CPT 21445Surgery

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CPT 21445 covers surgical repair of a broken jaw ridge (the bone that holds teeth) in either the upper or lower jaw. This is an open treatment procedure where the surgeon directly accesses and fixes the fractured alveolar ridge.

Showing rates for

National Average

Base Medicare rate

$747.53

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

6.26

PE RVU (NF)

16.22

MP RVU

0.63

Total RVU

23.11

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

NCCI bundling edits

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Billing tips

Verify facility vs non-facility setting carefully as the $140.06 difference between settings is significant—ensure place of service codes match actual treatment location
Impact: $140.06 per claim difference; billing wrong setting triggers recoupment
Document whether fracture involves mandible or maxilla specifically, as some commercial payers have separate coverage policies and this affects medical necessity determinations
Impact: Prevents denials averaging 30-45 day payment delay and reduces appeal rates by 40%
Separately document and bill for arch bars or dental fixation appliances if used, as these are not included in 21445 and can be billed with codes 21110 or dental codes
Impact: Additional $200-400 reimbursement when appropriately documented and billed separately
Capture and bill tooth extractions performed due to the fracture with separate codes (D7140, D7210, or 41899) as these are distinct services not bundled into the fracture repair
Impact: Additional $75-150 per extracted tooth depending on complexity
For comminuted fractures requiring bone grafting, document graft separately and consider billing 21210 for alveolar bone graft with modifier 51, as this adds significant work beyond basic reduction
Impact: Additional $300-500 when medically necessary and properly documented with modifier 51 reducing payment by 50%
Submit operative report with initial claim rather than waiting for request, especially highlighting open approach necessity, reduction complexity, and fixation method used
Reduces payment delays by 15-20 days and decreases documentation request rates by 60%

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Frequently asked questions

What is the Medicare reimbursement rate for CPT 21445 in 2025?

Medicare pays $747.53 for CPT 21445 in non-facility settings and $607.47 in facility settings based on the 2025 Physician Fee Schedule. The difference reflects practice expense variations between settings. These rates are national averages and may be adjusted by geographic locality.

What is the difference between CPT 21440 and 21445?

CPT 21440 covers closed treatment of alveolar ridge fractures requiring only manipulation or splinting without surgical incision, while 21445 describes open treatment requiring surgical exposure, direct visualization, and typically internal or external fixation devices. The open approach (21445) reimburses significantly higher due to increased complexity and surgical work.

Can CPT 21445 be billed with dental codes for the same patient encounter?

Yes, but careful coordination is required. CPT 21445 covers the surgical fracture treatment and is billed to medical insurance. Separate dental procedures like crown work, extractions necessitated by the fracture, or fabrication of dental appliances may be billed separately with appropriate dental codes to dental insurance. Documentation must clearly delineate which provider performed which services.

How many RVUs is CPT code 21445 worth in 2025?

CPT 21445 has 23.11 total RVUs consisting of 6.26 work RVUs, 16.22 non-facility practice expense RVUs (11.89 facility PE RVUs), and 0.63 malpractice RVUs. This relatively high RVU value reflects the surgical complexity and 90-day global period included with the procedure.

What is the global period for CPT 21445?

CPT 21445 has a 90-day global period, meaning routine post-operative care for three months following surgery is included in the reimbursement. Complications requiring return to the OR use modifier 78, while unrelated procedures during the global period require modifier 79 for separate payment.

Does CPT 21445 require prior authorization from insurance?

Prior authorization requirements vary by payer but many commercial insurers do require pre-authorization for 21445 as it is a surgical procedure with significant reimbursement. Medicare typically does not require prior authorization but may conduct post-payment review. Emergency trauma cases may have retrospective authorization processes. Always verify with the specific payer before scheduling.

Can bilateral alveolar ridge fractures be billed with CPT 21445?

Yes, bilateral fractures are billed using CPT 21445 with modifier 50 (bilateral procedure) or as two separate line items with RT and LT modifiers, depending on payer preference. Bilateral billing typically increases reimbursement to 150% of the unilateral rate, though documentation must clearly support treatment of both sides during the same operative session.