CPT 21048 Maxillary Tumor Excision Reimbursement | OpenPayer

Summary & Overview

CPT 21048: Maxillary Benign Tumor Excision via Intraoral Osteotomy

CPT code 21048 denotes the open surgical excision of a benign tumor of the maxilla performed via an intraoral osteotomy. This code captures a specialized maxillofacial surgical procedure used to remove fast-growing or locally destructive noncancerous lesions of the upper jaw bone. Clinically, it is relevant to oral and maxillofacial surgeons, otolaryngologists, and surgical oncologists working in head and neck specialties.

Nationally, accurate reporting of this procedure code matters for clinical documentation, facility and professional reimbursement, and outcome tracking for maxillary tumor management. Key payers in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. These payers typically influence coverage policies, prior authorization requirements, and coding guidelines for surgical head and neck procedures.

Readers will find a concise overview of the clinical context for 21048, common sites of service, and the typical service type. The publication outlines benchmarking and payer coverage considerations, highlights relevant policy and coding interpretations where available, and summarizes clinical factors that affect service setting and billing. Data not available in the input is noted where applicable, and the focus remains on national-level clinical and billing context rather than state-specific rules.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicare21048CPTmaxillamaxillofacial surgerytumor excisionintraoral osteotomyhead and neck surgerysurgical procedure

Billing Code Overview

CPT code 21048 describes the open surgical removal of a benign tumor of the maxilla (upper jaw bone) via an intraoral osteotomy. The procedure involves making an incision inside the mouth and cutting into the maxillary bone to excise a fast-growing or locally destructive noncancerous lesion.

Service type: Open surgical tumor excision involving intraoral osteotomy of the maxilla
Typical site of service: Operating room or ambulatory surgical center with intraoral access; typical setting is inpatient or outpatient surgical care depending on case complexity and perioperative needs

Clinical & Coding Specifications

Clinical Context

A 42-year-old patient presents with a progressively enlarging, nonmetastatic maxillary tumor causing facial swelling, malocclusion, and intermittent epistaxis. Imaging with maxillofacial CT demonstrates a well-circumscribed, expansile lesion of the maxilla suspicious for an aggressive benign neoplasm (for example, ameloblastoma or ossifying fibroma). After biopsy confirms a benign but locally destructive lesion, the oral and maxillofacial surgery team schedules an intraoral approach for resection via an osteotomy of the maxillary bone. The procedure is performed in an ambulatory surgery center or hospital operating room under general anesthesia. Intraoperative steps include mucosal incision, subperiosteal dissection, intraoral osteotomy of the maxilla to access and excise the tumor, hemostasis, possible en bloc removal of involved bone, reconstruction or grafting as indicated, and layered closure. Postoperative workflow includes PACU monitoring, pain and infection prophylaxis, oral wound care instructions, follow-up for wound checks and pathology review, and coordination with prosthodontics or reconstructive services if needed.

Coding Specifications

Modifier	Description	When to Use
`22`	Increased procedural services	Use when the surgery requires substantially greater effort, time, or complexity than typical for `21048` (document increased work).

CPT 21025: Debridement for Mandibular Osteomyelitis

CPT-21045-MANDIBLE-TUMOR-RESECTION-MANDIBULECTOMY

CPT 21045: Resection of Malignant Tumor of Mandible (Mandibulectomy)

CPT-21049-PARTIAL-MAXILLECTOMY-BENIGN-MAXILLARY-TUMOR

CPT 21049: Partial Maxillectomy for Benign Maxillary Tumor

CPT-21060-TMJ-MENISCECTOMY-OPEN-SURGICAL-REMOVAL-MENISCUS

CPT 21060: TMJ Meniscectomy, Open Surgical Removal of Meniscus

CPT-21047-MANDIBLE-MASS-EXCISION-PARTIAL-MANDIBULECTOMY-EXTRAORAL

CPT 21047: Excision of Benign Mandibular Mass with Partial Mandibulectomy

CPT-21040-MANDIBLE-BENIGN-TUMOR-ENUCLEATION-CURETTAGE

CPT 21040: Mandible Benign Tumor Enucleation/Curettage

CPT-21050-CONDYLECTOMY-MANDIBLE-TMJ-SURGERY

CPT 21050: Condylectomy of Mandible for TMJ Disorders

CPT-21011-FACE-SCALP-SOFT-TISSUE-TUMOR-EXCISION-LESS-THAN-2CM

CPT 21011: Excision of Small Soft Tissue Tumor of Face or Scalp

CPT-21032-TORUS-PALATINUS-EXCISION-HARD-PALATE

CPT 21032: Excision of Torus Palatinus

CPT-21029-BONE-TUMOR-CONTOURING-RESHAPING

CPT 21029: Removal of Benign Bone Tumor by Contouring/Reshaping

Showing 1–10 of 22

Taxonomy Code	Specialty	Notes
`206E00000X`	Oral and Maxillofacial Surgery	Primary specialty performing intraoral maxillary osteotomy and tumor resection.
`2080P0207X`	Otolaryngology (ENT)	ENT-head and neck surgeons commonly perform maxillary tumor resections, especially with sinonasal extension.
`207L00000X`	Plastic and Reconstructive Surgery	Performs reconstructive or microvascular procedures following maxillary resections.
`207K00000X`	General Surgery	Rarely involved; may assist in complex head and neck resections or multidisciplinary cases.
`208000000X`	Oral Surgery (Dentistry)	Dental specialists involved in preoperative planning and occlusal rehabilitation.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`C41.0`	Malignant neoplasm of bones of skull and face	Although malignant, included for differential; confirms malignant bone tumors when malignancy suspected (not for benign).
`D16.0`	Benign neoplasm of mandible	Related benign jaw neoplasm code; included for jaw tumor group but involves mandible rather than maxilla.
`D16.2`	Benign neoplasm of skull and face bones	Includes benign maxillary bone tumors such as ossifying fibroma or osteoma and is commonly used when coding benign maxillary tumors.
`K10.2`	Facial swelling, unspecified	Symptom code sometimes used in initial encounters for facial mass or swelling prompting imaging and biopsy.
`J34.89`	Other specified disorders of nose and nasal sinuses	Used when tumor involves the maxillary sinus or has sinonasal extension requiring combined approaches.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`21048`	Resection of benign tumor of maxilla via intraoral osteotomy — (primary code)	Primary code for open intraoral osteotomy and excision of a benign maxillary tumor.
`21045`	Excision of benign lesion of maxilla, limited	May be used for smaller, more limited maxillary bone resections when less extensive than `21048`.
`21046`	Excision of benign lesion of maxilla, radical	Used when a more extensive radical maxillectomy is required beyond the scope of `21048`.
`21076`	Reconstruction of mandible or maxilla with bone graft; autograft	May be performed during the same operative session when bone grafting or reconstruction is required after tumor removal.
`41210`	Excision of lesion of hard palate (localized)	Selected intraoral mucosal or palatal soft-tissue procedures that may be performed concurrently with maxillary tumor resection.
`20926`	Bone graft, mandible or maxilla; local autograft (e.g., iliac crest)	Used when grafting is required to reconstruct the defect following resection.

OpenPayer