CPT 21440Surgery

Cltx mndblr/max alv ridge fx

CPT code 21440 covers the treatment of a broken jaw or upper jaw bone (specifically the alveolar ridge, where teeth sit) using closed reduction techniques without surgery. This involves realigning the fractured bone segments and stabilizing them, typically with wiring or splinting.

Showing rates for

National Average

Base Medicare rate

$725.53

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

3.44

PE RVU (NF)

18.63

MP RVU

0.36

Total RVU

22.43

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

NCCI bundling edits

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Billing tips

Bill in the non-facility setting when performed in an office or ASC to capture the full $725.53 reimbursement versus $581.27 facility rate
Impact: Increases revenue by $144.26 per case (24.8% higher payment)
Document the specific anatomical location (mandible vs maxilla) and whether the fracture involves displacement requiring reduction, as this justifies 21440 over less complex codes
Impact: Prevents downcoding to lower-valued treatment codes that may pay $200-300 less
Separately bill for any imaging performed on the same day (panoramic radiographs, CT scans) with modifier 59 or XU if medically necessary and documented as distinct
Impact: Can add $50-250 in additional reimbursement depending on imaging modality
When interdental wiring or arch bars are applied, ensure documentation specifies this was integral to the fracture reduction, not a separate procedure
Impact: Prevents unbundling denials and rebilling delays averaging 30-45 days
Submit claims within 24-48 hours of service with complete operative notes attached for fracture cases to expedite payment and reduce review holds
Impact: Reduces payment turnaround time from 45-60 days to 14-21 days
For bilateral fractures, verify payer-specific modifier 50 policy; some payers require two line items with RT/LT instead of modifier 50
Impact: Ensures proper bilateral payment of approximately $1,088 versus single-side $725.53

Common denials

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Frequently asked questions

What is the Medicare reimbursement rate for CPT code 21440 in 2025?

The 2025 Medicare national average reimbursement for CPT 21440 is $725.53 in the non-facility setting and $581.27 in the facility setting. These rates are based on a total of 22.43 RVUs multiplied by the 2025 conversion factor of 32.3465.

What is the difference between CPT 21440 and 21445?

CPT 21440 is for closed treatment of mandibular or maxillary alveolar ridge fractures, meaning no surgical incision is made to expose the fracture site. CPT 21445 is for open treatment requiring surgical exposure and direct visualization of the fracture. The choice depends on whether surgical incision and open reduction techniques are necessary for adequate fracture management.

Can CPT 21440 be billed bilaterally with modifier 50?

Yes, CPT 21440 can be billed with modifier 50 when bilateral alveolar ridge fractures are treated during the same session, though you should verify your specific payer's bilateral procedure policy. Some payers prefer two line items with RT/LT modifiers instead of a single line with modifier 50. Bilateral billing typically results in 150% payment of the unilateral rate.

Is interdental wiring separately billable with CPT 21440?

No, routine interdental wiring or arch bar application performed as the primary method of stabilization for the alveolar ridge fracture is included in CPT 21440 and should not be separately billed. Attempting to bill wiring separately will result in bundling denials. Only if extensive additional dental work beyond standard fracture stabilization is required might separate billing be justified with appropriate documentation and modifiers.

What documentation is required to support medical necessity for CPT 21440?

Required documentation includes: detailed description of the fracture location and displacement, pre- and post-reduction radiographic findings, description of the closed reduction technique used, type of fixation applied, assessment of occlusion before and after treatment, and medical justification for the treatment approach. Clinical photographs and comparison imaging strengthen medical necessity support.

Which medical specialties typically bill CPT code 21440?

CPT 21440 is most commonly billed by oral and maxillofacial surgeons, followed by plastic surgeons specializing in facial trauma, otolaryngologists (ENT surgeons), and trauma surgeons with facial fracture management training. The procedure may be performed in emergency departments, hospitals, ambulatory surgical centers, or oral surgery offices depending on the complexity and patient stability.

How many RVUs is CPT 21440 worth in 2025?

CPT 21440 has a total of 22.43 RVUs in 2025, consisting of 3.44 work RVUs, 18.63 non-facility practice expense RVUs (14.17 facility PE RVUs), and 0.36 malpractice RVUs. This relatively high RVU value reflects the technical skill and resources required for facial fracture management.