Summary & Overview
CPT 21255: Zygomatic Arch and Glenoid Fossa Reconstruction, Autograft
CPT code 21255 covers surgical reconstruction of the zygomatic arch and glenoid fossa using the patient’s own bone and cartilage. This operative code is used for repair of traumatic, congenital, or post-surgical deformities of the lateral midface and temporomandibular region and is clinically important because it addresses functional and aesthetic outcomes that can affect mastication, facial symmetry, and orbital support. Payers commonly involved in coverage decisions include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare.
This publication provides a national overview of the code’s clinical scope, typical sites of service (hospital operating rooms and ambulatory surgical centers), and the procedural context in which autogenous grafts are used. Readers will find benchmarks and coverage considerations where available, summaries of common modifiers and billing practices, and clinical context that clarifies when reconstruction of the zygomatic arch and glenoid fossa is billed under this CPT code. Data not available in the input are noted explicitly. The content is intended to help clinical coders, revenue staff, and policy analysts understand the code’s purpose, common service settings, and the payer landscape relevant to facial skeletal reconstruction.
Billing Code Overview
CPT code 21255 describes reconstruction of the zygomatic arch and the glenoid fossa using autogenous bone and cartilage grafts to treat injuries or deformities of the lateral midface and temporomandibular region. The procedure involves reshaping or rebuilding the bony architecture beneath the eye socket and the socket that helps hold the upper jaw in place.
Service type: Surgical reconstruction of facial bones (autograft)
Typical site of service: Hospital operating room or ambulatory surgical center, often performed by oral and maxillofacial surgeons or plastic and reconstructive surgeons for traumatic, congenital, or post-oncologic deformities.
Data not available in the input for payers, taxonomies, ICD-10 diagnoses, and related codes.
Clinical & Coding Specifications
Clinical Context
A 42-year-old male presents after a motor vehicle collision with malunion and comminuted fracture of the zygomatic arch and associated glenoid fossa disruption causing facial asymmetry, malocclusion, trismus, and persistent pain. Examination and CT imaging confirm depressed zygomatic arch fragments with involvement of the glenoid fossa affecting the temporomandibular articulation. The reconstructive surgeon (oral and maxillofacial surgeon or plastic/reconstructive surgeon) plans open reconstruction using autologous bone and cartilage graft harvested from the patient (for example, iliac crest and conchal cartilage) to restore zygomatic arch contour and glenoid fossa anatomy.
Preoperative workflow includes history, surgical consent, facial CT with 3D reconstruction, dental/occlusal assessment, anesthesia evaluation, and documentation of functional deficits (trismus, malocclusion) and cosmetic deformity. Intraoperative steps include exposure of the zygomatic arch and glenoid fossa, debridement of nonviable bone, shaping and fixation of autograft, possible internal fixation with plates/screws, and verification of occlusion. Postoperative workflow includes inpatient observation or same-day discharge depending on complexity, pain control, antibiotics, wound care, jaw mobilization therapy, and follow-up imaging to confirm graft position and healing.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
11 | Normally without complication | Use when the service was performed as planned without complications. |