Summary & Overview
CPT 21244: Mandible Reconstruction with Metal Plate
CPT code 21244 covers reconstruction of the mandible with application of a metal plate that traverses the jaw bone to repair defects that impair jaw function. This complex maxillofacial procedure is clinically significant for patients with traumatic injuries, tumor resection defects, congenital abnormalities, or other conditions causing loss of mandibular continuity and function. Nationally, the code is relevant to surgical specialties including oral and maxillofacial surgery, otolaryngology, and plastic surgery and influences hospital surgical case-mix, resource allocation, and payer coverage determinations.
Key payers addressed in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical indications and typical care settings, payment and billing considerations across major payers, and benchmarks relevant to utilization and reimbursement practices. The publication also summarizes common billing modifiers and related coding context where available, and highlights areas where policy updates or payer-specific requirements can affect authorization and claim adjudication.
This national-focused summary provides clinicians, billing professionals, and policy analysts with the clinical definition, payer scope, and the topics covered so they can locate detailed benchmarks, payer policy comparisons, and coding guidance elsewhere in the full publication. Data not available in the input is identified where applicable.
Billing Code Overview
CPT code 21244 describes surgical reconstruction of the mandible (lower jaw) with placement of a metal plate that spans the jaw bone to repair defects that impair jaw function. This procedure is a reconstructive maxillofacial surgery intended to restore structural integrity and enable functional activities such as chewing, speaking, and maintaining occlusion.
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Service type: Reconstructive surgery of the mandible
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Typical site of service: Inpatient or outpatient surgical setting, commonly performed in an operating room or specialized surgical suite within a hospital or ambulatory surgical center
Clinical & Coding Specifications
Clinical Context
A 54-year-old male presents after a segmental mandibular resection for squamous cell carcinoma of the oral cavity with resultant mandibular discontinuity and impaired mastication and speech. Preoperative evaluation includes CT maxillofacial imaging and dental/oral surgery consultation. The reconstructive surgery involves restoring mandibular continuity and fixation by reconstructing the mandible and applying a transmandibular fixation plate that extends through the jaw bone to bridge the defect and restore function. Typical workflow: preoperative planning and imaging, general anesthesia with airway management, tumor resection (when staged) or debridement if traumatic/osteoradionecrosis related, plate selection and contouring, fixation of the metal plate(s) through remaining mandibular bone segments, intraoperative dental/occlusal assessment, closure, postoperative inpatient monitoring for airway, pain control, IV antibiotics, and follow-up for wound checks and possible plate removal or hardware revision if complications occur.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services | Use when work required is substantially greater than typical for additional complexity (document increased work). |
23 |