{"id":180630,"date":"2026-08-17T08:02:49","date_gmt":"2026-08-17T08:02:49","guid":{"rendered":"https:\/\/pabau.com\/?p=180630"},"modified":"2026-08-17T08:02:52","modified_gmt":"2026-08-17T08:02:52","slug":"cpt-code-21465","status":"publish","type":"post","link":"https:\/\/pabau.com\/es\/procedure-codes\/cpt-code-21465\/","title":{"rendered":"CPT code 21465: Open treatment of mandibular condylar fracture"},"content":{"rendered":"\n<script type=\"application\/ld+json\">{\"@context\":\"https:\/\/schema.org\",\"@type\":\"MedicalWebPage\",\"headline\":\"CPT code 21465: Open treatment of mandibular condylar fracture\",\"description\":\"CPT code 21465 covers open treatment of a mandibular condylar fracture. See the 2026 Medicare payment, CMS RVU values, modifier indicators, and the ICD-10 codes that support it.\",\"url\":\"https:\/\/pabau.com\/procedure-codes\/cpt-code-21465\/\",\"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\":\"2026-07-25\",\"dateModified\":\"2026-08-17\"}<\/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 21465 covers open treatment of a mandibular condylar fracture, whatever fixation the surgeon uses.<\/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>There is no closed-treatment code specific to the condyle, so closed care is reported with 21450 or 21451.<\/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>Medicare pays the same amount in a facility and an office, because CMS marks non-facility pricing NA for this code.<\/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>Condylar-process diagnoses now need laterality, so S02.611A or S02.612A replaces the retired S02.61XA.<\/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 keeps operative documentation, modifiers, and global periods in one record.<\/p>\n                        <\/div>\n                                                <\/div>\n        <\/div>\n    \n\n\n<p class=\"wp-block-paragraph\"><strong>CPT code 21465<\/strong> reports the open treatment of a mandibular condylar fracture. It sits in the Musculoskeletal System chapter of the AMA&#8217;s CPT code set, in the Head range that runs from 21000 to 21499.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">The code covers surgical access to the fracture, reduction of the condylar segment, and any plates or screws the surgeon places along the way. Fixation hardware is part of that work rather than a separate charge. What defines the code is the incision, not the hardware.<\/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\">Field<\/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\">Long descriptor<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Open treatment of mandibular condylar 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\">CMS short descriptor<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Optx mndblr cndylr fx<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Code family<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Musculoskeletal System, Head (21000-21499)<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Status<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Active and separately payable under the Medicare Physician Fee Schedule<\/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\">90 days<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Anesthesia<\/td>\n<td style=\"padding:12px 16px;color:#374151\">General anesthesia, billed separately by the anesthesiologist<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\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-open-treatment-vs-closed-treatment-choosing-the-right-code\" class=\"wp-block-heading\">Open treatment vs. closed treatment: Choosing the right code<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">There is no closed-treatment code specific to the condyle. Plenty of coding round-ups cite 21460 as the closed counterpart to 21465, but 21460 is not a CPT code and never has been. Closed care of a condylar fracture is reported with the general mandibular codes, 21450 or 21451.<\/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\">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\">Key distinction<\/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\">21450<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Closed treatment of mandibular fracture; without manipulation<\/td>\n<td style=\"padding:12px 16px;color:#374151\">No incision and no reduction. Observation, a soft diet, or a splint<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">21451<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Closed treatment of mandibular fracture; with manipulation<\/td>\n<td style=\"padding:12px 16px;color:#374151\">No incision, but the segment is reduced. Arch bars or intermaxillary fixation<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">21465<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Open treatment of mandibular condylar fracture<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Surgical incision to reach the condyle. The only condyle-specific code<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">21470<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Open treatment of complicated mandibular fracture by multiple surgical approaches<\/td>\n<td style=\"padding:12px 16px;color:#374151\">More than one approach, with internal fixation, interdental fixation, or wiring<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n\n\n<p class=\"wp-block-paragraph\">The operative note has to name the surgical approach to support 21465. Preauricular, retromandibular, and transparotid are the three you will see most often. A note that describes manipulation and arch bars does not support an open code, however displaced the condyle was on imaging.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">That distinction decides the payment as much as the code choice does. Reconstructive teams that run structured operative templates in a <a href=\"https:\/\/pabau.com\/industry\/plastic-surgery-emr\/\">plastic surgery EMR<\/a> tend to clear this bar without extra effort. <\/p>\n\n\n\n<p class=\"wp-block-paragraph\">The approach becomes a required field rather than something the surgeon has to remember to dictate.<\/p>\n\n\n\n<h2 id=\"h-year-medicare-payment-for-cpt-code-21465\" class=\"wp-block-heading\">2026 Medicare payment for CPT code 21465<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Medicare pays about $723.80 for CPT code 21465 in 2026, before locality adjustment. The figure is the same in a hospital, an ambulatory surgical center, and an office. CMS marks the non-facility practice expense \u00abNA\u00bb for this code, so there is no separate office rate to chase.<\/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\">Setting or participant<\/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 national payment<\/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 is built<\/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\">Facility (hospital or ASC)<\/td>\n<td style=\"padding:12px 16px;color:#374151\">$723.80<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Total 21.67 RVUs at the $33.4009 conversion factor<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Non-facility (office)<\/td>\n<td style=\"padding:12px 16px;color:#374151\">$723.80<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Non-facility practice expense is marked NA, so the facility value applies<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Qualifying APM participant<\/td>\n<td style=\"padding:12px 16px;color:#374151\">$727.41<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Same RVUs at the higher $33.5675 conversion factor<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n\n\n<p class=\"wp-block-paragraph\">2026 is the first year with two conversion factors. Qualifying participants in an advanced alternative payment model are paid at $33.5675, and everyone else at $33.4009. <\/p>\n\n\n\n<p class=\"wp-block-paragraph\">The difference is small on a single case, but it compounds across a busy trauma service. Our guide to <a href=\"https:\/\/pabau.com\/blog\/medicare-billing\/\">Medicare billing<\/a> covers how that split works across the rest of the fee schedule.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Commercial and managed care payers set their own rates against contract terms, so treat these figures as the Medicare baseline. You can confirm your own locality with the <a href=\"https:\/\/www.cms.gov\/medicare\/physician-fee-schedule\/search\/overview\" target=\"_blank\" rel=\"nofollow noopener\">CMS Physician Fee Schedule lookup tool<\/a>.<\/p>\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>Locality adjustment moves this payment further than most people expect. Run the 2026 geographic indices across the same 21.67 RVUs and the identical repair pays roughly $665 in Arkansas and roughly $858 in San Jose. Alaska sits above $930 because of its 1.5 work index. Check your own locality before you quote a number to a patient.<\/p>\n            <\/div>\n        <\/div>\n    \n\n\n<h2 id=\"h-rvu-breakdown-for-21465\" class=\"wp-block-heading\">RVU breakdown for 21465<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">CPT code 21465 carries 21.67 total RVUs in 2026, of which 12.79 are work. The facility and non-facility columns are identical, because CMS does not price this code in an office setting. The values below come from the CMS <a href=\"https:\/\/www.cms.gov\/medicare\/payment\/fee-schedules\/physician\/pfs-relative-value-files\" target=\"_blank\" rel=\"nofollow noopener\">physician fee schedule relative value files<\/a>.<\/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:center;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Facility value<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:center;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Non-facility value<\/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;text-align:center\">12.79<\/td>\n<td style=\"padding:12px 16px;color:#374151;text-align:center\">12.79<\/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<\/td>\n<td style=\"padding:12px 16px;color:#374151;text-align:center\">7.42<\/td>\n<td style=\"padding:12px 16px;color:#374151;text-align:center\">7.42 (marked NA)<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Malpractice RVU<\/td>\n<td style=\"padding:12px 16px;color:#374151;text-align:center\">1.46<\/td>\n<td style=\"padding:12px 16px;color:#374151;text-align:center\">1.46<\/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 RVU<\/td>\n<td style=\"padding:12px 16px;color:#374151;text-align:center\">21.67<\/td>\n<td style=\"padding:12px 16px;color:#374151;text-align:center\">21.67<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n\n\n<p class=\"wp-block-paragraph\">An \u00abNA\u00bb in the non-facility column is a pricing instruction, not a missing value. CMS uses it for procedures it does not expect to see performed in an office. The facility figure then applies wherever the case is billed. Treat any source that shows a higher office rate for 21465 as inverted.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">CMS republishes these values every January, and the work RVU has drifted down over recent cycles. It stood at 13.12 in 2024 and 12.79 in 2026. Pull the current file before you build a productivity target around it.<\/p>\n\n\n\n<h2 id=\"h-modifiers-and-cms-payment-indicators\" class=\"wp-block-heading\">Modifiers and CMS payment indicators<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">CMS attaches payment policy indicators to every code, and they settle most modifier arguments before they start. For 21465 the bilateral, co-surgeon, and assistant indicators are all permissive, while team surgery is not.<\/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\">What it reports<\/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 Medicare treats it for 21465<\/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\">-50<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Bilateral procedure<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Bilateral indicator 1, so both condyles in one session pay 150%<\/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 \/ -RT<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Side of the repair<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Accepted for unilateral cases. Some payers want these instead of -50<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\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-surgeon indicator 1, so it pays where the note justifies two surgeons<\/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 at surgery is payable<\/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\">Surgical team<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Team indicator 0, so team surgery is not payable on this code<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">-22<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Increased procedural services<\/td>\n<td style=\"padding:12px 16px;color:#374151\">No indicator. Carrier priced on review, so document the extra work in detail<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n\n\n<p class=\"wp-block-paragraph\">The multiple procedure indicator is 2, so standard reduction rules apply when 21465 is billed alongside another facial repair in the same session. Tracking which modifier belongs on which case is where surgical teams lose money. Pabau&#8217;s <a href=\"https:\/\/pabau.com\/features\/claims-management-software\/\">claims management software<\/a> keeps that detail attached to the treatment record instead of a side spreadsheet.<\/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-21465\/automate-claims-through-healthcode.webp\" alt=\"Automated claims and billing in Pabau\"\/><figcaption class=\"wp-element-caption\"><em>Pabau builds the claim from the coded procedure, so the modifier and place-of-service detail carries through without rekeying.<\/em><\/figcaption><\/figure>\n\n\n\n<div style=\"height:35px;width:800px\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div>\n\n\n\n<h2 id=\"h-icd-10-diagnosis-codes-that-support-medical-necessity\" class=\"wp-block-heading\">ICD-10 diagnosis codes that support medical necessity<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Condylar-process fractures need a laterality code. S02.611A covers the right side and S02.612A the left, both for an initial encounter with a closed fracture. Use S02.610A only where the operative record genuinely does not state a side.<\/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<\/tr>\n<\/thead>\n<tbody>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">S02.611A<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Fracture of condylar process of right mandible, initial encounter for closed 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\">S02.612A<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Fracture of condylar process of left mandible, initial encounter for closed fracture<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">S02.610A<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Fracture of condylar process of mandible, unspecified side, initial encounter for closed 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\">S02.611B \/ S02.612B<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Fracture of condylar process of right or left mandible, initial encounter for open fracture<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">S02.611D \/ S02.612D<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Fracture of condylar process of right or left mandible, subsequent encounter with routine healing<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">S02.621A \/ S02.622A<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Fracture of subcondylar process of right or left mandible, initial encounter for closed fracture<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">S02.69XA<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Fracture of mandible of other specified site, initial encounter for closed 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\">S02.609A<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Fracture of mandible, unspecified, initial encounter for closed fracture<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n\n\n<p class=\"wp-block-paragraph\">Two codes that still circulate widely are no longer valid. S02.61XA, S02.61XB, and S02.61XD were retired on September 30, 2016, when the condylar subcategory gained laterality. <\/p>\n\n\n\n<p class=\"wp-block-paragraph\">S02.60XA went the same way, and its replacement is S02.609A. You can check any of these against the <a href=\"https:\/\/www.cdc.gov\/nchs\/icd\/icd-10-cm\/index.html\" target=\"_blank\" rel=\"nofollow noopener\">current ICD-10-CM code files<\/a>.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Condylar and subcondylar are separate subcategories, and radiology reports use the terms loosely. If the imaging says subcondylar and the surgeon repaired the condyle, resolve it in the chart before the claim goes out. Query the surgeon rather than picking the code that matches the procedure.<\/p>\n\n\n\n<h2 id=\"h-related-mandibular-and-facial-fracture-codes\" class=\"wp-block-heading\">Related mandibular and facial fracture codes<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Mandibular fracture codes split along two axes: open versus closed, and whether interdental fixation was used. Picking the wrong sibling is a common audit trigger in oral and maxillofacial surgery, so it helps to see the family side by side.<\/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\">CPT 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\">2026 work RVU<\/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\">21450<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Closed treatment of mandibular fracture; without manipulation<\/td>\n<td style=\"padding:12px 16px;color:#374151\">3.62<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">21451<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Closed treatment of mandibular fracture; with manipulation<\/td>\n<td style=\"padding:12px 16px;color:#374151\">5.51<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">21453<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Closed treatment of mandibular fracture with interdental fixation<\/td>\n<td style=\"padding:12px 16px;color:#374151\">6.47<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\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<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\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<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">21465<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Open treatment of mandibular condylar fracture<\/td>\n<td style=\"padding:12px 16px;color:#374151\">12.79<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">21470<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Open treatment of complicated mandibular fracture by multiple surgical approaches<\/td>\n<td style=\"padding:12px 16px;color:#374151\">17.10<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n\n\n<p class=\"wp-block-paragraph\">Facial trauma rarely arrives one fracture at a time. A condylar repair often sits on the same operative note as work on the orbit or the midface. That brings <a href=\"https:\/\/pabau.com\/procedure-codes\/cpt-code-21407\/\">21407<\/a> and <a href=\"https:\/\/pabau.com\/procedure-codes\/cpt-code-21365\/\">21365<\/a> into the same claim.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Frontal sinus involvement adds <a href=\"https:\/\/pabau.com\/procedure-codes\/cpt-code-21343\/\">21343<\/a> to the picture. Sequence the highest-valued code first and let the multiple procedure rules reduce the rest, rather than leaving the payer to guess at the primary procedure. <\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Groups that also bill musculoskeletal repairs in a <a href=\"https:\/\/pabau.com\/industry\/sports-medicine-software\/\">sports medicine practice<\/a> will recognize the same sequencing logic.<\/p>\n\n\n\n<h2 id=\"h-billing-guidelines-and-documentation-requirements\" class=\"wp-block-heading\">Billing guidelines and documentation requirements<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Accurate billing for 21465 starts in the operating room. What the surgeon dictates on the day decides whether the claim survives a review months later.<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Name the approach.<\/strong> Record whether the access was preauricular, retromandibular, or transparotid, along with the degree of displacement and the reduction technique. Note the type and number of fixation devices if any were placed.<\/li>\n\n\n\n<li><strong>Say why, if there was no fixation.<\/strong> Open treatment stands on its own without hardware. A note that shows an open approach and no fixation still supports the code, provided the surgeon explains the clinical reasoning.<\/li>\n\n\n\n<li><strong>Match the place of service.<\/strong> Hospital outpatient is POS 22, inpatient is POS 21, and an ambulatory surgical center is POS 24. Because CMS does not price this code in an office, an office place of service on a 21465 claim invites a review.<\/li>\n\n\n\n<li><strong>Check NCCI edits.<\/strong> Run the code pair through the National Correct Coding Initiative edits before billing adjacent facial procedures on the same claim.<\/li>\n\n\n\n<li><strong>Respect the 90-day global period.<\/strong> Post-operative visits inside that window belong to the surgical fee. Only a new and unrelated problem is billed separately, and the note has to show it.<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">Global periods catch practices out most often when a patient transfers between surgeons mid-recovery. The same applies to other 90-day surgical codes such as <a href=\"https:\/\/pabau.com\/procedure-codes\/cpt-code-19316\/\">19316<\/a>, where the post-operative split has to be agreed in writing before either party bills.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Enrollment details matter too, since a claim under the wrong billing arrangement is denied before anyone reads the operative note. Our guide to the <a href=\"https:\/\/pabau.com\/blog\/medicare-provider-number\/\">Medicare provider number<\/a> covers what has to be on file for a surgical group.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Teams still working from scanned paper carry the most risk here. An illegible dictation cannot show the surgical approach, and that single omission turns an open code into a denial. <\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Structured <a href=\"https:\/\/pabau.com\/blog\/medical-forms-at-your-healthcare-practice\/\">medical forms<\/a> and typed operative records remove the argument entirely, and they also make <a href=\"https:\/\/pabau.com\/blog\/hipaa-compliance-for-medical-offices\/\">HIPAA compliance<\/a> easier to demonstrate at audit.<\/p>\n\n\n\n<h2 id=\"h-how-pabau-keeps-surgical-documentation-and-billing-in-one-place\" class=\"wp-block-heading\">How Pabau keeps surgical documentation and billing in one place<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Most surgical billing problems are handoff problems. Think about where the detail for a single condylar repair usually sits.<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>The surgical approach is buried in a dictation<\/li>\n\n\n\n<li>The fixation detail is in the surgeon&#8217;s head until someone asks<\/li>\n\n\n\n<li>The modifier decision sits in the biller&#8217;s inbox<\/li>\n\n\n\n<li>The global period lives with whoever remembers the date<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">Each handoff is a chance for something to drop, and a dropped detail on this code costs about $724.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Practice management software like Pabau removes those handoffs by keeping the whole case in one client record. The appointment, the consent, the operative note, the photographs, and the invoice all sit against the same patient. The person coding the claim can see what the surgeon actually did.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">That matters most on codes like 21465. One missing sentence about the approach is the difference between payment and a denial. Structured forms turn the approach into a field, and reporting shows which codes are being denied and why.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Pabau&#8217;s <a href=\"https:\/\/pabau.com\/blog\/patient-management-software\/\">patient management software<\/a> ties the clinical and financial sides of a case together. Its <a href=\"https:\/\/pabau.com\/features\/patient-intake-software\/\">digital forms<\/a> capture pre-operative assessments in a format a payer can follow.<\/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-21465\/customizable-consent-and-intake-forms.webp\" alt=\"Customizable consent and intake forms in Pabau\"\/><figcaption class=\"wp-element-caption\"><em>Customizable consent and intake forms record the pre-operative assessment in structured fields, so the surgical claim has documentation behind it.<\/em><\/figcaption><\/figure>\n\n\n\n<div style=\"height:35px;width:800px\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div>\n\n\n\n<p class=\"wp-block-paragraph\">Every Pabau subscription includes every feature, so a two-surgeon practice gets the same reporting and documentation tools as a multi-site group. The <a href=\"https:\/\/pabau.com\/blog\/practice-management-software\/\">practice management software overview<\/a> walks through how those pieces fit together for a surgical team.<\/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                    Reduce claim denials for surgical codes                <\/h3>\n\n                <p class=\"description\">\n                    Pabau keeps the operative note, the consent, and the invoice against one client record. Your billing team can see what the surgeon did before the claim ever 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 for surgical billing\"\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\">If you take one thing from this page, make it the open-versus-closed test. There is no condyle-specific closed code, so the incision in the operative note is what earns 21465 and its 21.67 RVUs. Everything else follows from that sentence in the chart.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">The trade-off worth remembering is that this code rewards documentation discipline rather than clinical complexity. A straightforward repair with a clear approach note gets paid. A difficult one with a vague note does not, and the appeal costs more than the difference.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Fix that at the point of dictation and the rest of the billing cycle gets quieter. <a href=\"https:\/\/pabau.com\/book-demo\/\">Book a demo<\/a> to see how Pabau keeps operative documentation, modifiers, and global periods together for oral and maxillofacial surgery teams.<\/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>Standardizing operative documentation across providers?<\/strong> <a href=\"https:\/\/pabau.com\/blog\/practice-management-software-features\/\">Practice management software features<\/a> sets out which tools actually reduce claim errors in a surgical setting.<\/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>Still scanning paper operative notes?<\/strong> <a href=\"https:\/\/pabau.com\/blog\/paperless-practice-hipaa-compliant\/\">Paperless practice and HIPAA compliance<\/a> explains how digital records hold up when a payer asks for the file.<\/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>Coding another facial fracture repair?<\/strong> <a href=\"https:\/\/pabau.com\/procedure-codes\/cpt-code-21337\/\">CPT code 21337<\/a> walks through the closed nasoseptal repair and its documentation requirements.<\/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>Billing debridement on the same admission?<\/strong> <a href=\"https:\/\/pabau.com\/procedure-codes\/cpt-code-11043\/\">CPT code 11043<\/a> covers depth, measurement, and the reporting rules that decide the unit count.<\/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>Weighing up a surgical group against solo practice?<\/strong> <a href=\"https:\/\/pabau.com\/blog\/group-practice-vs-private-practice\/\">Group practice vs private practice<\/a> compares how each model handles shared billing and co-surgeon work.<\/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-1786714620505\"><h3 class=\"schema-faq-question\">What does CPT code 21465 describe?<\/h3> <p class=\"schema-faq-answer\">CPT code 21465 reports the open treatment of a mandibular condylar fracture. It covers surgical access to the fracture, reduction of the displaced condylar segment, and any plates or screws placed during the repair. The fixation hardware is included in the code rather than billed separately.<\/p> <\/div> <div class=\"schema-faq-section\" id=\"faq-question-1786714620506\"><h3 class=\"schema-faq-question\">Is there a closed treatment code for a mandibular condylar fracture?<\/h3> <p class=\"schema-faq-answer\">No. CPT has no condyle-specific closed code, and 21460 is not a valid code despite appearing in many coding round-ups. Closed care of a condylar fracture is reported with 21450 without manipulation, or 21451 with manipulation.<\/p> <\/div> <div class=\"schema-faq-section\" id=\"faq-question-1786714620507\"><h3 class=\"schema-faq-question\">Does CPT 21465 require internal fixation?<\/h3> <p class=\"schema-faq-answer\">No. The descriptor reads \u201cOpen treatment of mandibular condylar fracture\u201d and says nothing about fixation. Surgical exposure of the fracture site is what defines the code. Where the surgeon places no hardware, the operative note should record the clinical reasoning.<\/p> <\/div> <div class=\"schema-faq-section\" id=\"faq-question-1786714620508\"><h3 class=\"schema-faq-question\">What ICD-10 codes pair with CPT 21465?<\/h3> <p class=\"schema-faq-answer\">Condylar-process fractures require laterality. Use S02.611A for the right side and S02.612A for the left, both initial encounter for a closed fracture. S02.610A covers an unspecified side. The older S02.61XA was retired in 2016 and will be rejected.<\/p> <\/div> <div class=\"schema-faq-section\" id=\"faq-question-1786714620509\"><h3 class=\"schema-faq-question\">What are the RVU values for CPT 21465?<\/h3> <p class=\"schema-faq-answer\">CPT 21465 carries 12.79 work RVUs, 7.42 practice expense RVUs, and 1.46 malpractice RVUs in 2026. That totals 21.67 RVUs. The facility and non-facility values are identical, because CMS marks non-facility pricing NA for this code.<\/p> <\/div> <div class=\"schema-faq-section\" id=\"faq-question-1786714620510\"><h3 class=\"schema-faq-question\">What is the global period for CPT code 21465?<\/h3> <p class=\"schema-faq-answer\">CPT code 21465 carries a 90-day global surgical period under Medicare. Evaluation and management visits inside that window are part of the surgical fee. A new and unrelated problem can be billed separately, provided the note documents it as such.<\/p> <\/div> <\/div>\n\n\n\n<p class=\"wp-block-paragraph\"><\/p>\n","protected":false},"excerpt":{"rendered":"<p>CPT code 21465 covers open treatment of a mandibular condylar fracture. Medicare pays $723.80 in 2026, and there is no closed condyle code.<\/p>\n","protected":false},"author":83,"featured_media":180626,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_yoast_wpseo_linkdex":"88","_yoast_wpseo_content_score":"60","_yoast_wpseo_is_cornerstone":"","_yoast_wpseo_keywordsynonyms":"[\"\",\"\",\"\",\"\",\"\"]","_yoast_wpseo_focuskw_text_input":"","_seo_original_html":"","footnotes":""},"categories":[1433,1546,1869],"tags":[1162,1602,2775,2653,1236,2668],"class_list":["post-180630","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-billing-codes","category-cpt-codes","category-united-states","tag-cpt-codes","tag-cpt-modifiers","tag-fracture-management","tag-laterality-coding","tag-medicare-reimbursement","tag-musculoskeletal-coding"],"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 21465: 2026 Medicare rate, RVUs and modifiers<\/title>\n<meta name=\"description\" content=\"CPT code 21465 covers open treatment of a mandibular condylar fracture. 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The fixation hardware is included in the code rather than billed separately.","inLanguage":"es"},"inLanguage":"es"},{"@type":"Question","@id":"https:\/\/pabau.com\/es\/procedure-codes\/cpt-code-21465\/#faq-question-1786714620506","position":2,"url":"https:\/\/pabau.com\/es\/procedure-codes\/cpt-code-21465\/#faq-question-1786714620506","name":"Is there a closed treatment code for a mandibular condylar fracture?","answerCount":1,"acceptedAnswer":{"@type":"Answer","text":"No. CPT has no condyle-specific closed code, and 21460 is not a valid code despite appearing in many coding round-ups. Closed care of a condylar fracture is reported with 21450 without manipulation, or 21451 with manipulation.","inLanguage":"es"},"inLanguage":"es"},{"@type":"Question","@id":"https:\/\/pabau.com\/es\/procedure-codes\/cpt-code-21465\/#faq-question-1786714620507","position":3,"url":"https:\/\/pabau.com\/es\/procedure-codes\/cpt-code-21465\/#faq-question-1786714620507","name":"Does CPT 21465 require internal fixation?","answerCount":1,"acceptedAnswer":{"@type":"Answer","text":"No. The descriptor reads \u201cOpen treatment of mandibular condylar fracture\u201d and says nothing about fixation. Surgical exposure of the fracture site is what defines the code. Where the surgeon places no hardware, the operative note should record the clinical reasoning.","inLanguage":"es"},"inLanguage":"es"},{"@type":"Question","@id":"https:\/\/pabau.com\/es\/procedure-codes\/cpt-code-21465\/#faq-question-1786714620508","position":4,"url":"https:\/\/pabau.com\/es\/procedure-codes\/cpt-code-21465\/#faq-question-1786714620508","name":"What ICD-10 codes pair with CPT 21465?","answerCount":1,"acceptedAnswer":{"@type":"Answer","text":"Condylar-process fractures require laterality. Use S02.611A for the right side and S02.612A for the left, both initial encounter for a closed fracture. S02.610A covers an unspecified side. The older S02.61XA was retired in 2016 and will be rejected.","inLanguage":"es"},"inLanguage":"es"},{"@type":"Question","@id":"https:\/\/pabau.com\/es\/procedure-codes\/cpt-code-21465\/#faq-question-1786714620509","position":5,"url":"https:\/\/pabau.com\/es\/procedure-codes\/cpt-code-21465\/#faq-question-1786714620509","name":"What are the RVU values for CPT 21465?","answerCount":1,"acceptedAnswer":{"@type":"Answer","text":"CPT 21465 carries 12.79 work RVUs, 7.42 practice expense RVUs, and 1.46 malpractice RVUs in 2026. That totals 21.67 RVUs. The facility and non-facility values are identical, because CMS marks non-facility pricing NA for this code.","inLanguage":"es"},"inLanguage":"es"},{"@type":"Question","@id":"https:\/\/pabau.com\/es\/procedure-codes\/cpt-code-21465\/#faq-question-1786714620510","position":6,"url":"https:\/\/pabau.com\/es\/procedure-codes\/cpt-code-21465\/#faq-question-1786714620510","name":"What is the global period for CPT code 21465?","answerCount":1,"acceptedAnswer":{"@type":"Answer","text":"CPT code 21465 carries a 90-day global surgical period under Medicare. Evaluation and management visits inside that window are part of the surgical fee. A new and unrelated problem can be billed separately, provided the note documents it as such.","inLanguage":"es"},"inLanguage":"es"}]}},"yoast":{"focus_keyword":"CPT code 21465","seo_title":"CPT code 21465: %%currentyear%% Medicare rate, RVUs and modifiers","meta_description":"CPT code 21465 covers open treatment of a mandibular condylar fracture. 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