CPT code 21445: Open treatment of alveolar ridge fracture

Key takeaways

CPT code 21445 covers open treatment of a mandibular or maxillary alveolar ridge fracture, the tooth-bearing bone of the jaw. CMS gives it 6.10 work RVUs and a 090 global period.

The official descriptor does not mention internal fixation. A fracture through the mandible itself, plated with hardware, belongs to CPT 21461 or CPT 21462.

CPT tags 21445 as a separate procedure. That means it bundles when the alveolar repair forms part of a larger jaw operation at the same site.

Pair the claim with S02.67 for the mandibular alveolus or S02.42 for the maxillary alveolus. The 7th character A means a closed fracture, not closed treatment.

Practice management software like Pabau attaches billing codes to the operative note, so coders work from what the surgeon actually recorded.

CPT code 21445 covers open treatment of a mandibular or maxillary alveolar ridge fracture. The alveolar ridge is the tooth-bearing rim of bone in the upper or lower jaw. Oral and maxillofacial surgeons report 21445 when that segment is exposed surgically and reduced. Practice management software like Pabau lets coding teams attach codes such as 21445 to the patient record without switching systems.

The official descriptor says nothing about plates, screws, or wires. That trips billers up, because «open treatment» sounds like hardware fixation. A displaced fracture through the body of the mandible, stabilized with plates, belongs to CPT 21461 or CPT 21462 instead.

What CPT code 21445 covers

The code sits in the Musculoskeletal – Head section of the AMA CPT codebook, under Fracture and/or Dislocation Procedures on the Head. It applies to the alveolus on its own, in either jaw. Its closed-treatment counterpart is CPT 21440, which carries the same anatomy in its descriptor.

Alveolar ridge fractures usually arrive with dental trauma. A blow to the face can shear a tooth-bearing segment loose while leaving the jawbone below it intact. Contact sports, falls, and assaults are the usual causes, so oral surgery and sports medicine teams both see these injuries.

Open treatment means the surgeon exposes that segment, repositions it, and holds it with arch bars, interdental wiring, or a splint. Interdental fixation applied for a condition other than a fracture carries its own code, CPT 21110.

CPT tags 21445 as a separate procedure. That designation limits when you may report it. Do not bill 21445 when the alveolar repair is an integral part of a larger jaw procedure at the same site. Report it when the alveolar segment is the reason for surgery, or when the work is genuinely distinct.

Medicare reimbursement rates for CPT code 21445

Medicare prices 21445 through the Resource-Based Relative Value Scale. The values below come from the January 2026 release of the CMS relative value files. Confirm your own locality figure in the CMS fee schedule lookup before you quote a rate.

Two conversion factors apply in 2026. Practices that do not qualify as advanced APM participants are paid on $33.4009. That puts 21445 at roughly $567 in a facility and $753 in an office. Qualifying participants are paid on $33.5675, lifting those figures to about $570 and $757. Geographic adjustment moves both numbers.

Note how far the office rate sits above the facility rate. The practice expense value carries most of that difference. For context on how allowables are structured across payer types, see our guide to procedure code fee schedules.

The Medicare dental exclusion and jaw fractures

Section 1862(a)(12) of the Social Security Act excludes payment for care of the teeth and the structures that directly support them. The alveolar ridge is one of those structures. That is why some code references warn that Medicare will not pay 21445 at all.

Trauma is treated differently. The Medicare Benefit Policy Manual covers wiring of the teeth when it is done as part of reducing a jaw fracture. The exclusion is aimed at routine dental work, not at fracture repair. Document the injury and the reduction, then check your MAC coverage article before writing the claim off.

Geographic payment adjustments (GPCI)

The Geographic Practice Cost Index adjusts the national rate for local cost differences. CMS applies a separate index to the work, practice expense, and malpractice components. High-cost markets such as Manhattan or San Francisco produce a higher allowable than rural localities.

• Work GPCI: Adjusts the physician work component. It runs from about 1.0 in rural areas to above 1.1 in high-cost localities.
• Practice expense GPCI: Reflects local rent and staff wages. It is the biggest driver of variation for 21445, because the practice expense RVU is the largest component.
• Malpractice GPCI: Adjusts for geographic differences in malpractice premiums. It moves the total least, since the malpractice RVU is only 0.69.

Confirm the GPCI values for your MAC region in the CMS lookup. Cross-check any rate you find in a third-party tool against CMS data before you submit.

Place of service and facility vs. non-facility rates

The place of service code on the claim decides which rate you are paid. Medicare pays the lower facility rate when a hospital or ambulatory surgical center absorbs overhead. It pays the higher non-facility rate when the practice carries those costs in-office.

Modifiers that apply to 21445

Modifier errors are one of the most common denial triggers on 21445 claims. The CMS fee schedule file assigns payment policy indicators to every code, and those indicators decide which modifiers can be paid. The table below pairs each modifier with the 2026 indicator for 21445.

Documentation requirements

Thin documentation is the most common reason 21445 claims fail. The record has to establish two things. The fracture ran through the alveolar ridge, and the segment was opened rather than reduced closed. That record also sits under HIPAA documentation rules, which govern who may open it and how long you keep it.

The operative note carries the claim. It needs the approach, the teeth involved, and the way the segment was stabilized. Notes that could equally describe a mandibular body fracture invite a request for records. A complicated mandibular fracture repaired through multiple approaches belongs to CPT 21470.

• Operative report: Describe the incision, the exposure of the alveolar segment, the reduction, and the stabilization used. Name the arch bars, wires, or splint applied.
• Fracture site: State that the fracture involved the alveolar ridge, and say whether it was maxillary or mandibular. Record laterality for mandibular cases.
• Teeth involved: List the tooth numbers in the mobile segment. Note any avulsed, luxated, or fractured teeth treated at the same time.
• Medical necessity for open treatment: Explain why closed reduction was not adequate. Segment mobility, displacement, and failed closed reduction are the usual reasons.
• Imaging: Attach or reference the panoramic radiograph, periapical films, or CT that confirm the alveolar fracture and its displacement.
• Separate procedure justification: If another jaw procedure was billed the same day, document why the alveolar repair was distinct from it.
• Post-operative plan: Record the follow-up schedule, the date the fixation comes off, and the diet or function restrictions given.

ICD-10 diagnosis codes used with CPT code 21445

Every 21445 claim needs a diagnosis code that supports an alveolar ridge fracture. The mandibular family is S02.67, and the maxillary equivalent is S02.42. The broad mandibular fracture codes that pair with 21461 and 21462 do not support this claim. A fracture of the ramus takes S02.642A, and it will not carry a 21445 claim.

The 7th character is where alveolar claims come apart. Under the S02 categories, A means initial encounter for a closed fracture and B means initial encounter for an open fracture. Open there describes a wound that reaches the bone. It has nothing to do with open surgical treatment.

So an intact gingiva over a fractured alveolar ridge, repaired by open treatment under 21445, still takes the A character. Coders who read B as «we opened it» put the wrong diagnosis on the claim. The later characters are D for routine healing, G for delayed healing, K for nonunion, and S for sequela.

Global period and post-operative billing for CPT 21445

CMS assigns 21445 a global period of 090, the 90-day major surgery package. The surgical fee therefore covers routine post-operative care for 90 days after the procedure. That window matters here, because alveolar fixation usually stays in place for several weeks. Teams that store the operative note in the patient record can track the global end date alongside it.

Services inside the global period that fall outside the package need a modifier to say so. Without one, the payer bundles the visit into the original fee.

• Included in the package: Routine post-operative visits, wound checks, suture removal, and the removal of the arch bars or wiring placed at surgery.
• Unrelated care (modifier 24 or 79): An unrelated condition treated during the 90 days takes modifier 24. An unrelated return to the OR takes modifier 79.
• Complications (modifier 78): A return to the OR for a complication of the alveolar repair. Payment reflects the intra-operative work only.
• Staged work (modifier 58): Planned staged or related procedures, such as later dental restoration of the segment by the same surgeon.

Related CPT codes: 21440, 21445, 21461, and 21462

Two pairs of codes get mixed up here, and the mix-up runs in both directions. CPT 21440 and 21445 are the closed and open options for an alveolar ridge fracture. CPT 21461 and 21462 are the open options for a mandibular fracture. Billing teams in plastic surgery and oral surgery practices meet this distinction constantly.

The RVU totals in that table run against expectation. CPT 21440 carries more total RVUs than 21445 in both settings, even though its work RVU is far lower. The closed code has a higher practice expense value, and practice expense dominates both totals. Choosing 21440 over 21445 is not automatically a downcode in payment terms.

Facial trauma rarely stays in one place. A malar area fracture treated percutaneously is CPT 21355, and a nasomaxillary complex fracture is CPT 21346.

A fracture of the palate or the maxilla above the alveolus takes CPT 21422. Apply the separate procedure rule before you report any of them alongside 21445.

Be careful with third-party code lookups on 21445. Several describe it as open treatment of a mandibular fracture with internal fixation, which is the concept behind 21461 and 21462. The official descriptor names the alveolar ridge and does not mention internal fixation at all. Verify any reference against the AAPC CPT code lookup or the AMA CPT codebook.

Common billing errors and denial reasons

Denials on this code follow a short and predictable list. The errors below account for most 21445 rejections in oral and maxillofacial surgery. Almost all of them are settled by the operative note or by the payment policy indicators.

• Coding a jawbone fracture as 21445: A fracture through the mandibular body, plated and screwed, is 21461 or 21462. Billing 21445 for it understates the work by nearly three work RVUs.
• Ignoring the separate procedure rule: Reporting 21445 alongside a larger jaw procedure at the same site triggers a bundling denial. Append modifier 59 or XS only when the sites are genuinely distinct.
• Expecting bilateral payment: Modifier 50 does nothing on a code with a bilateral indicator of 0. Practices that budget for 150% end up chasing a shortfall that was never payable.
• Billing co-surgery: Modifier 62 is not payable on 21445. The co-surgery indicator is 0, so both surgeons’ claims are denied.
• Wrong 7th character: Using B because the fracture was treated openly. B means an open wound at the fracture, so most 21445 claims should carry A.
• Missing laterality: Submitting S02.670A when the note names a side. The mandibular alveolus codes require right or left, and payers reject the unspecified option.
• Wrong place of service: Billing POS 11 for work done in an ASC. The facility and non-facility rates differ by nearly $190 on this code, so the correction comes back as a recoupment.

Billing CPT code 21445 with Pabau

An alveolar ridge claim travels from the operatory to the billing office and on to the payer. Every handoff is a chance for the fracture site to blur into a generic jaw fracture. Pabau keeps documentation and code assignment in one platform, so what the surgeon recorded is what the biller submits.

The claims management software in Pabau supports pre-submission review. Billing staff can flag a missing laterality, an unsupported modifier, or a thin operative note before the claim leaves the practice.

The result is fewer records requests and a shorter revenue cycle on surgical claims. Read more about how oral surgery practice management software joins the clinical and financial sides of the practice.

Keep alveolar ridge claims tied to the operative note

Pabau records the fracture site, the teeth involved, and the fixation used inside the patient record, then bills from it. The detail that separates CPT 21445 from a mandibular fracture code is in the claim before it goes out.

Book a demo

Conclusion

CPT 21445 is a narrow code with a wide reputation for being misread. It covers the tooth-bearing alveolar ridge, not the jawbone below it, and its descriptor never mentions internal fixation. Get that boundary right and the rest follows. That means the S02.67 or S02.42 diagnosis, the A character, and the 090 global period. It also means a modifier set that rules out 50 and 62.

Pabau ties the operative note to the claim and flags the gaps before submission. To see how that works for an oral and maxillofacial surgery billing team, book a demo.

Continue your research

Billing another facial fracture? CPT 21407 covers open treatment of an orbital fracture with an implant.

Rebuilding the jaw after trauma? CPT 21215 sets out the RVUs and modifiers for a mandibular bone graft.

Fracture still not healed? S02.651K is the diagnosis for nonunion at the angle of the right mandible.

Following the patient through healing? S02.600D covers a body-of-mandible fracture seen at a routine follow-up visit.

Treating a lesion rather than a fracture? CPT 21047 covers excision of a benign tumor or cyst of the mandible.

Frequently asked questions