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CPT code 21461 covers the surgical repair of a broken jaw (mandible) using techniques that do not require wiring the teeth together. The surgeon realigns and stabilizes the fractured bone using plates, screws, or other fixation methods while allowing the patient to open their mouth.
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
Distinguish clearly from 21462 (with interdental fixation) in operative report - document why interdental fixation was not necessary
Impact: Prevents downcoding or denial; 21462 has different reimbursement profile and documentation requirements
Bill in facility setting when performed in hospital to capture both facility fee and professional component at $1011.48
Impact: Practice receives professional fee while hospital bills facility fee, optimizing total revenue versus non-facility setting
Document number and location of plates/screws used in detail - specify angle, body, symphysis, or parasymphysis fracture location
Impact: Strengthens medical necessity documentation and supports appeal if audited; specific anatomic detail reduces denial rate by approximately 30%
When treating multiple fractures, bill each fracture site separately using modifier 59 or XS if different anatomic sites
Impact: Can add $1500-$3000 in additional reimbursement per additional fracture site when properly documented
For bilateral fractures, verify payer policy on modifier 50 versus two line items with LT/RT before submitting
Impact: Some payers require bilateral modifier 50 (150% payment) while others prefer separate line items; incorrect format causes 25% denial rate
Submit with trauma diagnosis codes (S02.6- series) including 7th character for episode of care and external cause codes
Impact: Complete diagnosis coding reduces medical necessity denials by 40% and supports higher severity DRG assignment in facility billing
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