{"id":175530,"date":"2026-08-11T12:27:49","date_gmt":"2026-08-11T12:27:49","guid":{"rendered":"https:\/\/pabau.com\/?p=175530"},"modified":"2026-08-11T14:53:34","modified_gmt":"2026-08-11T14:53:34","slug":"cpt-code-21445","status":"publish","type":"post","link":"https:\/\/pabau.com\/es\/procedure-codes\/cpt-code-21445\/","title":{"rendered":"CPT code 21445: Open treatment of alveolar ridge fracture"},"content":{"rendered":"\n<script type=\"application\/ld+json\">{\"@context\":\"https:\/\/schema.org\",\"@type\":\"MedicalWebPage\",\"headline\":\"CPT code 21445: Open treatment of alveolar ridge fracture\",\"description\":\"CPT code 21445 covers open treatment of a mandibular or maxillary alveolar ridge fracture. Learn 2026 Medicare RVUs, modifiers, ICD-10 codes, and billing guidelines.\",\"url\":\"https:\/\/pabau.com\/procedure-codes\/cpt-code-21445\/\",\"audience\":{\"@type\":\"MedicalAudience\",\"audienceType\":\"Clinician\"},\"reviewedBy\":{\"@type\":\"Person\",\"name\":\"Dr Vanja Kitanova\",\"jobTitle\":\"Medical Reviewer\",\"affiliation\":{\"@type\":\"Organization\",\"name\":\"Pabau\"},\"knowsAbout\":[\"Medical Coding\",\"Clinical Documentation\",\"Healthcare Billing\",\"Clinical Safety\"],\"sameAs\":\"https:\/\/pabau.com\/blog\/author\/vanja\/\"},\"datePublished\":\"2026-08-08\",\"dateModified\":\"2026-08-11\"}<\/script>\n\n\n        <div id=\"key_takeaways\">\n            <div class=\"header\">\n                                    <img decoding=\"async\" src=\"https:\/\/pabau.com\/wp-content\/uploads\/2025\/12\/Key-Takeaways-Icon.svg\" alt=\"Key takeaways\" height=\"42\" width=\"42\">\n                                <h3>Key takeaways<\/h3>\n            <\/div>\n            <div class=\"list\">\n                                                            <div class=\"item\">\n                            <div>\n                                <svg width=\"20\" height=\"27\" viewBox=\"0 0 20 27\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                                    <path\n                                        d=\"M18.6223 14.3857C19.1246 13.8975 19.1246 13.1045 18.6223 12.6162L12.1938 6.36621C11.6915 5.87793 10.8759 5.87793 10.3737 6.36621C9.87143 6.85449 9.87143 7.64746 10.3737 8.13574L14.6125 12.2529H2.28571C1.57455 12.2529 1 12.8115 1 13.5029C1 14.1943 1.57455 14.7529 2.28571 14.7529H14.6085L10.3777 18.8701C9.87545 19.3584 9.87545 20.1514 10.3777 20.6396C10.8799 21.1279 11.6955 21.1279 12.1978 20.6396L18.6263 14.3896L18.6223 14.3857Z\"\n                                        fill=\"#3D3D46\" \/>\n                                <\/svg>\n                            <\/div>\n                            <p>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.<\/p>\n                        <\/div>\n                                                                                <div class=\"item\">\n                            <div>\n                                <svg width=\"20\" height=\"27\" viewBox=\"0 0 20 27\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                                    <path\n                                        d=\"M18.6223 14.3857C19.1246 13.8975 19.1246 13.1045 18.6223 12.6162L12.1938 6.36621C11.6915 5.87793 10.8759 5.87793 10.3737 6.36621C9.87143 6.85449 9.87143 7.64746 10.3737 8.13574L14.6125 12.2529H2.28571C1.57455 12.2529 1 12.8115 1 13.5029C1 14.1943 1.57455 14.7529 2.28571 14.7529H14.6085L10.3777 18.8701C9.87545 19.3584 9.87545 20.1514 10.3777 20.6396C10.8799 21.1279 11.6955 21.1279 12.1978 20.6396L18.6263 14.3896L18.6223 14.3857Z\"\n                                        fill=\"#3D3D46\" \/>\n                                <\/svg>\n                            <\/div>\n                            <p>The official descriptor does not mention internal fixation. A fracture through the mandible itself, plated with hardware, belongs to CPT 21461 or CPT 21462.<\/p>\n                        <\/div>\n                                                                                <div class=\"item\">\n                            <div>\n                                <svg width=\"20\" height=\"27\" viewBox=\"0 0 20 27\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                                    <path\n                                        d=\"M18.6223 14.3857C19.1246 13.8975 19.1246 13.1045 18.6223 12.6162L12.1938 6.36621C11.6915 5.87793 10.8759 5.87793 10.3737 6.36621C9.87143 6.85449 9.87143 7.64746 10.3737 8.13574L14.6125 12.2529H2.28571C1.57455 12.2529 1 12.8115 1 13.5029C1 14.1943 1.57455 14.7529 2.28571 14.7529H14.6085L10.3777 18.8701C9.87545 19.3584 9.87545 20.1514 10.3777 20.6396C10.8799 21.1279 11.6955 21.1279 12.1978 20.6396L18.6263 14.3896L18.6223 14.3857Z\"\n                                        fill=\"#3D3D46\" \/>\n                                <\/svg>\n                            <\/div>\n                            <p>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.<\/p>\n                        <\/div>\n                                                                                <div class=\"item\">\n                            <div>\n                                <svg width=\"20\" height=\"27\" viewBox=\"0 0 20 27\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                                    <path\n                                        d=\"M18.6223 14.3857C19.1246 13.8975 19.1246 13.1045 18.6223 12.6162L12.1938 6.36621C11.6915 5.87793 10.8759 5.87793 10.3737 6.36621C9.87143 6.85449 9.87143 7.64746 10.3737 8.13574L14.6125 12.2529H2.28571C1.57455 12.2529 1 12.8115 1 13.5029C1 14.1943 1.57455 14.7529 2.28571 14.7529H14.6085L10.3777 18.8701C9.87545 19.3584 9.87545 20.1514 10.3777 20.6396C10.8799 21.1279 11.6955 21.1279 12.1978 20.6396L18.6263 14.3896L18.6223 14.3857Z\"\n                                        fill=\"#3D3D46\" \/>\n                                <\/svg>\n                            <\/div>\n                            <p>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.<\/p>\n                        <\/div>\n                                                                                <div class=\"item\">\n                            <div>\n                                <svg width=\"20\" height=\"27\" viewBox=\"0 0 20 27\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                                    <path\n                                        d=\"M18.6223 14.3857C19.1246 13.8975 19.1246 13.1045 18.6223 12.6162L12.1938 6.36621C11.6915 5.87793 10.8759 5.87793 10.3737 6.36621C9.87143 6.85449 9.87143 7.64746 10.3737 8.13574L14.6125 12.2529H2.28571C1.57455 12.2529 1 12.8115 1 13.5029C1 14.1943 1.57455 14.7529 2.28571 14.7529H14.6085L10.3777 18.8701C9.87545 19.3584 9.87545 20.1514 10.3777 20.6396C10.8799 21.1279 11.6955 21.1279 12.1978 20.6396L18.6263 14.3896L18.6223 14.3857Z\"\n                                        fill=\"#3D3D46\" \/>\n                                <\/svg>\n                            <\/div>\n                            <p>Practice management software like Pabau attaches billing codes to the operative note, so coders work from what the surgeon actually recorded.<\/p>\n                        <\/div>\n                                                <\/div>\n        <\/div>\n    \n\n\n<p class=\"wp-block-paragraph\">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.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">The official descriptor says nothing about plates, screws, or wires. That trips billers up, because \u00abopen treatment\u00bb sounds like hardware fixation. A displaced fracture through the body of the mandible, stabilized with plates, belongs to CPT 21461 or CPT 21462 instead.<\/p>\n\n\n\n<div style=\"height:20px\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div>\n\n\n\n<figure class=\"wp-block-embed is-type-video is-provider-youtube wp-block-embed-youtube wp-embed-aspect-16-9 wp-has-aspect-ratio\"><div class=\"wp-block-embed__wrapper\">\n<iframe title=\"CPT Coding Pitfalls Every Medical Practice Faces\" width=\"800\" height=\"450\" src=\"https:\/\/www.youtube.com\/embed\/vbvV5okdXKg?feature=oembed\" frameborder=\"0\" allow=\"accelerometer; autoplay; clipboard-write; encrypted-media; gyroscope; picture-in-picture; web-share\" referrerpolicy=\"strict-origin-when-cross-origin\" allowfullscreen><\/iframe>\n<\/div><\/figure>\n\n\n\n<h2 id=\"h-what-cpt-code-21445-covers\" class=\"wp-block-heading\">What CPT code 21445 covers<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">The code sits in the <strong>Musculoskeletal &#8211; Head<\/strong> section of the <a href=\"https:\/\/www.ama-assn.org\/practice-management\/cpt\/cpt-code-set-overview\" target=\"_blank\" rel=\"nofollow noopener\">AMA CPT codebook<\/a>, 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.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">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 <a href=\"https:\/\/pabau.com\/industry\/sports-medicine-software\/\">sports medicine<\/a> teams both see these injuries.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">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, <a href=\"https:\/\/pabau.com\/procedure-codes\/cpt-code-21110\/\">CPT 21110<\/a>.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">CPT tags 21445 as a <strong>separate procedure<\/strong>. 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.<\/p>\n\n\n\n<table style=\"width:100%;border-collapse:separate;border-spacing:0;border-radius:12px;overflow:hidden;font-size:15px;line-height:1.5;margin:1.5em 0 2em;box-shadow:0 2px 12px rgba(0,0,0,0.08)\">\n<thead>\n<tr>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Attribute<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Detail<\/th>\n<\/tr>\n<\/thead>\n<tbody>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">CPT code<\/td>\n<td style=\"padding:12px 16px;color:#374151\">21445<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Full descriptor<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Open treatment of mandibular or maxillary alveolar ridge fracture (separate procedure)<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">CPT section<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Musculoskeletal &#8211; Head (Fracture and\/or Dislocation Procedures)<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Anatomy treated<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Alveolar ridge (tooth-bearing bone) of the mandible or the maxilla<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Internal fixation<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Not named in the descriptor. Arch bars, interdental wiring, or a splint are the usual stabilization<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Closed treatment counterpart<\/td>\n<td style=\"padding:12px 16px;color:#374151\">CPT 21440<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Often confused with<\/td>\n<td style=\"padding:12px 16px;color:#374151\">CPT 21461 and CPT 21462, which cover open treatment of a mandibular fracture<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Typical providers<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Oral and maxillofacial surgeons, ENT surgeons, plastic surgeons<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Global period<\/td>\n<td style=\"padding:12px 16px;color:#374151\">090, a 90-day major surgery package<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n\n\n<h2 id=\"h-medicare-reimbursement-rates-for-cpt-code-21445\" class=\"wp-block-heading\">Medicare reimbursement rates for CPT code 21445<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Medicare prices 21445 through the Resource-Based Relative Value Scale. The values below come from the January 2026 release of the <a href=\"https:\/\/www.cms.gov\/medicare\/payment\/fee-schedules\/physician\/pfs-relative-value-files\" target=\"_blank\" rel=\"nofollow noopener\">CMS relative value files<\/a>. Confirm your own locality figure in the <a href=\"https:\/\/www.cms.gov\/medicare\/physician-fee-schedule\/search\/overview\" target=\"_blank\" rel=\"nofollow noopener\">CMS fee schedule lookup<\/a> before you quote a rate.<\/p>\n\n\n\n<table style=\"width:100%;border-collapse:separate;border-spacing:0;border-radius:12px;overflow:hidden;font-size:15px;line-height:1.5;margin:1.5em 0 2em;box-shadow:0 2px 12px rgba(0,0,0,0.08)\">\n<thead>\n<tr>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">RVU component<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">2026 value for 21445<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">What it reflects<\/th>\n<\/tr>\n<\/thead>\n<tbody>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Work RVU<\/td>\n<td style=\"padding:12px 16px;color:#374151\">6.10<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Surgeon time, skill, and intensity for the alveolar repair<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Practice expense RVU (non-facility)<\/td>\n<td style=\"padding:12px 16px;color:#374151\">15.76<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Office overhead when the practice supplies staff, room, and materials<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Practice expense RVU (facility)<\/td>\n<td style=\"padding:12px 16px;color:#374151\">10.18<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Reduced overhead because the hospital or ASC bills its own costs<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Malpractice RVU<\/td>\n<td style=\"padding:12px 16px;color:#374151\">0.69<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Liability cost attached to the procedure<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Total RVUs (non-facility)<\/td>\n<td style=\"padding:12px 16px;color:#374151\">22.55<\/td>\n<td style=\"padding:12px 16px;color:#374151\">The office-setting total before geographic adjustment<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Total RVUs (facility)<\/td>\n<td style=\"padding:12px 16px;color:#374151\">16.97<\/td>\n<td style=\"padding:12px 16px;color:#374151\">The hospital or ASC total before geographic adjustment<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n\n\n<p class=\"wp-block-paragraph\">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.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">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 <a href=\"https:\/\/pabau.com\/procedure-codes\/bupa-procedure-codes-fee-schedule\/\">procedure code fee schedules<\/a>.<\/p>\n\n\n\n<h3 id=\"h-the-medicare-dental-exclusion-and-jaw-fractures\" class=\"wp-block-heading\">The Medicare dental exclusion and jaw fractures<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">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.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Trauma is treated differently. The <a href=\"https:\/\/www.cms.gov\/regulations-and-guidance\/guidance\/manuals\/downloads\/bp102c15.pdf\" target=\"_blank\" rel=\"nofollow noopener\">Medicare Benefit Policy Manual<\/a> 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.<\/p>\n\n\n\n<h3 id=\"h-geographic-payment-adjustments-gpci\" class=\"wp-block-heading\">Geographic payment adjustments (GPCI)<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">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.<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Work GPCI:<\/strong> Adjusts the physician work component. It runs from about 1.0 in rural areas to above 1.1 in high-cost localities.<\/li>\n\n\n\n<li><strong>Practice expense GPCI:<\/strong> Reflects local rent and staff wages. It is the biggest driver of variation for 21445, because the practice expense RVU is the largest component.<\/li>\n\n\n\n<li><strong>Malpractice GPCI:<\/strong> Adjusts for geographic differences in malpractice premiums. It moves the total least, since the malpractice RVU is only 0.69.<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">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.<\/p>\n\n\n\n<figure class=\"wp-block-image size-large\"><img decoding=\"async\" src=\"https:\/\/cdn.pabau.com\/cdn\/attachments\/pulse\/content-engine\/billing_codes\/cpt-code-21445\/fully-integrated-with-pabau-billing.webp\" alt=\"Fully Integrated with Pabau Billing\"\/><figcaption class=\"wp-element-caption\"><em>Pabau&#8217;s billing module sits inside the patient record, so a code like 21445 is attached to the operative note rather than rekeyed later.<\/em><\/figcaption><\/figure>\n\n\n\n<div style=\"height:35px\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div>\n\n\n\n<h3 id=\"h-place-of-service-and-facility-vs-non-facility-rates\" class=\"wp-block-heading\">Place of service and facility vs. non-facility rates<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">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.<\/p>\n\n\n\n<table style=\"width:100%;border-collapse:separate;border-spacing:0;border-radius:12px;overflow:hidden;font-size:15px;line-height:1.5;margin:1.5em 0 2em;box-shadow:0 2px 12px rgba(0,0,0,0.08)\">\n<thead>\n<tr>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">POS code<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Setting<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Rate type<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Notes<\/th>\n<\/tr>\n<\/thead>\n<tbody>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">POS 21<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Inpatient hospital<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Facility<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Common when the alveolar fracture accompanies other facial trauma<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">POS 22<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Outpatient hospital<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Facility<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Used when the repair is scheduled rather than done on the trauma admission<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">POS 24<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Ambulatory surgical center<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Facility<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Do not bill POS 11 for ASC work. The mismatch is a frequent recoupment trigger<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">POS 11<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Office<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Non-facility<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Medicare publishes a full office rate for 21445, so in-office repair is priced and payable<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n\n\n<h2 id=\"h-modifiers-that-apply-to-21445\" class=\"wp-block-heading\">Modifiers that apply to 21445<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">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.<\/p>\n\n\n\n<table style=\"width:100%;border-collapse:separate;border-spacing:0;border-radius:12px;overflow:hidden;font-size:15px;line-height:1.5;margin:1.5em 0 2em;box-shadow:0 2px 12px rgba(0,0,0,0.08)\">\n<thead>\n<tr>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Modifier<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Name<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">How it applies to 21445<\/th>\n<\/tr>\n<\/thead>\n<tbody>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">59 or XS<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Distinct procedural service<\/td>\n<td style=\"padding:12px 16px;color:#374151\">The route around the separate procedure designation. Use it when the alveolar repair is at a site distinct from the other jaw surgery<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">51<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Multiple procedures<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Multiple procedure indicator 2, so standard reductions apply. Append it to the lower-valued code in the session<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">50<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Bilateral procedure<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Bilateral indicator 0, so the 150% adjustment does not apply. Appending 50 will not increase payment<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">80<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Assistant surgeon<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Assistant indicator 2, so an assistant may be paid without extra documentation. Payment runs at 16% of the allowable<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">AS<\/td>\n<td style=\"padding:12px 16px;color:#374151\">PA or NP assistant at surgery<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Used when a non-physician assists. Payment runs at 85% of the assistant-at-surgery amount<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">62<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Two surgeons<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Co-surgery indicator 0, so co-surgeons are not permitted on this code. A 62 claim will be denied<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">66<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Team surgery<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Team surgery indicator 0, so team surgery is not permitted on 21445<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">LT or RT<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Left or right side<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Some MACs ask for laterality on mandibular sites. Check your local coverage article before appending<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n\n        <div id=\"pro_tip\">\n            <div class=\"img\">\n                <svg width=\"42\" height=\"42\" viewBox=\"0 0 42 42\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                    <path fill-rule=\"evenodd\" clip-rule=\"evenodd\"\n                        d=\"M12.6383 19.5238C12.6632 21.2071 12.8734 22.9926 12.0685 24.5523C11.0341 26.8917 8.45076 28.169 7.56292 30.5918C6.63082 33.1061 7.19505 36.185 9.31371 37.9786C10.929 39.5678 13.4183 39.9873 15.6061 39.5463C17.4592 39.073 19.1049 37.8388 19.9706 36.1608C20.781 34.7141 20.7866 32.9904 20.5293 31.3985C20.1006 29.3092 18.3775 27.8705 16.9807 26.362C14.8814 24.1005 14.6684 20.6854 15.595 17.8915C16.4331 15.4768 19.0026 14.2344 20.0425 11.9461C20.7202 10.6769 20.7506 9.20327 20.6068 7.81304C20.1864 5.40098 18.3139 3.23631 15.8716 2.56674C13.9742 2.03969 11.8224 2.30052 10.1739 3.37614C8.70522 4.34688 7.5878 5.86618 7.28356 7.58178C6.76081 9.82981 7.53525 12.2822 9.20307 13.9118C10.7658 15.4741 12.4806 17.2273 12.6383 19.5238Z\"\n                        fill=\"#2BADD4\" \/>\n                    <path fill-rule=\"evenodd\" clip-rule=\"evenodd\"\n                        d=\"M22.7048 19.8387C22.6822 22.3279 24.4507 24.6234 26.7493 25.4682C28.0531 25.961 29.4725 25.9183 30.7989 25.5487C32.0575 24.9955 33.301 24.2237 34.0069 23.0092C34.8384 21.5811 35.2982 19.8286 34.7832 18.2094C34.3611 16.2507 32.8739 14.6541 31.0275 13.9426C28.6736 12.9595 25.8073 13.7942 24.1719 15.7001C23.2022 16.8366 22.6143 18.3326 22.7048 19.8387Z\"\n                        fill=\"#2BADD4\" \/>\n                <\/svg>\n            <\/div>\n            <div class=\"text\">\n                <h3>Pro Tip<\/h3>\n                <p>Stop appending modifier 50 to 21445 out of habit. The 2026 CMS fee schedule file gives the code a bilateral surgery indicator of 0. The 150% bilateral adjustment does not apply, so the claim pays at the single-procedure rate either way. The same file gives 21445 a co-surgery indicator of 0, which means a modifier 62 claim will be denied. Pull the payment policy indicators once, save them next to the code in your billing system, and you remove two denial sources permanently.<\/p>\n            <\/div>\n        <\/div>\n    \n\n\n<h2 id=\"h-documentation-requirements\" class=\"wp-block-heading\">Documentation requirements<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">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 <a href=\"https:\/\/pabau.com\/blog\/hipaa-compliance-for-medical-offices\/\">HIPAA documentation rules<\/a>, which govern who may open it and how long you keep it.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">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 <a href=\"https:\/\/pabau.com\/procedure-codes\/cpt-code-21470\/\">CPT 21470<\/a>.<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Operative report:<\/strong> Describe the incision, the exposure of the alveolar segment, the reduction, and the stabilization used. Name the arch bars, wires, or splint applied.<\/li>\n\n\n\n<li><strong>Fracture site:<\/strong> State that the fracture involved the alveolar ridge, and say whether it was maxillary or mandibular. Record laterality for mandibular cases.<\/li>\n\n\n\n<li><strong>Teeth involved:<\/strong> List the tooth numbers in the mobile segment. Note any avulsed, luxated, or fractured teeth treated at the same time.<\/li>\n\n\n\n<li><strong>Medical necessity for open treatment:<\/strong> Explain why closed reduction was not adequate. Segment mobility, displacement, and failed closed reduction are the usual reasons.<\/li>\n\n\n\n<li><strong>Imaging:<\/strong> Attach or reference the panoramic radiograph, periapical films, or CT that confirm the alveolar fracture and its displacement.<\/li>\n\n\n\n<li><strong>Separate procedure justification:<\/strong> If another jaw procedure was billed the same day, document why the alveolar repair was distinct from it.<\/li>\n\n\n\n<li><strong>Post-operative plan:<\/strong> Record the follow-up schedule, the date the fixation comes off, and the diet or function restrictions given.<\/li>\n<\/ul>\n\n\n\n<h2 id=\"h-icd-10-diagnosis-codes-used-with-cpt-code-21445\" class=\"wp-block-heading\">ICD-10 diagnosis codes used with CPT code 21445<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">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 <a href=\"https:\/\/pabau.com\/diagnostic-codes\/icd-10-code-s02642a\/\">S02.642A<\/a>, and it will not carry a 21445 claim.<\/p>\n\n\n\n<table style=\"width:100%;border-collapse:separate;border-spacing:0;border-radius:12px;overflow:hidden;font-size:15px;line-height:1.5;margin:1.5em 0 2em;box-shadow:0 2px 12px rgba(0,0,0,0.08)\">\n<thead>\n<tr>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">ICD-10-CM code<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Description<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Notes<\/th>\n<\/tr>\n<\/thead>\n<tbody>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">S02.671A<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Fracture of alveolus of right mandible, initial encounter for closed fracture<\/td>\n<td style=\"padding:12px 16px;color:#374151\">The most specific mandibular option. Use it whenever the note gives a side<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">S02.672A<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Fracture of alveolus of left mandible, initial encounter for closed fracture<\/td>\n<td style=\"padding:12px 16px;color:#374151\">The left-side counterpart. Laterality is required at this level of the code<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">S02.670A<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Fracture of alveolus of mandible, unspecified side, initial encounter for closed fracture<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Use only when the record genuinely does not establish a side<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">S02.42XA<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Fracture of alveolus of maxilla, initial encounter for closed fracture<\/td>\n<td style=\"padding:12px 16px;color:#374151\">The maxillary option. ICD-10 gives it no laterality, so no side is reported<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">S02.671B<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Fracture of alveolus of right mandible, initial encounter for open fracture<\/td>\n<td style=\"padding:12px 16px;color:#374151\">For a wound that communicates with the fracture, not for open surgical treatment<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">S02.5XXA<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Fracture of tooth (traumatic), initial encounter for closed fracture<\/td>\n<td style=\"padding:12px 16px;color:#374151\">A secondary code when teeth in the segment are fractured as well<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">S02.671D<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Fracture of alveolus of right mandible, subsequent encounter for fracture with routine healing<\/td>\n<td style=\"padding:12px 16px;color:#374151\">For separately billable follow-up after the operative episode<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n\n\n<p class=\"wp-block-paragraph\">The 7th character is where alveolar claims come apart. Under the S02 categories, A means initial encounter for a <em>closed<\/em> fracture and B means initial encounter for an <em>open<\/em> fracture. Open there describes a wound that reaches the bone. It has nothing to do with open surgical treatment.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">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 \u00abwe opened it\u00bb 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.<\/p>\n\n\n\n<h2 id=\"h-global-period-and-post-operative-billing-for-cpt-21445\" class=\"wp-block-heading\">Global period and post-operative billing for CPT 21445<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">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 <a href=\"https:\/\/pabau.com\/features\/medical-records-management\/\">patient record<\/a> can track the global end date alongside it.<\/p>\n\n\n\n<figure class=\"wp-block-image size-large\"><img decoding=\"async\" src=\"https:\/\/cdn.pabau.com\/cdn\/attachments\/pulse\/content-engine\/billing_codes\/cpt-code-21445\/digital-forms.webp\" alt=\"Digital forms\"\/><figcaption class=\"wp-element-caption\"><em>Digital forms capture the fracture site, the teeth involved, and the fixation used, so the 21445 claim is supported before it leaves the practice.<\/em><\/figcaption><\/figure>\n\n\n\n<div style=\"height:35px\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div>\n\n\n\n<p class=\"wp-block-paragraph\">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.<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Included in the package:<\/strong> Routine post-operative visits, wound checks, suture removal, and the removal of the arch bars or wiring placed at surgery.<\/li>\n\n\n\n<li><strong>Unrelated care (modifier 24 or 79):<\/strong> An unrelated condition treated during the 90 days takes modifier 24. An unrelated return to the OR takes modifier 79.<\/li>\n\n\n\n<li><strong>Complications (modifier 78):<\/strong> A return to the OR for a complication of the alveolar repair. Payment reflects the intra-operative work only.<\/li>\n\n\n\n<li><strong>Staged work (modifier 58):<\/strong> Planned staged or related procedures, such as later dental restoration of the segment by the same surgeon.<\/li>\n<\/ul>\n\n\n\n<h2 id=\"h-related-cpt-codes-cpt-21440-vs-cpt-21445\" class=\"wp-block-heading\">Related CPT codes: 21440, 21445, 21461, and 21462<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">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 <em>alveolar ridge<\/em> fracture. CPT 21461 and 21462 are the open options for a <em>mandibular<\/em> fracture. Billing teams in <a href=\"https:\/\/pabau.com\/industry\/plastic-surgery-emr\/\">plastic surgery<\/a> and oral surgery practices meet this distinction constantly.<\/p>\n\n\n\n<table style=\"width:100%;border-collapse:separate;border-spacing:0;border-radius:12px;overflow:hidden;font-size:15px;line-height:1.5;margin:1.5em 0 2em;box-shadow:0 2px 12px rgba(0,0,0,0.08)\">\n<thead>\n<tr>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Code<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Descriptor<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Work RVU<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Total RVUs (facility)<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">When to use it<\/th>\n<\/tr>\n<\/thead>\n<tbody>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">21440<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Closed treatment of mandibular or maxillary alveolar ridge fracture (separate procedure)<\/td>\n<td style=\"padding:12px 16px;color:#374151\">3.35<\/td>\n<td style=\"padding:12px 16px;color:#374151\">18.01<\/td>\n<td style=\"padding:12px 16px;color:#374151\">The segment is reduced and splinted without surgical exposure<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">21445<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Open treatment of mandibular or maxillary alveolar ridge fracture (separate procedure)<\/td>\n<td style=\"padding:12px 16px;color:#374151\">6.10<\/td>\n<td style=\"padding:12px 16px;color:#374151\">16.97<\/td>\n<td style=\"padding:12px 16px;color:#374151\">The alveolar segment is surgically exposed, reduced, and stabilized<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">21461<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Open treatment of mandibular fracture without interdental fixation<\/td>\n<td style=\"padding:12px 16px;color:#374151\">9.08<\/td>\n<td style=\"padding:12px 16px;color:#374151\">29.05<\/td>\n<td style=\"padding:12px 16px;color:#374151\">A fracture through the mandible itself, plated without interdental fixation<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">21462<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Open treatment of mandibular fracture with interdental fixation<\/td>\n<td style=\"padding:12px 16px;color:#374151\">10.73<\/td>\n<td style=\"padding:12px 16px;color:#374151\">33.13<\/td>\n<td style=\"padding:12px 16px;color:#374151\">The same repair, with the jaws wired or banded together as part of it<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n\n\n<p class=\"wp-block-paragraph\">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.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Facial trauma rarely stays in one place. A malar area fracture treated percutaneously is <a href=\"https:\/\/pabau.com\/procedure-codes\/cpt-code-21355\/\">CPT 21355<\/a>, and a nasomaxillary complex fracture is <a href=\"https:\/\/pabau.com\/procedure-codes\/cpt-code-21346\/\">CPT 21346<\/a>.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">A fracture of the palate or the maxilla above the alveolus takes <a href=\"https:\/\/pabau.com\/procedure-codes\/cpt-code-21422\/\">CPT 21422<\/a>. Apply the separate procedure rule before you report any of them alongside 21445.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">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 <a href=\"https:\/\/www.aapc.com\/codes\/cpt-codes-range\/\" target=\"_blank\" rel=\"nofollow noopener\">AAPC CPT code lookup<\/a> or the AMA CPT codebook.<\/p>\n\n\n\n<h2 id=\"h-common-billing-errors-and-denial-reasons\" class=\"wp-block-heading\">Common billing errors and denial reasons<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">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.<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Coding a jawbone fracture as 21445:<\/strong> 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.<\/li>\n\n\n\n<li><strong>Ignoring the separate procedure rule:<\/strong> 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.<\/li>\n\n\n\n<li><strong>Expecting bilateral payment:<\/strong> 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.<\/li>\n\n\n\n<li><strong>Billing co-surgery:<\/strong> Modifier 62 is not payable on 21445. The co-surgery indicator is 0, so both surgeons&#8217; claims are denied.<\/li>\n\n\n\n<li><strong>Wrong 7th character:<\/strong> Using B because the fracture was treated openly. B means an open wound at the fracture, so most 21445 claims should carry A.<\/li>\n\n\n\n<li><strong>Missing laterality:<\/strong> Submitting S02.670A when the note names a side. The mandibular alveolus codes require right or left, and payers reject the unspecified option.<\/li>\n\n\n\n<li><strong>Wrong place of service:<\/strong> 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.<\/li>\n<\/ul>\n\n\n        <div id=\"pro_tip\">\n            <div class=\"img\">\n                <svg width=\"42\" height=\"42\" viewBox=\"0 0 42 42\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                    <path fill-rule=\"evenodd\" clip-rule=\"evenodd\"\n                        d=\"M12.6383 19.5238C12.6632 21.2071 12.8734 22.9926 12.0685 24.5523C11.0341 26.8917 8.45076 28.169 7.56292 30.5918C6.63082 33.1061 7.19505 36.185 9.31371 37.9786C10.929 39.5678 13.4183 39.9873 15.6061 39.5463C17.4592 39.073 19.1049 37.8388 19.9706 36.1608C20.781 34.7141 20.7866 32.9904 20.5293 31.3985C20.1006 29.3092 18.3775 27.8705 16.9807 26.362C14.8814 24.1005 14.6684 20.6854 15.595 17.8915C16.4331 15.4768 19.0026 14.2344 20.0425 11.9461C20.7202 10.6769 20.7506 9.20327 20.6068 7.81304C20.1864 5.40098 18.3139 3.23631 15.8716 2.56674C13.9742 2.03969 11.8224 2.30052 10.1739 3.37614C8.70522 4.34688 7.5878 5.86618 7.28356 7.58178C6.76081 9.82981 7.53525 12.2822 9.20307 13.9118C10.7658 15.4741 12.4806 17.2273 12.6383 19.5238Z\"\n                        fill=\"#2BADD4\" \/>\n                    <path fill-rule=\"evenodd\" clip-rule=\"evenodd\"\n                        d=\"M22.7048 19.8387C22.6822 22.3279 24.4507 24.6234 26.7493 25.4682C28.0531 25.961 29.4725 25.9183 30.7989 25.5487C32.0575 24.9955 33.301 24.2237 34.0069 23.0092C34.8384 21.5811 35.2982 19.8286 34.7832 18.2094C34.3611 16.2507 32.8739 14.6541 31.0275 13.9426C28.6736 12.9595 25.8073 13.7942 24.1719 15.7001C23.2022 16.8366 22.6143 18.3326 22.7048 19.8387Z\"\n                        fill=\"#2BADD4\" \/>\n                <\/svg>\n            <\/div>\n            <div class=\"text\">\n                <h3>Pro Tip<\/h3>\n                <p>Audit any encounter where 21445 and 21440 appear together. Both codes describe the same alveolar ridge, so billing them for one fracture on one date is an obvious auditor flag. If two separate alveolar segments were genuinely treated, make sure the operative note names each site distinctly and append modifier 51 to the lower-valued code. Run the same check against 21461 and 21462, which frequently absorb an alveolar repair at the same site.<\/p>\n            <\/div>\n        <\/div>\n    \n\n\n<h2 id=\"h-billing-cpt-code-21445-with-pabau\" class=\"wp-block-heading\">Billing CPT code 21445 with Pabau<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">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.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">The <a href=\"https:\/\/pabau.com\/features\/claims-management-software\/\">claims management software<\/a> 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.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">The result is fewer records requests and a shorter revenue cycle on surgical claims. Read more about how <a href=\"https:\/\/pabau.com\/blog\/practice-management-software\/\">oral surgery practice management<\/a> software joins the clinical and financial sides of the practice.<\/p>\n\n\n        <div id=\"book_a_demo\">\n            <div class=\"left-side\">\n                <div class=\"logo\">\n                    <img decoding=\"async\"\n                        src=\"https:\/\/pabau.com\/wp-content\/uploads\/2026\/01\/Logo.svg\"\n                        alt=\"Logo\"\n                        loading=\"lazy\"\n                    \/>\n                <\/div>\n\n                <h3 class=\"heading\">\n                    Keep alveolar ridge claims tied to the operative note                <\/h3>\n\n                <p class=\"description\">\n                    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.                <\/p>\n\n                <div class=\"button-group\">\n                    <a href=\"\/book-demo\/\" class=\"btn btn-scale-effect btn-cta-color btn-md\">\n                        <span class=\"btn-text\">Book a demo<\/span>\n                        <div class=\"btn-icon btn-icon-right\" aria-hidden=\"true\">\n                            <svg\n                                width=\"14\"\n                                height=\"12\"\n                                viewBox=\"0 0 14 12\"\n                                fill=\"none\"\n                                xmlns=\"http:\/\/www.w3.org\/2000\/svg\"\n                            >\n                                <path\n                                    d=\"M0.75 4.77295C0.335786 4.77295 0 5.10874 0 5.52295C0 5.93716 0.335786 6.27295 0.75 6.27295V5.52295V4.77295ZM13.2803 6.05328C13.5732 5.76039 13.5732 5.28551 13.2803 4.99262L8.50736 0.219648C8.21447 -0.073245 7.73959 -0.073245 7.4467 0.219648C7.15381 0.512542 7.15381 0.987415 7.4467 1.28031L11.6893 5.52295L7.4467 9.76559C7.15381 10.0585 7.15381 10.5334 7.4467 10.8263C7.73959 11.1191 8.21447 11.1191 8.50736 10.8263L13.2803 6.05328ZM0.75 5.52295V6.27295L12.75 6.27295V5.52295V4.77295L0.75 4.77295V5.52295Z\"\n                                    fill=\"currentColor\"\n                                ><\/path>\n                            <\/svg>\n                        <\/div>\n                    <\/a>\n                <\/div>\n            <\/div>\n\n            <div class=\"right-side\">\n                <img decoding=\"async\"\n                    src=\"https:\/\/pabau.com\/wp-content\/uploads\/2026\/01\/Home-Page-Concept-4.webp\"\n                    alt=\"Pabau claims management dashboard\"\n                    loading=\"lazy\"\n                \/>\n            <\/div>\n        <\/div>\n        \n\n\n<h2 id=\"h-conclusion\" class=\"wp-block-heading\">Conclusion<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">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.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">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, <a href=\"https:\/\/pabau.com\/book-demo\/\">book a demo<\/a>.<\/p>\n\n\n        <div id=\"expert_picks\">\n            <div class=\"header\">\n                                    <img decoding=\"async\" src=\"https:\/\/pabau.com\/wp-content\/uploads\/2025\/11\/Expert-Picks.svg\" alt=\"Continue your research\" height=\"42\" width=\"42\">\n                                <h3>Continue your research<\/h3>\n            <\/div>\n            <div class=\"content\">\n                                                            <div class=\"item\">\n                            <div>\n                                <svg width=\"20\" height=\"27\" viewBox=\"0 0 20 27\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                                    <path\n                                        d=\"M18.6223 14.3857C19.1246 13.8975 19.1246 13.1045 18.6223 12.6162L12.1938 6.36621C11.6915 5.87793 10.8759 5.87793 10.3737 6.36621C9.87143 6.85449 9.87143 7.64746 10.3737 8.13574L14.6125 12.2529H2.28571C1.57455 12.2529 1 12.8115 1 13.5029C1 14.1943 1.57455 14.7529 2.28571 14.7529H14.6085L10.3777 18.8701C9.87545 19.3584 9.87545 20.1514 10.3777 20.6396C10.8799 21.1279 11.6955 21.1279 12.1978 20.6396L18.6263 14.3896L18.6223 14.3857Z\"\n                                        fill=\"#54B2D3\" \/>\n                                <\/svg>\n                            <\/div>\n                            <p><strong>Billing another facial fracture?<\/strong> <a href=\"https:\/\/pabau.com\/procedure-codes\/cpt-code-21407\/\">CPT 21407<\/a> covers open treatment of an orbital fracture with an implant.<\/p>\n                        <\/div>\n                                                                                <div class=\"item\">\n                            <div>\n                                <svg width=\"20\" height=\"27\" viewBox=\"0 0 20 27\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                                    <path\n                                        d=\"M18.6223 14.3857C19.1246 13.8975 19.1246 13.1045 18.6223 12.6162L12.1938 6.36621C11.6915 5.87793 10.8759 5.87793 10.3737 6.36621C9.87143 6.85449 9.87143 7.64746 10.3737 8.13574L14.6125 12.2529H2.28571C1.57455 12.2529 1 12.8115 1 13.5029C1 14.1943 1.57455 14.7529 2.28571 14.7529H14.6085L10.3777 18.8701C9.87545 19.3584 9.87545 20.1514 10.3777 20.6396C10.8799 21.1279 11.6955 21.1279 12.1978 20.6396L18.6263 14.3896L18.6223 14.3857Z\"\n                                        fill=\"#54B2D3\" \/>\n                                <\/svg>\n                            <\/div>\n                            <p><strong>Rebuilding the jaw after trauma?<\/strong> <a href=\"https:\/\/pabau.com\/procedure-codes\/cpt-code-21215\/\">CPT 21215<\/a> sets out the RVUs and modifiers for a mandibular bone graft.<\/p>\n                        <\/div>\n                                                                                <div class=\"item\">\n                            <div>\n                                <svg width=\"20\" height=\"27\" viewBox=\"0 0 20 27\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                                    <path\n                                        d=\"M18.6223 14.3857C19.1246 13.8975 19.1246 13.1045 18.6223 12.6162L12.1938 6.36621C11.6915 5.87793 10.8759 5.87793 10.3737 6.36621C9.87143 6.85449 9.87143 7.64746 10.3737 8.13574L14.6125 12.2529H2.28571C1.57455 12.2529 1 12.8115 1 13.5029C1 14.1943 1.57455 14.7529 2.28571 14.7529H14.6085L10.3777 18.8701C9.87545 19.3584 9.87545 20.1514 10.3777 20.6396C10.8799 21.1279 11.6955 21.1279 12.1978 20.6396L18.6263 14.3896L18.6223 14.3857Z\"\n                                        fill=\"#54B2D3\" \/>\n                                <\/svg>\n                            <\/div>\n                            <p><strong>Fracture still not healed?<\/strong> <a href=\"https:\/\/pabau.com\/diagnostic-codes\/icd-10-code-s02651k\/\">S02.651K<\/a> is the diagnosis for nonunion at the angle of the right mandible.<\/p>\n                        <\/div>\n                                                                                <div class=\"item\">\n                            <div>\n                                <svg width=\"20\" height=\"27\" viewBox=\"0 0 20 27\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                                    <path\n                                        d=\"M18.6223 14.3857C19.1246 13.8975 19.1246 13.1045 18.6223 12.6162L12.1938 6.36621C11.6915 5.87793 10.8759 5.87793 10.3737 6.36621C9.87143 6.85449 9.87143 7.64746 10.3737 8.13574L14.6125 12.2529H2.28571C1.57455 12.2529 1 12.8115 1 13.5029C1 14.1943 1.57455 14.7529 2.28571 14.7529H14.6085L10.3777 18.8701C9.87545 19.3584 9.87545 20.1514 10.3777 20.6396C10.8799 21.1279 11.6955 21.1279 12.1978 20.6396L18.6263 14.3896L18.6223 14.3857Z\"\n                                        fill=\"#54B2D3\" \/>\n                                <\/svg>\n                            <\/div>\n                            <p><strong>Following the patient through healing?<\/strong> <a href=\"https:\/\/pabau.com\/diagnostic-codes\/icd-10-code-s02600d\/\">S02.600D<\/a> covers a body-of-mandible fracture seen at a routine follow-up visit.<\/p>\n                        <\/div>\n                                                                                <div class=\"item\">\n                            <div>\n                                <svg width=\"20\" height=\"27\" viewBox=\"0 0 20 27\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                                    <path\n                                        d=\"M18.6223 14.3857C19.1246 13.8975 19.1246 13.1045 18.6223 12.6162L12.1938 6.36621C11.6915 5.87793 10.8759 5.87793 10.3737 6.36621C9.87143 6.85449 9.87143 7.64746 10.3737 8.13574L14.6125 12.2529H2.28571C1.57455 12.2529 1 12.8115 1 13.5029C1 14.1943 1.57455 14.7529 2.28571 14.7529H14.6085L10.3777 18.8701C9.87545 19.3584 9.87545 20.1514 10.3777 20.6396C10.8799 21.1279 11.6955 21.1279 12.1978 20.6396L18.6263 14.3896L18.6223 14.3857Z\"\n                                        fill=\"#54B2D3\" \/>\n                                <\/svg>\n                            <\/div>\n                            <p><strong>Treating a lesion rather than a fracture?<\/strong> <a href=\"https:\/\/pabau.com\/procedure-codes\/cpt-code-21047\/\">CPT 21047<\/a> covers excision of a benign tumor or cyst of the mandible.<\/p>\n                        <\/div>\n                                                <\/div>\n        <\/div>\n    \n\n\n<h2 id=\"h-frequently-asked-questions\" class=\"wp-block-heading\">Frequently asked questions<\/h2>\n\n\n\n<div class=\"schema-faq wp-block-yoast-faq-block\"><div class=\"schema-faq-section\" id=\"faq-question-1786435254678\"><h3 class=\"schema-faq-question\">What is CPT code 21445 used for?<\/h3> <p class=\"schema-faq-answer\">CPT code 21445 bills 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. Surgeons report it when that segment is surgically exposed, repositioned, and stabilized. Its closed-treatment counterpart is CPT 21440.<\/p> <\/div> <div class=\"schema-faq-section\" id=\"faq-question-1786435254679\"><h3 class=\"schema-faq-question\">Does CPT 21445 include internal fixation?<\/h3> <p class=\"schema-faq-answer\">No. The official descriptor for 21445 says nothing about internal fixation. Alveolar segments are usually held with arch bars, interdental wiring, or a splint. A mandibular fracture repaired with plates and screws belongs to CPT 21461 or CPT 21462 instead.<\/p> <\/div> <div class=\"schema-faq-section\" id=\"faq-question-1786435254680\"><h3 class=\"schema-faq-question\">What is the difference between CPT 21440 and CPT 21445?<\/h3> <p class=\"schema-faq-answer\">Both codes describe the same alveolar ridge fracture. CPT 21440 covers closed treatment, where the segment is reduced without surgical exposure. CPT 21445 covers open treatment, where the surgeon opens the site. 21445 carries the higher work RVU, at 6.10 against 3.35. Its total RVUs are lower, because 21440 has the larger practice expense value.<\/p> <\/div> <div class=\"schema-faq-section\" id=\"faq-question-1786435254681\"><h3 class=\"schema-faq-question\">What ICD-10 codes are used with CPT 21445?<\/h3> <p class=\"schema-faq-answer\">Use S02.671A or S02.672A for a right or left mandibular alveolus fracture, and S02.42XA for the maxillary alveolus. S02.670A covers an unspecified side. Add S02.5XXA when teeth in the segment are fractured too. The 7th character A means a closed fracture, not closed treatment.<\/p> <\/div> <div class=\"schema-faq-section\" id=\"faq-question-1786435254682\"><h3 class=\"schema-faq-question\">What is the global period for CPT 21445?<\/h3> <p class=\"schema-faq-answer\">CPT 21445 carries a global period of 090, the 90-day major surgery package. Routine post-operative visits, wound checks, and removal of the fixation placed at surgery are all included. Separately billable work inside the window needs modifier 24, 58, 78, or 79.<\/p> <\/div> <div class=\"schema-faq-section\" id=\"faq-question-1786435254683\"><h3 class=\"schema-faq-question\">Which modifiers apply to CPT code 21445?<\/h3> <p class=\"schema-faq-answer\">Modifier 51 covers multiple procedures, and modifier 59 or XS handles the separate procedure designation. Modifier 80 or AS covers an assistant at surgery. Modifier 50 gains nothing, because CMS gives the code a bilateral indicator of 0. Modifier 62 is not payable, since co-surgery is not permitted on this code.<\/p> <\/div> <div class=\"schema-faq-section\" id=\"faq-question-1786435254684\"><h3 class=\"schema-faq-question\">Can CPT 21445 be billed with another jaw procedure?<\/h3> <p class=\"schema-faq-answer\">Only when the alveolar repair is distinct from the other procedure. CPT designates 21445 a separate procedure, so it bundles when it forms part of a larger operation at the same site. Document each site separately and append modifier 59 or XS when the work is genuinely independent.<\/p> <\/div> <div class=\"schema-faq-section\" id=\"faq-question-1786435254685\"><h3 class=\"schema-faq-question\">What documentation is required to bill CPT 21445?<\/h3> <p class=\"schema-faq-answer\">The operative note must name the alveolar ridge as the fracture site, and state the jaw and the laterality. List the teeth in the mobile segment, then describe the exposure and the stabilization used. Add imaging that confirms the fracture, plus a statement of why closed reduction was not adequate.<\/p> <\/div> <\/div>\n\n","protected":false},"excerpt":{"rendered":"<p>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 [&hellip;]<\/p>\n","protected":false},"author":82,"featured_media":175529,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_yoast_wpseo_linkdex":"83","_yoast_wpseo_content_score":"30","_yoast_wpseo_is_cornerstone":"","_yoast_wpseo_keywordsynonyms":"[\"\",\"\",\"\",\"\"]","_yoast_wpseo_focuskw_text_input":"","_seo_original_html":"","footnotes":""},"categories":[1433,1546],"tags":[2405,1162,2776,1602,3368],"class_list":["post-175530","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-billing-codes","category-cpt-codes","tag-cpt-code-documentation","tag-cpt-codes","tag-cpt-coding","tag-cpt-modifiers","tag-oral-surgery-billing"],"yoast_head":"<!-- This site is optimized with the Yoast SEO Premium plugin v28.2 (Yoast SEO v28.2) - https:\/\/yoast.com\/product\/yoast-seo-premium-wordpress\/ -->\n<title>CPT code 21445: Alveolar ridge fracture billing guide 2026<\/title>\n<meta name=\"description\" content=\"CPT 21445 covers open treatment of an alveolar ridge fracture, not a plated mandible. See 2026 RVUs, modifiers and ICD-10 codes.\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/pabau.com\/es\/procedure-codes\/cpt-code-21445\/\" \/>\n<meta property=\"og:locale\" content=\"es_ES\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"CPT code 21445: Alveolar ridge fracture billing guide 2026\" \/>\n<meta property=\"og:description\" content=\"CPT 21445 covers open treatment of an alveolar ridge fracture, not a plated mandible. 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Off the clock: binging true crime docuseries, baking and dreaming about travel.\",\"url\":\"https:\\\/\\\/pabau.com\\\/es\\\/blog\\\/author\\\/maja-popovska\\\/\"},{\"@type\":\"Question\",\"@id\":\"https:\\\/\\\/pabau.com\\\/es\\\/procedure-codes\\\/cpt-code-21445\\\/#faq-question-1786435254678\",\"position\":1,\"url\":\"https:\\\/\\\/pabau.com\\\/es\\\/procedure-codes\\\/cpt-code-21445\\\/#faq-question-1786435254678\",\"name\":\"What is CPT code 21445 used for?\",\"answerCount\":1,\"acceptedAnswer\":{\"@type\":\"Answer\",\"text\":\"CPT code 21445 bills 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. Surgeons report it when that segment is surgically exposed, repositioned, and stabilized. Its closed-treatment counterpart is CPT 21440.\",\"inLanguage\":\"es\"},\"inLanguage\":\"es\"},{\"@type\":\"Question\",\"@id\":\"https:\\\/\\\/pabau.com\\\/es\\\/procedure-codes\\\/cpt-code-21445\\\/#faq-question-1786435254679\",\"position\":2,\"url\":\"https:\\\/\\\/pabau.com\\\/es\\\/procedure-codes\\\/cpt-code-21445\\\/#faq-question-1786435254679\",\"name\":\"Does CPT 21445 include internal fixation?\",\"answerCount\":1,\"acceptedAnswer\":{\"@type\":\"Answer\",\"text\":\"No. The official descriptor for 21445 says nothing about internal fixation. Alveolar segments are usually held with arch bars, interdental wiring, or a splint. A mandibular fracture repaired with plates and screws belongs to CPT 21461 or CPT 21462 instead.\",\"inLanguage\":\"es\"},\"inLanguage\":\"es\"},{\"@type\":\"Question\",\"@id\":\"https:\\\/\\\/pabau.com\\\/es\\\/procedure-codes\\\/cpt-code-21445\\\/#faq-question-1786435254680\",\"position\":3,\"url\":\"https:\\\/\\\/pabau.com\\\/es\\\/procedure-codes\\\/cpt-code-21445\\\/#faq-question-1786435254680\",\"name\":\"What is the difference between CPT 21440 and CPT 21445?\",\"answerCount\":1,\"acceptedAnswer\":{\"@type\":\"Answer\",\"text\":\"Both codes describe the same alveolar ridge fracture. CPT 21440 covers closed treatment, where the segment is reduced without surgical exposure. CPT 21445 covers open treatment, where the surgeon opens the site. 21445 carries the higher work RVU, at 6.10 against 3.35. Its total RVUs are lower, because 21440 has the larger practice expense value.\",\"inLanguage\":\"es\"},\"inLanguage\":\"es\"},{\"@type\":\"Question\",\"@id\":\"https:\\\/\\\/pabau.com\\\/es\\\/procedure-codes\\\/cpt-code-21445\\\/#faq-question-1786435254681\",\"position\":4,\"url\":\"https:\\\/\\\/pabau.com\\\/es\\\/procedure-codes\\\/cpt-code-21445\\\/#faq-question-1786435254681\",\"name\":\"What ICD-10 codes are used with CPT 21445?\",\"answerCount\":1,\"acceptedAnswer\":{\"@type\":\"Answer\",\"text\":\"Use S02.671A or S02.672A for a right or left mandibular alveolus fracture, and S02.42XA for the maxillary alveolus. S02.670A covers an unspecified side. Add S02.5XXA when teeth in the segment are fractured too. The 7th character A means a closed fracture, not closed treatment.\",\"inLanguage\":\"es\"},\"inLanguage\":\"es\"},{\"@type\":\"Question\",\"@id\":\"https:\\\/\\\/pabau.com\\\/es\\\/procedure-codes\\\/cpt-code-21445\\\/#faq-question-1786435254682\",\"position\":5,\"url\":\"https:\\\/\\\/pabau.com\\\/es\\\/procedure-codes\\\/cpt-code-21445\\\/#faq-question-1786435254682\",\"name\":\"What is the global period for CPT 21445?\",\"answerCount\":1,\"acceptedAnswer\":{\"@type\":\"Answer\",\"text\":\"CPT 21445 carries a global period of 090, the 90-day major surgery package. Routine post-operative visits, wound checks, and removal of the fixation placed at surgery are all included. Separately billable work inside the window needs modifier 24, 58, 78, or 79.\",\"inLanguage\":\"es\"},\"inLanguage\":\"es\"},{\"@type\":\"Question\",\"@id\":\"https:\\\/\\\/pabau.com\\\/es\\\/procedure-codes\\\/cpt-code-21445\\\/#faq-question-1786435254683\",\"position\":6,\"url\":\"https:\\\/\\\/pabau.com\\\/es\\\/procedure-codes\\\/cpt-code-21445\\\/#faq-question-1786435254683\",\"name\":\"Which modifiers apply to CPT code 21445?\",\"answerCount\":1,\"acceptedAnswer\":{\"@type\":\"Answer\",\"text\":\"Modifier 51 covers multiple procedures, and modifier 59 or XS handles the separate procedure designation. Modifier 80 or AS covers an assistant at surgery. Modifier 50 gains nothing, because CMS gives the code a bilateral indicator of 0. Modifier 62 is not payable, since co-surgery is not permitted on this code.\",\"inLanguage\":\"es\"},\"inLanguage\":\"es\"},{\"@type\":\"Question\",\"@id\":\"https:\\\/\\\/pabau.com\\\/es\\\/procedure-codes\\\/cpt-code-21445\\\/#faq-question-1786435254684\",\"position\":7,\"url\":\"https:\\\/\\\/pabau.com\\\/es\\\/procedure-codes\\\/cpt-code-21445\\\/#faq-question-1786435254684\",\"name\":\"Can CPT 21445 be billed with another jaw procedure?\",\"answerCount\":1,\"acceptedAnswer\":{\"@type\":\"Answer\",\"text\":\"Only when the alveolar repair is distinct from the other procedure. CPT designates 21445 a separate procedure, so it bundles when it forms part of a larger operation at the same site. Document each site separately and append modifier 59 or XS when the work is genuinely independent.\",\"inLanguage\":\"es\"},\"inLanguage\":\"es\"},{\"@type\":\"Question\",\"@id\":\"https:\\\/\\\/pabau.com\\\/es\\\/procedure-codes\\\/cpt-code-21445\\\/#faq-question-1786435254685\",\"position\":8,\"url\":\"https:\\\/\\\/pabau.com\\\/es\\\/procedure-codes\\\/cpt-code-21445\\\/#faq-question-1786435254685\",\"name\":\"What documentation is required to bill CPT 21445?\",\"answerCount\":1,\"acceptedAnswer\":{\"@type\":\"Answer\",\"text\":\"The operative note must name the alveolar ridge as the fracture site, and state the jaw and the laterality. List the teeth in the mobile segment, then describe the exposure and the stabilization used. 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Off the clock: binging true crime docuseries, baking and dreaming about travel.","url":"https:\/\/pabau.com\/es\/blog\/author\/maja-popovska\/"},{"@type":"Question","@id":"https:\/\/pabau.com\/es\/procedure-codes\/cpt-code-21445\/#faq-question-1786435254678","position":1,"url":"https:\/\/pabau.com\/es\/procedure-codes\/cpt-code-21445\/#faq-question-1786435254678","name":"What is CPT code 21445 used for?","answerCount":1,"acceptedAnswer":{"@type":"Answer","text":"CPT code 21445 bills 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. Surgeons report it when that segment is surgically exposed, repositioned, and stabilized. Its closed-treatment counterpart is CPT 21440.","inLanguage":"es"},"inLanguage":"es"},{"@type":"Question","@id":"https:\/\/pabau.com\/es\/procedure-codes\/cpt-code-21445\/#faq-question-1786435254679","position":2,"url":"https:\/\/pabau.com\/es\/procedure-codes\/cpt-code-21445\/#faq-question-1786435254679","name":"Does CPT 21445 include internal fixation?","answerCount":1,"acceptedAnswer":{"@type":"Answer","text":"No. The official descriptor for 21445 says nothing about internal fixation. Alveolar segments are usually held with arch bars, interdental wiring, or a splint. A mandibular fracture repaired with plates and screws belongs to CPT 21461 or CPT 21462 instead.","inLanguage":"es"},"inLanguage":"es"},{"@type":"Question","@id":"https:\/\/pabau.com\/es\/procedure-codes\/cpt-code-21445\/#faq-question-1786435254680","position":3,"url":"https:\/\/pabau.com\/es\/procedure-codes\/cpt-code-21445\/#faq-question-1786435254680","name":"What is the difference between CPT 21440 and CPT 21445?","answerCount":1,"acceptedAnswer":{"@type":"Answer","text":"Both codes describe the same alveolar ridge fracture. CPT 21440 covers closed treatment, where the segment is reduced without surgical exposure. CPT 21445 covers open treatment, where the surgeon opens the site. 21445 carries the higher work RVU, at 6.10 against 3.35. Its total RVUs are lower, because 21440 has the larger practice expense value.","inLanguage":"es"},"inLanguage":"es"},{"@type":"Question","@id":"https:\/\/pabau.com\/es\/procedure-codes\/cpt-code-21445\/#faq-question-1786435254681","position":4,"url":"https:\/\/pabau.com\/es\/procedure-codes\/cpt-code-21445\/#faq-question-1786435254681","name":"What ICD-10 codes are used with CPT 21445?","answerCount":1,"acceptedAnswer":{"@type":"Answer","text":"Use S02.671A or S02.672A for a right or left mandibular alveolus fracture, and S02.42XA for the maxillary alveolus. S02.670A covers an unspecified side. Add S02.5XXA when teeth in the segment are fractured too. The 7th character A means a closed fracture, not closed treatment.","inLanguage":"es"},"inLanguage":"es"},{"@type":"Question","@id":"https:\/\/pabau.com\/es\/procedure-codes\/cpt-code-21445\/#faq-question-1786435254682","position":5,"url":"https:\/\/pabau.com\/es\/procedure-codes\/cpt-code-21445\/#faq-question-1786435254682","name":"What is the global period for CPT 21445?","answerCount":1,"acceptedAnswer":{"@type":"Answer","text":"CPT 21445 carries a global period of 090, the 90-day major surgery package. Routine post-operative visits, wound checks, and removal of the fixation placed at surgery are all included. Separately billable work inside the window needs modifier 24, 58, 78, or 79.","inLanguage":"es"},"inLanguage":"es"},{"@type":"Question","@id":"https:\/\/pabau.com\/es\/procedure-codes\/cpt-code-21445\/#faq-question-1786435254683","position":6,"url":"https:\/\/pabau.com\/es\/procedure-codes\/cpt-code-21445\/#faq-question-1786435254683","name":"Which modifiers apply to CPT code 21445?","answerCount":1,"acceptedAnswer":{"@type":"Answer","text":"Modifier 51 covers multiple procedures, and modifier 59 or XS handles the separate procedure designation. Modifier 80 or AS covers an assistant at surgery. Modifier 50 gains nothing, because CMS gives the code a bilateral indicator of 0. Modifier 62 is not payable, since co-surgery is not permitted on this code.","inLanguage":"es"},"inLanguage":"es"},{"@type":"Question","@id":"https:\/\/pabau.com\/es\/procedure-codes\/cpt-code-21445\/#faq-question-1786435254684","position":7,"url":"https:\/\/pabau.com\/es\/procedure-codes\/cpt-code-21445\/#faq-question-1786435254684","name":"Can CPT 21445 be billed with another jaw procedure?","answerCount":1,"acceptedAnswer":{"@type":"Answer","text":"Only when the alveolar repair is distinct from the other procedure. CPT designates 21445 a separate procedure, so it bundles when it forms part of a larger operation at the same site. Document each site separately and append modifier 59 or XS when the work is genuinely independent.","inLanguage":"es"},"inLanguage":"es"},{"@type":"Question","@id":"https:\/\/pabau.com\/es\/procedure-codes\/cpt-code-21445\/#faq-question-1786435254685","position":8,"url":"https:\/\/pabau.com\/es\/procedure-codes\/cpt-code-21445\/#faq-question-1786435254685","name":"What documentation is required to bill CPT 21445?","answerCount":1,"acceptedAnswer":{"@type":"Answer","text":"The operative note must name the alveolar ridge as the fracture site, and state the jaw and the laterality. List the teeth in the mobile segment, then describe the exposure and the stabilization used. Add imaging that confirms the fracture, plus a statement of why closed reduction was not adequate.","inLanguage":"es"},"inLanguage":"es"}]}},"yoast":{"focus_keyword":"CPT code 21445","seo_title":"CPT code 21445: Alveolar ridge fracture billing guide 2026","meta_description":"CPT 21445 covers open treatment of an alveolar ridge fracture, not a plated mandible. 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