Summary & Overview
CPT 21461: Open Repair of Mandibular Fracture, Incision Approach
CPT code 21461 designates open surgical repair of a fractured mandible accessed via an incision to reduce and stabilize damage from blunt facial trauma. This code captures a common maxillofacial operative procedure with implications for trauma, oral and maxillofacial surgery, and hospital surgical services. Nationally, mandible fracture repair is an important procedural category for emergency surgical care, trauma system capacity, and inpatient/same-day surgical utilization.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a clinical context for the procedure, typical sites of service (hospital operating room or ambulatory surgical center), and the kinds of benchmarks and policy factors that affect how the code is used in billing and reimbursement. The publication summarizes payment benchmarks, common practice settings, and coding considerations relevant to payers and providers. It also outlines areas where policy updates and payer coverage rules commonly influence authorization and payment for operative mandibular fracture repair.
Data not available in the input for specific payer rates, associated taxonomies, ICD-10 diagnosis pairings, and related codes.
Billing Code Overview
CPT code 21461 describes surgical treatment of a mandibular (lower jaw) fracture accessed through an incision to repair damage caused by blunt facial trauma. The service involves open operative management to reduce and stabilize the fractured mandible.
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Service type: Surgical fracture repair (open reduction and internal fixation of the mandible)
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Typical site of service: Hospital operating room or ambulatory surgical center, depending on clinical urgency and patient status
Data not available in the input for associated taxonomies, ICD-10 diagnoses, or related codes.
Clinical & Coding Specifications
Clinical Context
A 28-year-old male presents to the emergency department after an assault with blunt facial trauma. He reports facial pain, malocclusion, and numbness of the lower lip. Examination and maxillofacial CT confirm a displaced fracture of the mandibular body. The patient is brought to the operating room for open reduction and internal fixation. Under general anesthesia, the oral and maxillofacial surgeon makes an incision to access the mandibular fracture, achieves reduction, and secures fixation with plates and screws. Postoperative workflow includes recovery unit monitoring, postoperative imaging as needed, oral antibiotics and analgesia, wound care instructions, and a short course of soft-diet restrictions. The typical site of service is an ambulatory surgery center or hospital operating room depending on acuity and comorbidities. Billing uses 21461 for open treatment of a mandible fracture accessed through an incision with internal fixation.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services | Use when the procedure required substantially greater work than typical due to complexity or extensive dissection. |
23 |