Summary & Overview
CPT 21146: LeFort I Midface Reconstruction, Maxillary Advancement
CPT code 21146 covers LeFort I midface osteotomy with microsurgical reconstruction and bone grafting to advance and reposition the maxilla for correction of congenital or acquired facial deformities. This code captures complex craniofacial reconstructive work that has implications for surgical planning, facility resource use, and national payment policy due to its operative complexity and potential need for inpatient care. Key payers in national analyses include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will gain a concise overview of the clinical context for the procedure, typical sites of service, and which major payers underwrite care. The publication summarizes common billing considerations, expected service lines, and benchmarking themes relevant to payers and provider organizations. It also outlines areas where policy changes or coverage edits could affect authorization, utilization management, and reimbursement pathways. Data not available in the input is explicitly noted where applicable; the focus remains on clinical and billing characterization for a national audience rather than state-level program specifics.
Billing Code Overview
CPT code 21146 describes a LeFort I midface osteotomy with reconstruction using microsurgery and bone grafting to correct congenital or acquired deformities. The procedure repositions the maxilla (the upper jaw bone) by moving the teeth-bearing portion of the maxilla forward and reconstructing associated facial bones.
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Service type: Reconstructive midface surgery involving osteotomy, microsurgical reconstruction, and bone grafting
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Typical site of service: Inpatient or outpatient surgical setting such as a hospital operating room or ambulatory surgical center depending on clinical complexity and perioperative needs
Clinical & Coding Specifications
Clinical Context
A 22-year-old patient with a congenital maxillary hypoplasia and malocclusion presents for corrective midface advancement via LeFort I osteotomy with bone grafting and microsurgical reconstruction. Preoperative assessment includes orthodontic alignment, 3D imaging (CT or CBCT) for surgical planning, and multidisciplinary coordination with oral and maxillofacial surgery and anesthesiology. On the day of surgery the patient undergoes general anesthesia in an operating room; the procedure involves maxillary osteotomy, mobilization and advancement of the maxilla, fixation with plates and screws, and placement of autologous or allogeneic bone graft material. Postoperative care includes monitoring in a post-anesthesia care unit, inpatient observation for airway and bleeding concerns, pain control, antibiotic prophylaxis as indicated, dietary modification, and follow-up with the surgeon and orthodontist for occlusion and hardware assessment. Typical site of service is an inpatient or outpatient hospital operating room within a tertiary care center or academic medical center. Service type is major reconstructive craniofacial surgery performed by oral and maxillofacial surgeons or plastic and reconstructive surgeons specializing in craniofacial procedures.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services | Use when work, time, or complexity substantially exceeds usual for 21146. |