Summary & Overview
CPT 21150: LeFort II Midface Reconstruction
CPT code 21150 represents LeFort II midface reconstruction, a complex facial reconstructive surgery used to correct congenital or acquired deformities such as Treacher Collins syndrome. Nationally, this code captures surgical interventions that restore midfacial structure and function, with implications for specialized surgical services, hospital resource use, and payer authorization practices.
Key payers in most analyses include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of clinical context for the procedure, expected sites of service, common billing modifiers, and payer coverage patterns where available. The publication outlines typical benchmarks used in evaluating claims for complex craniofacial reconstruction and highlights relevant policy considerations that affect prior authorization and medical necessity determinations.
This summary provides clinicians, coders, and health policy professionals with a concise reference to the clinical purpose of the code, payer landscape, and the types of information that inform reimbursement and coverage decisions at a national level. Data not available in the input is noted where applicable.
Billing Code Overview
CPT code 21150 describes reconstruction of the midface using a LeFort II osteotomy to correct congenital or acquired facial deformities, such as Treacher Collins syndrome. The procedure involves restructuring the central midfacial skeleton to restore form and function.
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Service type: Facial reconstructive surgery (LeFort II midface reconstruction)
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Typical site of service: Hospital operating room or specialized surgical center
Clinical & Coding Specifications
Clinical Context
A 14-year-old adolescent with Treacher Collins syndrome presents with midface hypoplasia causing malocclusion, airway compromise with obstructive sleep apnea symptoms, and aesthetic facial asymmetry. The multidisciplinary team includes a craniofacial surgeon, pediatric anesthesiologist, orthodontist, and speech therapist. Preoperative workflow includes clinical evaluation, 3D CT imaging for surgical planning, orthodontic alignment as indicated, and anesthetic assessment given potential airway challenges. The patient is scheduled for a LeFort II midface advancement and reconstruction under general endotracheal anesthesia. Intraoperative steps include osteotomies through the LeFort II pattern, mobilization of midfacial segments, internal fixation with plates and screws, possible bone grafting, and evaluation of occlusion. Postoperative care involves airway monitoring, pain control, antibiotic prophylaxis as indicated, inpatient observation for 24–48 hours, follow-up imaging to confirm bony position, and staged orthodontic rehabilitation and speech/feeding therapy as needed.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | Default/No modifier | Use when no specific modifier applies to the service |
22 |