Summary & Overview
CPT 21245: Reconstruction of Maxilla or Mandible with Metal Plate
CPT code 21245 represents surgical reconstruction of a portion of the maxilla or mandible with application of a metal plate to repair defects that impair jaw function. This procedure is a key component of reconstructive maxillofacial care, addressing structural and functional deficits from trauma, tumor resection, congenital anomalies, or degenerative conditions. Nationally, the code matters because it captures complex surgical repair that often involves multidisciplinary teams and can drive significant resource use, perioperative planning, and post-operative rehabilitation.
Key payers considered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical context and typical sites of service, plus benchmark expectations and policy considerations relevant to coverage and billing for reconstructive jaw surgery. The publication outlines coding nuances, common modifiers, and associated billing practices where available, and highlights implications for prior authorization, documentation, and claim adjudication. Practical insights include expected care settings, the role of surgical implants (metal plate fixation), and the types of clinical scenarios that commonly generate use of CPT code 21245.
Data not available in the input for associated taxonomies, specific ICD-10 diagnoses, and payer-specific reimbursement rates.
Billing Code Overview
CPT code 21245 describes surgical reconstruction of a portion of the maxilla or mandible (upper or lower jaw) with application of a metal plate to the jaw bone to repair defects that impair jaw function. The procedure focuses on restoring structural integrity and functional capability of the jaw when defects—congenital, post-traumatic, or disease-related—interfere with chewing, speech, or facial support.
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Service type: Reconstructive maxillofacial surgery
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Typical site of service: Inpatient or outpatient operating room, hospital surgical suite, or ambulatory surgery center
Clinical & Coding Specifications
Clinical Context
A 54-year-old male presents with a segmental defect of the left mandible following surgical resection of an ameloblastoma. The patient has difficulty with mastication, malocclusion, and facial asymmetry. Preoperative workup includes CT maxillofacial imaging, dental occlusal analysis, and medical clearance. The surgical workflow involves general anesthesia, resection confirmation, reconstruction of the mandibular defect using local bone graft or vascularized free flap as indicated, and fixation of a rigid reconstruction plate to the superior border of the mandible to restore continuity and function. Intraoperative steps include exposure of the mandible, contouring and trimming of the plate, plate fixation with bicortical screws, assessment of occlusion, revision of soft tissues, and placement of drains as needed. Postoperative care includes inpatient monitoring for airway compromise, pain control, antibiotics, wound checks, radiographic confirmation of plate position, nutritional support (enteral or soft diet), and outpatient follow-up with the oral and maxillofacial surgery team for wound healing and prosthetic/dental rehabilitation planning.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services | Use when the reconstruction required substantially greater work or complexity than typical and documentation supports increased work. |