CPT 21462Surgery

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CPT code 21462 covers the surgical repair of a broken jaw (mandible) using wires or other devices attached to the teeth to hold the jaw in proper position while it heals.

Showing rates for

National Average

Base Medicare rate

$1,872.86

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

11.01

PE RVU (NF)

45.44

MP RVU

1.45

Total RVU

57.9

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

NCCI bundling edits

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Billing tips

Document the specific interdental fixation technique used (arch bars, Erich arch bars, ivy loops, wire fixation) and number of teeth involved
Impact: Missing interdental fixation documentation results in downcoding to 21453 (closed treatment) with $749.14 less reimbursement
Bill in facility setting when performed in hospital or ASC to capture both professional ($1123.72) and facility fees, rather than office setting
Impact: Total reimbursement increases significantly as facility captures separate technical component payment while professional fee is $749.14 lower but combined payment exceeds non-facility
Verify that open treatment is documented versus closed treatment; open requires surgical incision or exposure even if minimal
Impact: Closed treatment codes (21453-21454) reimburse $400-600 less; clear operative note stating incision/exposure prevents denial
Submit separate claims for associated services like pre-operative CT imaging (70486) or post-operative panoramic x-rays (70110) on different dates
Impact: Imaging codes add $200-400 in additional reimbursement when medically necessary and separately documented
For multiple fracture sites, bill each fracture location separately when different surgical approaches are used (e.g., 21462 for body fracture, 21470 for condyle fracture)
Impact: Multiple procedure payment rules apply with second procedure at 50%, potentially adding $561.36 for complex bilateral cases
Document medical necessity for interdental fixation over simpler closed reduction, including fracture displacement, occlusion disruption, or patient compliance concerns

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Frequently asked questions

What is the 2025 Medicare reimbursement rate for CPT code 21462?

The 2025 Medicare national average non-facility rate for CPT 21462 is $1872.86, while the facility rate is $1123.72. Actual reimbursement varies by geographic location based on locality-specific adjustments to the conversion factor.

What is the difference between CPT 21462 and 21453 for mandibular fracture treatment?

CPT 21462 is for open treatment of mandibular fracture with interdental fixation, requiring surgical exposure and fixation devices attached to teeth. CPT 21453 is closed treatment with interdental fixation, without surgical incision. The open approach (21462) reimburses approximately $750 more due to increased surgical complexity.

How many RVUs is CPT code 21462 worth in 2025?

CPT 21462 has a total of 57.9 RVUs in 2025, consisting of 11.01 work RVUs, 45.44 non-facility practice expense RVUs (22.28 facility), and 1.45 malpractice RVUs. This makes it a high-value surgical procedure code.

Can CPT 21462 be billed bilaterally with modifier 50?

Yes, when bilateral mandibular fractures are treated with interdental fixation on both sides during the same operative session, modifier 50 can be appended. This typically increases reimbursement to 150% of the unilateral rate, but verify payer-specific bilateral surgery policies.

What documentation is required to bill CPT 21462 instead of a closed treatment code?

Documentation must clearly describe surgical incision or exposure of the fracture site, the interdental fixation technique used (arch bars, wires, etc.), number of teeth involved, and fracture reduction method. Operative notes should explicitly state 'open treatment' and describe the surgical approach to prevent downcoding.

Can tooth extraction codes be billed separately with CPT 21462?

Tooth extractions performed as part of fracture management may be separately billable with modifier 59 if they are distinct procedures not integral to the fracture repair. Documentation must demonstrate the extraction was medically necessary beyond the fracture treatment (e.g., non-restorable tooth, separate pathology).

What is the global period for CPT code 21462?

CPT 21462 has a 90-day global period, meaning routine postoperative care including fixation removal and follow-up visits are included in the initial payment. Any unrelated procedures or complications requiring return to the OR during this period require modifier 79 or 78 respectively.