Cltx mndblr fx w/o mnpj
CPT 21450 covers closed treatment of a broken jaw (mandible fracture) without the doctor manipulating or moving the bone fragments back into position. This is the least invasive approach to treating a jaw fracture that doesn't require surgery or hands-on realignment.
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
Conversion factor: 32.3465 · Source: CMS MPFS RVU25A · Confidence: High
NCCI bundling edits
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Billing tips
Clearly document the absence of manipulation in the operative or procedure note. Use explicit language such as 'no manipulation performed' or 'fracture managed conservatively without reduction' to justify 21450 over 21451
Impact: Prevents downcoding from 21451 (with manipulation, $747.92 non-facility) to 21450, protecting against $175.06 payment difference and audit risk
Bill in the non-facility setting when performed in the office or clinic to capture the higher rate. Document the setting of service accurately on the claim
Impact: Non-facility rate pays $105.45 more than facility rate ($572.86 vs $467.41), representing 22.5% higher reimbursement
Verify the global period (90 days) and ensure all related follow-up visits within this period are not separately billed unless mediated by appropriate modifiers for new problems
Impact: Prevents claim denials for follow-up visits and potential recoupment of incorrectly billed E/M services during global period
When treating multiple fracture sites, bill each fracture separately with appropriate modifiers (51, 59, or XS as applicable) and ensure documentation supports distinct fractures
Impact: Multiple procedure rules apply: second procedure pays at 50% ($286.43 for facility setting), ensuring appropriate reimbursement for complex cases
Do not bill 21450 with interdental wiring or fixation codes (21497) on the same date of service; these services bundle or indicate a higher-level fracture treatment code should be used
Impact: Prevents bundling denials and NCCI edits that would result in complete denial of one or both services
Obtain pre-authorization when required by commercial payers, even though Medicare does not require it. Many payers classify fracture treatment as requiring prior approval
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