 on single line rather than LT/RT on separate lines to ensure proper 150% payment calculation
Impact: Ensures maximum bilateral reimbursement of approximately $1,499.27 rather than risk of duplicate claim rejection
Separately bill implant/graft materials using appropriate HCPCS or supply codes with modifier 99 when facility rules permit
Impact: Implant costs ($500-$3,000) may be separately reimbursable in ASC/office settings; verify LCD policies in your jurisdiction
When performed with other facial skeletal procedures, sequence 21270 appropriately considering RVU values to minimize multiple procedure reductions
Impact: Proper sequencing prevents unnecessary payment reductions; 21270 as primary code preserves full $999.51 vs 50% reduction as secondary
Append modifier 22 with detailed documentation when anatomical complexity, revision surgery, or custom implant fabrication significantly increases work
Impact: Well-documented modifier 22 claims can secure 20-30% additional payment ($199.90-$299.85) for increased complexity

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Frequently asked questions

What is the Medicare reimbursement rate for CPT 21270 in 2025?

The 2025 Medicare national average payment for CPT 21270 is $999.51 in non-facility settings and $735.24 in facility settings. The total RVU is 30.9 with a work RVU of 10.63.

Does Medicare cover cheek bone augmentation surgery?

Medicare may cover CPT 21270 when performed for reconstructive purposes such as congenital deformity, traumatic injury, or post-surgical defects. Purely cosmetic malar augmentation is not covered and results in patient financial responsibility. Documentation must clearly establish medical necessity.

How do you bill for bilateral cheek bone augmentation?

Bill bilateral cheek bone augmentation using CPT 21270 with modifier 50 on a single line item. This typically results in 150% payment of the unilateral rate, approximately $1,499.27 for non-facility settings. Do not submit separate line items with LT/RT modifiers as this may trigger duplicate claim denials.

What modifiers are commonly used with CPT code 21270?

Common modifiers for 21270 include modifier 50 (bilateral procedure), LT/RT (laterality), 22 (increased procedural services for complex cases), 51 (multiple procedures), 78 (return to OR during postop period), and 54 (surgical care only). Modifier selection depends on specific procedural circumstances and payer requirements.

Can CPT 21270 be billed with facial fracture repair codes?

CPT 21270 may be subject to NCCI bundling edits when billed with facial fracture repair codes. If the augmentation is distinct, separate, and medically necessary beyond fracture repair, modifier 59 or XS may be appropriate with clear documentation showing separate procedures. Always verify current CCI edits before billing multiple facial skeletal codes together.

What documentation is required to bill CPT 21270?

Required documentation includes detailed history establishing medical necessity, pre-operative photographs with measurements, informed consent, complete operative report specifying implant details and fixation method, implant tracking information (lot numbers, manufacturer), anesthesia records, and clear differentiation between reconstructive and cosmetic indication. Insufficient documentation is a common denial reason.

What is the difference between facility and non-facility rates for 21270?

The non-facility rate ($999.51) applies when the procedure is performed in an office-based surgical suite where the practice owns the equipment and assumes facility costs. The facility rate ($735.24) applies in hospital outpatient or ASC settings where the facility bills separately for facility fees. The $264.27 difference reflects practice expense variations between settings.