Summary & Overview
CPT 21248: Jaw Reconstruction With Implant
CPT code 21248 represents surgical reconstruction of a portion of the maxilla or mandible with insertion of a metallic or ceramic implant to repair defects and restore function. This procedure is clinically significant for patients with traumatic injury, oncologic resection, congenital defects, or severe degenerative conditions that compromise jaw integrity and oral function. Nationally, accurate coding for complex craniofacial and mandibular reconstruction affects access to reconstructive services and appropriate coverage for high-resource surgical care.
Key payers covered in this overview include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise explanation of the clinical context for 21248, the typical settings where the procedure is performed, and what to expect when this service appears on a claim. The publication provides benchmark considerations, reimbursement and billing policy context where available, and clinical notes that clarify the procedure scope. If payer-specific policies or coverage criteria exist, those are noted separately; where payer or coding-specific data is not provided, the text states "Data not available in the input." This summary is intended for clinicians, coding professionals, and policy analysts seeking a clear national-level description of CPT code 21248 and its clinical implications.
Billing Code Overview
CPT code 21248 describes reconstruction of a portion of the upper or lower jaw (maxilla or mandible) to repair defects and restore function. The procedure includes insertion of a metallic or ceramic implant into bone to strengthen the reconstructed segment.
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Service type: Surgical reconstruction with implant placement
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Typical site of service: Hospital operating room or ambulatory surgical center
Clinical & Coding Specifications
Clinical Context
A 56-year-old patient presents with a localized mandibular defect after resection of an odontogenic tumor. The oral and maxillofacial surgery team evaluates the patient for reconstruction to restore mandibular continuity, masticatory function, and dental implant support. Preoperative workflow includes imaging (panoramic radiograph and CT or cone beam CT), medical optimization, and dental/prosthetic planning. In the operating room under general anesthesia, the surgeon debrides the defect, prepares the recipient bone, and inserts a metallic or ceramic implant (reconstruction plate, custom implant, or load-bearing implant) into the maxilla or mandible to reinforce bone structure and enable future prosthetic rehabilitation. Postoperative workflow includes inpatient monitoring for airway and bleeding, pain control, antibiotic therapy as indicated, follow-up imaging to confirm implant position, and staged prosthetic or grafting procedures as needed.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services | Use when work, time, or complexity substantially greater than usual for 21248. |
24 |