CPT 21453Surgery

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CPT code 21453 covers the surgical treatment of a broken jaw (mandible) using wires or other devices attached to the teeth to hold the jaw in place while it heals. This is called interdental fixation and helps stabilize the fracture without major surgery.

Showing rates for

National Average

Base Medicare rate

$1,046.73

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

6.64

PE RVU (NF)

24.84

MP RVU

0.88

Total RVU

32.36

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

NCCI bundling edits

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Billing tips

Bill in facility setting when performed in hospital or ASC to capture the $892.12 facility rate, understanding the practice receives this amount while facility bills separately for resources
Impact: Setting selection affects payment by $154.61; ensure place of service code matches actual location (21-22 for hospital, 24 for ASC)
Document the specific type of interdental fixation used (Erich arch bars, ivy loops, bridle wires) and number of teeth involved, as inadequate documentation of technique is a leading denial cause
Impact: Prevents denials requiring appeals; proper documentation supports medical necessity and can reduce audit risk by 40-60%
When multiple facial fractures are treated, sequence 21453 first due to its high work RVU (6.64) to maximize reimbursement before modifier 51 reductions apply to additional codes
Impact: Proper sequencing can preserve $400-500 in reimbursement compared to listing as secondary procedure
Verify patient has adequate dentition for interdental fixation before scheduling; edentulous or partially edentulous patients may require different approach codes (21431, 21432)
Impact: Prevents use of incorrect code which leads to denial; ensures documentation supports chosen treatment method
Bill separately for pre-operative imaging (70110, 70100) and post-fixation radiographs when performed and documented with distinct medical necessity
Impact: Can add $50-150 in legitimate additional reimbursement when properly documented as separate diagnostic services
For Medicare patients, ensure medical necessity is clearly documented including failure of conservative management or reason why open reduction is not indicated

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Frequently asked questions

What is the Medicare reimbursement rate for CPT 21453 in 2025?

The 2025 Medicare national average reimbursement for CPT 21453 is $1,046.73 in non-facility settings and $892.12 in facility settings. The work RVU is 6.64 with a total RVU of 32.36 based on the CMS Physician Fee Schedule.

What is the difference between CPT 21453 and 21454?

CPT 21453 describes closed treatment of mandibular fracture with interdental fixation, meaning no surgical incision is made. CPT 21454 involves open treatment requiring a surgical incision through skin or mucosa to access and reduce the fracture. The treatment approach fundamentally changes the code selection.

Can CPT 21453 be billed with an E/M code on the same day?

Yes, but modifier 25 must be appended to the E/M code to indicate a significant, separately identifiable evaluation and management service beyond the routine pre-procedure assessment. Documentation must clearly support that a distinct diagnostic evaluation occurred prior to the decision for surgery.

How many RVUs is CPT code 21453 worth?

CPT 21453 has a total of 32.36 RVUs, consisting of 6.64 work RVUs, 24.84 non-facility practice expense RVUs (20.06 facility), and 0.88 malpractice RVUs based on the 2025 Medicare Physician Fee Schedule.

What type of fixation is included in CPT 21453?

CPT 21453 includes interdental fixation methods such as arch bars (including Erich arch bars), ivy loops, bridle wires, or similar devices that attach to teeth to immobilize the mandible. The fixation must be adequate to stabilize the fracture and maintain proper occlusion during healing.

Can 21453 be used for patients without teeth?

No, CPT 21453 specifically requires interdental fixation which necessitates adequate dentition. For edentulous patients or those with insufficient teeth, alternative codes such as 21431 (closed treatment without manipulation) or 21432 (closed treatment with manipulation) should be considered, or open reduction with different fixation methods may be required.

What is the global period for CPT 21453?

CPT 21453 has a 90-day global surgical period. This means all routine postoperative care for 90 days following the procedure is included in the reimbursement, including removal of interdental fixation if performed within this timeframe. Complications or unrelated services may be separately billable with appropriate modifiers.