Summary & Overview
CPT 21347: Nasomaxillary Complex Fracture Repair
CPT code 21347 represents surgical repair of nasomaxillary complex fractures — procedures to reduce and stabilize fractures of the nasal bones and the maxilla following blunt force trauma. This code is central to trauma, oral and maxillofacial, and otolaryngology surgical billing because management of facial fractures often requires multidisciplinary care and significant operative resources.
Key national payers included in this analysis are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Coverage, prior authorization requirements, and allowed payments for surgical facial fracture repair vary by payer and plan type, affecting provider reimbursement and patient out-of-pocket costs.
Readers will gain a concise overview of the clinical intent of the code, typical sites of service, common billing modifiers and payer patterns, and a summary of benchmarks and policy considerations relevant to reimbursement for facial fracture repair. The publication also summarizes clinical context for use of the code, common documentation elements, and areas where payer policy updates commonly occur. Data not available in the input will be noted where applicable.
Billing Code Overview
CPT code 21347 describes surgical repair of a nasomaxillary complex fracture, addressing injuries to the nasal bones and the maxilla (upper jaw) that typically result from blunt force trauma. The procedure restores facial structure and function by reducing and stabilizing fractures in the nasal-maxillary region.
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Service type: Surgical repair of facial fractures
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Typical site of service: Hospital operating room or ambulatory surgery center
Clinical & Coding Specifications
Clinical Context
A 28-year-old male presents to the emergency department after an altercation with blunt facial trauma. He reports nasal deformity, epistaxis, facial swelling, malocclusion of the upper teeth, and periorbital tenderness. A focused facial CT demonstrates a nasomaxillary complex fracture involving the nasal bones and anterior maxillary buttress with displacement. After initial emergency airway and hemostasis management, the patient is scheduled for open reduction and internal fixation of the nasomaxillary complex under general anesthesia. The surgical workflow includes preoperative imaging review, consent, administration of general anesthesia, surgical exposure of the nasomaxillary complex, reduction of displaced bony fragments, fixation with plates and/or screws as indicated, irrigation, soft-tissue repair, postoperative imaging as needed, and discharge with instructions for wound care and follow-up.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services | Use when the procedure requires substantially greater work than typical due to complexity, e.g., extensive comminution or prolonged operative time. |
23 | Unusual anesthesia required |