Summary & Overview
CPT 21267: Orbital Repositioning with Osteotomy and Bone Graft
CPT code 21267 denotes surgical repositioning of one side of the orbit with osteotomies and bone grafting to treat facial deformities from trauma or congenital conditions. This procedure is clinically significant because it addresses functional and structural defects of the orbital skeleton that can affect vision, ocular alignment, and facial symmetry. Nationally, coverage and payment for complex craniofacial reconstructive procedures like this influence access to specialty surgical care and the coordination of multidisciplinary teams.
Key payers examined 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 settings, along with payer coverage considerations, common billing modifiers, and related coding context. The publication also summarizes typical sites of service and what to expect in terms of coding complexity for reconstructive orbital procedures.
This summary equips clinicians, coding professionals, and policy analysts with the clinical framing and payer landscape needed to interpret CPT code 21267 in a national context, including where to look for benchmarks, policy updates, and operational implications for surgical scheduling and billing workflows.
Billing Code Overview
CPT code 21267 describes surgical repositioning of one side of the orbit, the bony cavity that contains the eye, to correct facial deformity from trauma or congenital conditions. The procedure includes osteotomies (controlled cuts into the bone) without entering the cranium and the application of bone grafts to reconstruct the orbital framework.
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Service type: Reconstructive orbital osteotomy with bone grafting
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Typical site of service: Operating room or ambulatory surgical center for inpatient or outpatient surgical management of facial/orbital deformity
Clinical & Coding Specifications
Clinical Context
A 34-year-old male presents after a motor vehicle collision with left midface trauma, periorbital deformity, and diplopia. Imaging demonstrates orbital floor and medial wall fractures with displacement of the left orbital rim and loss of orbital volume causing enophthalmos. The surgeon plans a reconstructive orbital osteotomy and repositioning with bone grafting to restore orbital volume and ocular alignment. Preoperative workflow includes CT facial bones with 3D reconstruction, ophthalmology evaluation for extraocular muscle entrapment and visual acuity testing, anesthesia preoperative assessment, and informed consent documenting risks including vision loss, infection, and need for secondary procedures.
On the day of surgery, the patient undergoes general anesthesia. The surgeon performs external and transconjunctival approaches as needed, performs osteotomies of the orbital rim and walls without entering the cranial vault, repositions the orbital contents and bony orbit, and places autologous or alloplastic bone grafts/implants for augmentation. Intraoperative steps include hemostasis, orbital volume assessment, fixation of repositioned bone segments, and closure. Postoperative workflow includes ophthalmology and plastic surgery rounds, imaging as indicated, pain control, antibiotics when indicated, and outpatient follow-up for vision assessment and wound healing. Typical recovery involves short inpatient stay or same-day discharge depending on complexity and comorbidities.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 |