Summary & Overview
CPT 21435: Repair of Craniofacial Separation and Midface Fracture with Fixation
CPT code 21435 represents open surgical repair of fractures that separate the cranium from the facial bones, commonly used for severe midface injuries affecting the nasal bridge and upper jaw. Nationally, this code denotes complex reconstructive trauma care that typically requires hospital-based operative management and fixation devices to restore facial structure and function. Its use is concentrated in trauma centers and tertiary care hospitals where multidisciplinary teams manage high-acuity facial injuries.
Key payers included in this overview are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a clinical and billing context for the procedure, typical sites of service, and the service type involved. The publication outlines benchmarks and policy-relevant considerations such as coding specificity, hospital-based service implications, and payer coverage patterns. Where available, readers will also see comparisons of reimbursement practice and utilization trends across major payers.
This summary provides the foundational information clinicians, billing professionals, and policy analysts need to understand when and how 21435 is used, what setting it implies, and the kinds of documentation and coding precision that support accurate reporting and payer adjudication. Data not available in the input is noted as such in relevant sections.
Billing Code Overview
CPT code 21435 describes surgical repair for fractures that separate the cranium (skull) from the facial bones, addressing injuries to the nasal bridge or upper jaw following severe facial trauma. The procedure involves an incision to access the fracture and the application of internal and/or external fixation devices to maintain alignment during healing.
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Service type: Surgical open repair with fixation for craniofacial separation and midface fractures
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Typical site of service: Hospital operating room or trauma center surgical suite
Clinical & Coding Specifications
Clinical Context
A 34-year-old male is brought to the emergency department after a motor vehicle collision with facial impact. He has deformity across the nasal bridge and upper jaw with malocclusion, epistaxis, and periorbital swelling. CT imaging demonstrates a Le Fort I/II fracture pattern with craniofacial dissociation requiring operative reduction and fixation. The patient is evaluated by the trauma team and an oral and maxillofacial surgeon or plastic/reconstructive surgeon. Preoperative consent is obtained, anesthesia is given, and the surgeon performs open reduction and internal fixation through intraoral and external incisions, applying plates and screws to stabilize the maxilla and nasal bridge. Postoperative care includes inpatient observation for airway, hemorrhage, and infection, with follow-up for hardware check and occlusal assessment.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
62 | Two surgeons | When two surgeons work together as primary surgeons, each performing distinct portions of the procedure |
80 | Assistant surgeon | When a surgical assistant (non-physician or physician assistant) provides assistance during the operation |