CPT 21142 Two‑Segment LeFort I | Reimbursement | OpenPayer

Summary & Overview

CPT 21142: Two-Segment LeFort I Maxillary Advancement

CPT code 21142 specifies a two-segment LeFort I maxillary advancement: a surgical reconstruction that mobilizes and advances the tooth-bearing portion of the maxilla and associated midface bones to correct congenital or acquired deformities. The code captures a complex orthognathic procedure that affects occlusion, facial symmetry, and airway or functional outcomes, making it clinically significant for craniofacial surgery and reconstructive specialties.

Key payers included in national coverage discussions are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers can expect a concise briefing on clinical context, common settings where the service is delivered, and how the procedure is represented in billing workflows. The publication summarizes common payer engagement and coding considerations, provides benchmarking context where available, and outlines the clinical indications and procedural scope associated with the code.

This summary is intended to inform clinical leaders, coding professionals, and policy analysts about the nature and billing classification of the procedure, typical sites of service, and what to look for when reviewing claims and coverage policies for orthognathic and midface reconstructive surgery. Data not available in the input: associated taxonomies, specific ICD-10 diagnoses, related codes, and payer-specific reimbursement rates or policies.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareCPT 21142maxillary osteotomyLeFort Iorthognathic surgerycraniofacial reconstructionmidface advancement

Billing Code Overview

CPT code 21142 describes a surgical procedure that advances the maxilla (upper jaw) and associated midface bones in two segments during a LeFort I osteotomy, repositioning the tooth-bearing portion of the maxilla to correct congenital or acquired facial deformities. The procedure involves mobilization and forward movement of the maxillary skeletal segments to reconstruct facial bone relationships and improve occlusion and facial balance.

Service type: Maxillary osteotomy, two-segment LeFort I advancement

Typical site of service: Inpatient or outpatient hospital surgical setting or ambulatory surgery center, depending on patient complexity and perioperative needs.

Clinical & Coding Specifications

Clinical Context

A 24-year-old patient with congenital maxillary hypoplasia and Class III malocclusion presents for orthognathic surgery. The surgical team elects a two-segment LeFort I osteotomy to advance the maxillary segments, reposition the dentoalveolar-bearing portion of the maxilla, correct occlusion, and improve facial symmetry. Preoperative workflow includes orthodontic preparation with braces for dental decompensation, comprehensive surgical planning with 3D imaging and model surgery, medical clearance, and consent. On the day of surgery the procedure is performed in a hospital or ambulatory surgery center under general anesthesia. Intraoperative steps include maxillary osteotomies in two segments, mobilization and forward advancement of bone segments, interpositional bone grafting or fixation with plates and screws as needed, and occlusal stabilization with intermaxillary fixation or rigid internal fixation. Postoperative workflow includes recovery in PACU, hospital observation or same-day discharge depending on complexity and comorbidities, postoperative antibiotics and analgesia, dietary modifications, and follow-up with the oral and maxillofacial surgery and orthodontics teams for occlusal evaluation and hardware removal if indicated.

Coding Specifications

Modifier	Description	When to Use
`22`	Increased procedural services	Use when work, time, or complexity substantially exceeds typical for `21142` and documentation supports additional resources.

CPT 21282: Canthopexy for Lateral Canthal Tendon Repair

CPT-21244-MANDIBLE-RECONSTRUCTION-WITH-METAL-PLATE

CPT 21244: Mandible Reconstruction with Metal Plate

CPT-21255-ZYGOMATIC-ARCH-AND-GLENOID-FOSSA-RECONSTRUCTION-AUTOGRAFT

CPT 21255: Zygomatic Arch and Glenoid Fossa Reconstruction, Autograft

CPT-21141-LEFORT-I-MAXILLARY-OSTEOTOMY-MIDFACE-RECONSTRUCTION

CPT 21141: LeFort I Maxillary Osteotomy, Midface Reconstruction

CPT-21160-EXTENSIVE-CRANIOFACIAL-RECONSTRUCTION-AUTOLOGOUS-GRAFT

CPT 21160: Extensive Craniofacial Reconstruction with Autologous Bone Graft

CPT-21235-AUTOGENOUS-EAR-CARTILAGE-GRAFT-NASAL-AURICULAR-REPAIR

CPT 21235: Autogenous Ear Cartilage Graft for Nasal or Auricular Repair

CPT-21184-EXTENSIVE-CRANIOFACIAL-BONE-RECONSTRUCTION-AUTOLOGOUS-GRAFT

CPT 21184: Extensive Craniofacial Bone Reconstruction with Autologous Graft

CPT-21138-FOREHEAD-CONTOURING-AND-FOREHEAD-REDUCTION

CPT 21138: Forehead Contouring and Forehead Reduction

CPT-21172-EXTENSIVE-FACIAL-RECONSTRUCTION-WITH-BONE-GRAFT

CPT 21172: Extensive Facial Skeletal Reconstruction with Autologous Bone Graft

CPT-21146-LEFORT-I-MIDFACE-RECONSTRUCTION-MAXILLARY-ADVANCEMENT

CPT 21146: LeFort I Midface Reconstruction, Maxillary Advancement

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Taxonomy Code	Specialty	Notes
`Data not available in the input.`	Oral and Maxillofacial Surgery	Primary specialty performing LeFort I osteotomy; manages surgical planning, osteotomies, fixation, and perioperative care.
`Data not available in the input.`	Plastic and Reconstructive Surgery	Performs complex midface reconstructions, often in combined craniofacial cases and facial aesthetic adjustments.
`Data not available in the input.`	Otolaryngology — Head and Neck Surgery	Performs orthognathic surgery in some centers, particularly when airway or sinonasal issues coexist.
`Data not available in the input.`	Orthodontics (for planning and postoperative management)	Not a surgical taxonomy but integral to pre- and postoperative dental preparation and finishing.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`Q35.9`	Cleft palate, unspecified	Maxillary hypoplasia and dental-alveolar malposition from cleft lip/palate often require maxillary advancement via LeFort I.
`Q67.6`	Other congenital deformities of skull and face bones	Broad category that can encompass congenital midface hypoplasia treated with segmental maxillary osteotomy.
`M26.63`	Acquired malocclusion, maxillary hypoplasia	Direct indication for surgical maxillary advancement to correct occlusion and function.
`S02.4XXA`	Fracture of malar and maxillary bones, initial encounter	Posttraumatic maxillary deformity or malunion can require reconstructive LeFort-type osteotomy.
`Q67.8`	Other congenital deformities of skull and face bones	Includes diverse congenital midface anomalies potentially treated with LeFort I advancement.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`21045`	Reconstruction, mandible, lower jaw, with plating or bone graft; complex reconstruction	May be performed in combined jaw reconstruction cases when mandibular surgery is required in addition to maxillary advancement.
`21137`	Genioplasty, augmentation, sliding or other osteotomy; with or without plate fixation	Often performed concurrently to address chin position after LeFort I to optimize facial balance.
`21210`	Reconstruction of orbital floor and maxilla with bone graft; simple	May be performed when midface fractures or defects accompany deformity requiring reconstruction at time of LeFort-type procedures.
`21246`	Reconstruction, midface, with osteotomy/osteoplasty; complex	Related when additional midface work beyond a two-segment LeFort I is required for congenital or acquired deformity.
`70350`	CT scan, maxillofacial, without contrast	Preoperative 3D imaging frequently used for surgical planning and virtual surgical simulation prior to `21142`.
`21248`	Grafting, bone; mandible or maxilla, per site	Supplemental bone grafting for augmentation or to fill gaps created by segmental advancements during LeFort procedures.

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