{"id":180632,"date":"2026-08-17T08:39:07","date_gmt":"2026-08-17T08:39:07","guid":{"rendered":"https:\/\/pabau.com\/?p=180632"},"modified":"2026-08-17T08:39:09","modified_gmt":"2026-08-17T08:39:09","slug":"cpt-code-21432","status":"publish","type":"post","link":"https:\/\/pabau.com\/es\/procedure-codes\/cpt-code-21432\/","title":{"rendered":"CPT code 21432: Open treatment of craniofacial separation (LeFort III)"},"content":{"rendered":"\n<script type=\"application\/ld+json\">{\"@context\":\"https:\/\/schema.org\",\"@type\":\"MedicalWebPage\",\"headline\":\"CPT code 21432: Open treatment of craniofacial separation (LeFort III)\",\"description\":\"CPT code 21432 covers open treatment of craniofacial separation (LeFort III type), with wiring and\/or internal fixation. This guide covers RVUs, Medicare reimbursement, ICD-10 pairings, modifiers, global period, and documentation requirements.\",\"url\":\"https:\/\/pabau.com\/procedure-codes\/cpt-code-21432\/\",\"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\":\"2026-08-07\",\"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 21432 describes open treatment of craniofacial separation (LeFort III type), with wiring and\/or internal fixation.<\/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 code belongs to the LeFort III ladder 21431-21436, not to a general facial-bone fracture range.<\/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>Fixation is part of the descriptor, so an open LeFort III repair without wiring or internal fixation does not meet the definition of 21432.<\/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>21432 carries a 90-day global period and 20.12 total RVUs, worth roughly $672 at the 2026 national rate.<\/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 S02.413A or S02.413B, the ICD-10-CM codes for LeFort III fracture, or expect a medical-necessity denial.<\/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 validates code combinations and tracks prior authorization, which cuts denials on high-complexity surgical codes.<\/p>\n                        <\/div>\n                                                <\/div>\n        <\/div>\n    \n\n\n<p class=\"wp-block-paragraph\">CPT code 21432 describes the <strong>open treatment of craniofacial separation (LeFort III type); with wiring and\/or internal fixation<\/strong>. That is the descriptor published by the American Medical Association&#8217;s CPT Editorial Panel in the AMA CPT code set.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Two elements of it carry the whole code. The injury must be a LeFort III craniofacial separation, and the repair must involve wiring or internal fixation.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">A LeFort III fracture separates the entire midface from the skull base. The fracture line runs through the nasofrontal suture, the medial and lateral orbital walls, and the zygomatic arches. <\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Patients typically arrive after high-energy trauma, often with an elongated face and a mobile midface. Repair is performed by oral and maxillofacial surgeons, plastic surgeons, and craniofacial specialists.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Surgeons reach the fracture through intraoral buccal sulcus incisions, or through subciliary, transconjunctival, or coronal approaches. The segments are reduced and then held with wires, miniplates, or screws.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Wiring for a condition other than a fracture belongs to <a href=\"https:\/\/pabau.com\/procedure-codes\/cpt-code-21497\/\">21497<\/a>, so it never stands in for this code. Practices billing this work regularly run it through <a href=\"https:\/\/pabau.com\/industry\/plastic-surgery-emr\/\">plastic surgery EMR software<\/a> that keeps the operative detail attached to the 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\">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\">Details<\/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\">21432<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Official descriptor<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Open treatment of craniofacial separation (LeFort III type); with wiring and\/or internal fixation<\/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\">Surgery, Musculoskeletal System, Head &#8211; 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\">Code family<\/td>\n<td style=\"padding:12px 16px;color:#374151\">21431-21436, craniofacial separation (LeFort III type)<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Fracture level<\/td>\n<td style=\"padding:12px 16px;color:#374151\">LeFort III, complete separation of the midface from the skull base<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Global period<\/td>\n<td style=\"padding:12px 16px;color:#374151\">090 (90-day major surgery global period)<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Total RVUs (2026)<\/td>\n<td style=\"padding:12px 16px;color:#374151\">20.12 (work 8.60, practice expense 9.93, malpractice 1.59)<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Applicable specialties<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Oral and maxillofacial surgery, plastic surgery, craniofacial surgery<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Facility vs. non-facility<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Facility (hospital or ASC); the RVU total is the same in both settings<\/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-where-21432-sits-in-the-lefort-iii-code-family\" class=\"wp-block-heading\">Where 21432 sits in the LeFort III code family<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">21432 is the second rung of a five-code ladder for LeFort III craniofacial separation. The ladder runs 21431, 21432, 21433, 21435, and 21436. <\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Selection turns on two questions. Was the treatment closed or open, and what made an open repair complicated? The operative report has to justify the rung you bill.<\/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\">Official 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\">Total RVUs \/ 2026 national allowable<\/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 differentiator<\/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\">21431<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Closed treatment of craniofacial separation (LeFort III type); with interdental wire fixation or fixation of denture or splint<\/td>\n<td style=\"padding:12px 16px;color:#374151\">19.37 \/ $646.98<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Closed approach; no surgical exposure of the 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\"><strong>21432<\/strong><\/td>\n<td style=\"padding:12px 16px;color:#374151\"><strong>Open treatment of craniofacial separation (LeFort III type); with wiring and\/or internal fixation<\/strong><\/td>\n<td style=\"padding:12px 16px;color:#374151\"><strong>20.12 \/ $672.03<\/strong><\/td>\n<td style=\"padding:12px 16px;color:#374151\"><strong>Open approach, uncomplicated; wiring or internal fixation is required<\/strong><\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">21433<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Open treatment of craniofacial separation (LeFort III type); complicated (eg, comminuted or involving cranial nerve foramina), multiple surgical approaches<\/td>\n<td style=\"padding:12px 16px;color:#374151\">45.70 \/ $1,526.42<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Comminution or cranial nerve foramina, plus multiple surgical approaches<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">21435<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Open treatment of craniofacial separation (LeFort III type); complicated, utilizing internal and\/or external fixation techniques (eg, head cap, halo device, and\/or intermaxillary fixation)<\/td>\n<td style=\"padding:12px 16px;color:#374151\">37.77 \/ $1,261.55<\/td>\n<td style=\"padding:12px 16px;color:#374151\">External fixation hardware such as a head cap, halo, or IMF<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">21436<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Open treatment of craniofacial separation (LeFort III type); complicated, multiple surgical approaches, internal fixation, with bone grafting (includes obtaining graft)<\/td>\n<td style=\"padding:12px 16px;color:#374151\">54.03 \/ $1,804.65<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Bone grafting, including harvest of the graft<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n\n\n<p class=\"wp-block-paragraph\">RVU figures reflect the 2026 national unadjusted values. The allowable column applies the CY2026 conversion factor of $33.4009 for clinicians who are not qualifying APM participants. Your own payment will differ once the geographic practice cost index is applied.<\/p>\n\n\n\n<h3 id=\"h-the-ladder-does-not-climb-in-a-straight-line\" class=\"wp-block-heading\">The ladder does not climb in a straight line<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">Coders often assume the higher code number pays more. In this family it doesn&#8217;t. <a href=\"https:\/\/pabau.com\/procedure-codes\/cpt-code-21433\/\">21433<\/a> carries 45.70 total RVUs, while 21435 carries 37.77. A comminuted LeFort III repaired through multiple approaches is valued above one stabilized with a halo device.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Choosing by code number instead of by operative detail can cost several hundred dollars a case. It can also expose the practice to an upcoding finding.<\/p>\n\n\n\n<h3 id=\"h-codes-that-get-confused-with-21432\" class=\"wp-block-heading\">Codes that get confused with 21432<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">Three lookalike errors account for most misrouted LeFort claims. The first is 21430, which is not a valid CPT code. Nasomaxillary complex fracture treated by closed reduction is 21345, and it belongs to the LeFort II ladder.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">The second is treating 21432 as a general craniofacial fracture code, when the descriptor is tied to LeFort III separation. A complicated malar area fracture is coded from <a href=\"https:\/\/pabau.com\/procedure-codes\/cpt-code-21365\/\">21365<\/a> instead. The third is billing a LeFort I or LeFort II injury from the LeFort III range.<\/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\">Fracture level<\/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\">Closed treatment<\/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\">Open treatment<\/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\">Paired ICD-10-CM<\/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\">LeFort I (palatal or maxillary)<\/td>\n<td style=\"padding:12px 16px;color:#374151\">21421<\/td>\n<td style=\"padding:12px 16px;color:#374151\">21422 (standard), 21423 (complicated, multiple approaches)<\/td>\n<td style=\"padding:12px 16px;color:#374151\">S02.411A or S02.411B<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">LeFort II (nasomaxillary complex)<\/td>\n<td style=\"padding:12px 16px;color:#374151\">21345<\/td>\n<td style=\"padding:12px 16px;color:#374151\">21346 (wiring or local fixation), 21347 (multiple open approaches), 21348 (bone grafting)<\/td>\n<td style=\"padding:12px 16px;color:#374151\">S02.412A or S02.412B<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\"><strong>LeFort III (craniofacial separation)<\/strong><\/td>\n<td style=\"padding:12px 16px;color:#374151\"><strong>21431<\/strong><\/td>\n<td style=\"padding:12px 16px;color:#374151\"><strong>21432<\/strong> (wiring or internal fixation), 21433, 21435, 21436<\/td>\n<td style=\"padding:12px 16px;color:#374151\"><strong>S02.413A or S02.413B<\/strong><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n\n\n<h3 id=\"h-21432-vs-21435-the-key-distinction\" class=\"wp-block-heading\">21432 vs. 21435: The key distinction<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">21432 covers an uncomplicated open LeFort III repair held with wires, plates, or screws. 21435 applies only when the case is complicated and external or internal fixation techniques are used. Those include a head cap, a halo device, or intermaxillary fixation. Bone grafting moves the case to 21436, not 21435.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Billing 21435 without documented complexity and fixation hardware is an upcoding error that the Office of Inspector General looks for. Verify the distinction against the <a href=\"https:\/\/www.aapc.com\/codes\/cpt-codes-range\/\" target=\"_blank\" rel=\"nofollow noopener\">AAPC Codify CPT lookup<\/a> when in doubt.<\/p>\n\n\n\n<h2 id=\"h-icd-10-cm-diagnosis-codes-that-pair-with-21432\" class=\"wp-block-heading\">ICD-10-CM diagnosis codes that pair with 21432<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">The diagnosis that supports 21432 is a LeFort III fracture, coded from the S02.41 subcategory. S02.413 is not billable on its own and always takes a seventh character. That character records the encounter and, for an initial encounter, whether the fracture was open or closed.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Broader S02 codes such as S02.8 do not describe craniofacial separation and invite a medical-necessity denial. The same seventh-character discipline runs through every fracture code in the S chapter, including <a href=\"https:\/\/pabau.com\/diagnostic-codes\/icd-10-code-s42302k\/\">S42.302K<\/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\">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\">S02.413A<\/td>\n<td style=\"padding:12px 16px;color:#374151\">LeFort III fracture, initial encounter for closed fracture<\/td>\n<td style=\"padding:12px 16px;color:#374151\">The default pairing for a first 21432 repair of a closed injury<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">S02.413B<\/td>\n<td style=\"padding:12px 16px;color:#374151\">LeFort III fracture, initial encounter for open fracture<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Use when the operative note documents an open, or compound, fracture<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">S02.413D<\/td>\n<td style=\"padding:12px 16px;color:#374151\">LeFort III fracture, subsequent encounter for fracture with routine healing<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Follow-up care after active treatment has ended<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">S02.413G \/ S02.413K<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Subsequent encounter for fracture with delayed healing, or with nonunion<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Supports revision surgery outside the original global period<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">S02.411A \/ S02.412A<\/td>\n<td style=\"padding:12px 16px;color:#374151\">LeFort I and LeFort II fracture, initial encounter for closed fracture<\/td>\n<td style=\"padding:12px 16px;color:#374151\">These pair with 21421-21423 and 21345-21348, not with 21432<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">S09.90XA<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Unspecified injury of head, initial encounter<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Secondary code only, when an associated head injury is documented<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n\n\n<p class=\"wp-block-paragraph\">Payers deny claims where the diagnosis is less specific than the operative report. A CT report that describes midface separation supports S02.413, so a generic facial fracture code on the claim is a mismatch. <\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Verify codes against the <a href=\"https:\/\/icd10cmtool.cdc.gov\/\" target=\"_blank\" rel=\"nofollow noopener\">CDC\/NCHS ICD-10-CM web tool<\/a> for the applicable fiscal year before submission.<\/p>\n\n\n\n<h2 id=\"h-medicare-reimbursement-and-rvus-for-cpt-code-21432\" class=\"wp-block-heading\">Medicare reimbursement and RVUs for CPT code 21432<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Medicare pays for 21432 through the Physician Fee Schedule formula. Each RVU component is adjusted by the geographic practice cost index for your locality. The adjusted total is then multiplied by the annual conversion factor. <\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Figures below are the 2026 national unadjusted values, and you should confirm them in 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> before contracting.<\/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 national value<\/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 covers<\/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 (wRVU)<\/td>\n<td style=\"padding:12px 16px;color:#374151\">8.60<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Surgeon time, skill, and intensity<\/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\">9.93<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Overhead, staff, and equipment<\/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\">1.59<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Professional liability component<\/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\">20.12<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Basis for the Medicare payment calculation<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Conversion factor (2026)<\/td>\n<td style=\"padding:12px 16px;color:#374151\">$33.5675 for qualifying APM participants, $33.4009 for everyone else<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Annual dollar multiplier set in the CMS final rule<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">National allowable<\/td>\n<td style=\"padding:12px 16px;color:#374151\">About $672.03 at the non-QP conversion factor<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Before any geographic adjustment or payer discount<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n\n\n<p class=\"wp-block-paragraph\">The two conversion factors come from the CY2026 Physician Fee Schedule final rule. Qualifying participants in advanced alternative payment models receive the higher figure. <\/p>\n\n\n\n<p class=\"wp-block-paragraph\">That allowable pays the surgeon only. The anesthesia provider bills separately, and radical surgery on the facial bones maps to <a href=\"https:\/\/pabau.com\/procedure-codes\/cpt-code-00192\/\">00192<\/a>. Commercial payers set their own schedules, usually as a percentage of the Medicare allowable, so check your contract for the rate that applies.<\/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>Before you finalize a fee schedule for CPT 21432, pull the MPFS data for your own MAC jurisdiction. Payment moves meaningfully with the Geographic Practice Cost Index. Also check which conversion factor applies to your clinicians, because the QP and non-QP figures differ by about $3 per case at this RVU level.<\/p>\n            <\/div>\n        <\/div>\n    \n\n\n<h2 id=\"h-the-90-day-global-period\" class=\"wp-block-heading\">The 90-day global period<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">CPT 21432 carries a 090 global surgery indicator, which is a 90-day major surgery global period. Routine post-operative care in that window is bundled into the surgical fee. Knowing what sits inside and outside the window prevents both under-collection and compliance exposure.<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Included in the global period:<\/strong> Routine post-op visits, suture removal, dressing changes, and management of expected surgical complications within 90 days.<\/li>\n\n\n\n<li><strong>Not included:<\/strong> Treatment of a new, unrelated condition, and any complication that requires a return to the operating room. Append modifier 78 for the return trip.<\/li>\n\n\n\n<li><strong>Staged procedures:<\/strong> A LeFort III repair is often staged with orbital or mandibular work such as <a href=\"https:\/\/pabau.com\/procedure-codes\/cpt-code-21465\/\">21465<\/a>. Append modifier 58 when the second procedure was planned.<\/li>\n\n\n\n<li><strong>Day counting:<\/strong> CMS counts the day before surgery, the day of surgery, and the 90 days that follow.<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">Billing an evaluation and management visit during the global period without a modifier is a frequent denial trigger. So is billing complication management without modifier 78. Both are routinely recouped on audit.<\/p>\n\n\n\n<h2 id=\"h-modifiers-this-code-attracts\" class=\"wp-block-heading\">Modifiers this code attracts<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Modifier selection for 21432 changes both payment and audit exposure. Every modifier has to be backed by something specific in the operative or clinical record. Panfacial cases often carry a second repair in the same session, such as <a href=\"https:\/\/pabau.com\/procedure-codes\/cpt-code-21452\/\">21452<\/a>, which is where modifier 51 comes in.<\/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\">When to apply<\/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\">Documentation required<\/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\">Reimbursement impact<\/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\">22<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Work substantially greater than a typical LeFort III repair<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Operative report describing the added complexity and the extra time it took<\/td>\n<td style=\"padding:12px 16px;color:#374151\">May increase payment 15-30%; requires payer review<\/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 in the same operative session<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Every procedure documented in the operative report<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Secondary procedure paid at 50% of the fee schedule<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">59<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Distinct procedural service, to bypass an NCCI edit<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Separate session, encounter, or anatomical site documented<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Allows separate payment where an edit would otherwise bundle<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">78<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Return to the OR for a complication during the global period<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Documentation of the complication and why a return was necessary<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Reduced payment; no new global period starts<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">79<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Unrelated procedure during the global period<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Records showing the new procedure is unrelated to the LeFort III repair<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Full payment; a new global period starts<\/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\">Operative note naming the assistant and explaining medical necessity<\/td>\n<td style=\"padding:12px 16px;color:#374151\">16% of the primary surgeon&#8217;s fee; payer-specific acceptance<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n\n\n<p class=\"wp-block-paragraph\">Modifier 22 is the one most often misapplied on this code. It needs an operative report that explains what made the case harder than a typical LeFort III repair. Calling the procedure \u00abdifficult\u00bb is not enough. Most payers ask for a cover letter and read the full operative note before releasing extra payment.<\/p>\n\n\n\n<h2 id=\"h-prior-authorization-requirements\" class=\"wp-block-heading\">Prior authorization requirements<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Medicare rarely requires prior authorization for 21432, but commercial payers increasingly do. Requirements shift by plan year and contract. Maintaining <a href=\"https:\/\/pabau.com\/blog\/hipaa-compliance-software\/\">HIPAA-compliant billing workflows<\/a> includes tracking authorization status before any elective craniofacial case reaches the operating room.<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Check payer policies:<\/strong> Use the payer&#8217;s authorization portal before scheduling. Some Medicaid plans require authorization for every LeFort code.<\/li>\n\n\n\n<li><strong>Emergency exception:<\/strong> Medicare and most commercial payers waive prior authorization for emergency craniofacial repair. Document the emergent circumstances in the record.<\/li>\n\n\n\n<li><strong>What to submit:<\/strong> The CT report showing the LeFort III fracture pattern, mechanism of injury, clinical photographs, comorbidities, and the planned surgical approach.<\/li>\n\n\n\n<li><strong>Denial response:<\/strong> Request a peer-to-peer review inside the payer&#8217;s appeal window. Send the surgeon&#8217;s operative plan and the supporting radiology findings.<\/li>\n<\/ul>\n\n\n\n<h2 id=\"h-documentation-requirements-for-clean-claims\" class=\"wp-block-heading\">Documentation requirements for clean claims<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">The operative report decides whether a 21432 claim survives. A coder cannot assign this code without reading it, so the clinical and billing teams need the note to capture every required element. Using <a href=\"https:\/\/pabau.com\/features\/patient-intake-software\/\">digital forms<\/a> built for surgical documentation keeps pre-operative checklists and consent records in place before the day of surgery.<\/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-21432\/customizable-consent-and-intake-forms.webp\" alt=\"Customizable consent and intake forms\"\/><figcaption class=\"wp-element-caption\"><em>Customizable consent and intake forms capture surgical consent and pre-operative history before the day of a LeFort III repair.<\/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<ul class=\"wp-block-list\">\n<li><strong>Fracture level:<\/strong> The note must identify the injury as a LeFort III craniofacial separation, with the fracture lines and pre-operative CT findings referenced.<\/li>\n\n\n\n<li><strong>Surgical approach:<\/strong> Incision locations, tissue planes entered, and access routes. The number of approaches separates 21432 from 21433.<\/li>\n\n\n\n<li><strong>Fixation technique:<\/strong> Wiring or internal fixation must be documented, with plate dimensions, screw count, and fixation sites. Fixation is part of the 21432 descriptor, not an optional extra.<\/li>\n\n\n\n<li><strong>Complexity findings:<\/strong> Comminution, cranial nerve foramina involvement, external fixation hardware, or bone grafting. These are what move a case to 21433, 21435, or 21436.<\/li>\n\n\n\n<li><strong>Surgeon identity and credentials:<\/strong> The attending, any assistant surgeon, and their roles, which modifier 80 claims depend on.<\/li>\n\n\n\n<li><strong>Medical necessity:<\/strong> Clinical indication and imaging findings, which is what the diagnosis code on the claim has to match.<\/li>\n\n\n\n<li><strong>Operative time:<\/strong> Total time in surgery, which supports a modifier 22 claim when it is genuinely elevated.<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">Facial trauma records get requested long after discharge. Insurers, attorneys, and payer auditors ask for the same operative note and imaging, so keep the two together from the start. <\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Practices with steady trauma volume handle those requests in <a href=\"https:\/\/pabau.com\/industry\/lp\/medico-legal-software\/\">medico-legal software<\/a> instead of digging through paper files.<\/p>\n\n\n\n<h2 id=\"h-common-billing-errors-and-denial-prevention\" class=\"wp-block-heading\">Common billing errors and denial prevention<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">21432 denies more often than lower-complexity facial fracture codes. The documentation burden is heavier, and the neighboring codes are easy to reach for by mistake. These are the failure points seen most often in AAPC coding discussions and OIG audit guidance.<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Error: reporting 21430.<\/strong> That code does not exist. Closed treatment of a nasomaxillary complex fracture is 21345, and it sits in the LeFort II ladder.<\/li>\n\n\n\n<li><strong>Error: using 21432 as a general craniofacial fracture code.<\/strong> The descriptor is limited to LeFort III separation with wiring or internal fixation. Other facial bone work has its own codes, such as <a href=\"https:\/\/pabau.com\/procedure-codes\/cpt-code-21026\/\">21026<\/a>.<\/li>\n\n\n\n<li><strong>Error: billing 21433, 21435, or 21436 without the complexity finding.<\/strong> Multiple approaches, external fixation hardware, and bone grafting each have to appear in the operative note.<\/li>\n\n\n\n<li><strong>Error: missing or late prior authorization.<\/strong> An elective craniofacial claim without authorization is denied automatically. Track authorization status before the procedure date.<\/li>\n\n\n\n<li><strong>Error: modifier 22 with a generic note.<\/strong> The claim will be denied or will trigger a post-payment audit. The note has to quantify the extra work.<\/li>\n\n\n\n<li><strong>Error: ICD-10 mismatch.<\/strong> A generic S02.8 code on a documented LeFort III separation understates the injury. Use S02.413 with the correct seventh character.<\/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>Run a quarterly internal audit of your LeFort claims. Pull the last 20, check each code against the operative report, and confirm the ICD-10 seventh character matches the documented fracture type. Pay particular attention to any claim coded 21433, 21435, or 21436, since those carry double the RVUs of 21432 and draw the most payer scrutiny.<\/p>\n            <\/div>\n        <\/div>\n    \n\n\n<h2 id=\"h-how-practice-management-software-streamlines-21432-billing\" class=\"wp-block-heading\">How practice management software streamlines 21432 billing<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">A LeFort III claim touches more hands than a standard outpatient encounter. Pre-authorization tracking, operative report review, modifier selection, ICD-10 pairing, global period monitoring, and audit defense all sit on the same case. Handling each step manually compounds the error rate.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><a href=\"https:\/\/pabau.com\/blog\/practice-management-software\/\">Practice management software<\/a> like Pabau brings those steps into one system. Its <a href=\"https:\/\/pabau.com\/features\/claims-management-software\/\">claims management software<\/a> flags a missing prior authorization before the procedure, and validates CPT and ICD-10 pairings against NCCI edit logic.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Missing detail in the operative note surfaces before the claim goes out. Teams get fewer denials, shorter reimbursement cycles, and an audit trail they can defend. Joining billing to clinical documentation also removes the rekeying step between the note and the claim.<\/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-21432\/automate-claims-through-healthcode.webp\" alt=\"Automate claims and billing with Pabau\"\/><figcaption class=\"wp-element-caption\"><em>Automated claim submission in Pabau routes surgical claims to the payer without rekeying codes from the operative report.<\/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\">For oral and maxillofacial surgery practices, the practical wins are specific. You can track global period end dates across a whole caseload. <\/p>\n\n\n\n<p class=\"wp-block-paragraph\">You can flag post-op visits that need a modifier review, and produce payer-specific authorization packets from one place. That takes a large share of the administrative load off high-acuity surgical codes.<\/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 complex surgical codes                <\/h3>\n\n                <p class=\"description\">\n                    Pabau&#8217;s practice management platform tracks prior authorization status and validates CPT and ICD-10 code combinations. It also flags documentation gaps before claims go out, so billing teams spend less time on rework.                <\/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 practice management platform\"\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 21432 is a narrow code with a wide margin for error. It applies to one injury, a LeFort III craniofacial separation, and one repair, an open reduction held with wiring or internal fixation. Miss either element and the claim is wrong before it is submitted.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">The 90-day global period, the RVU jump to 21433 and 21436, and the S02.413 diagnosis all rest on one document. Write the operative report so a coder can pick the rung without guessing, and the rest of the claim follows.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Pabau helps surgical practices track prior authorization, validate code pairings, and build the audit-ready trail these codes demand. To see how it fits your billing workflow, <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>Need to see how billing software cuts surgical claim denials?<\/strong> <a href=\"https:\/\/pabau.com\/blog\/practice-management-software-features\/\">Practice management software features<\/a> covers the capabilities that support complex surgical billing.<\/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 a graft in the same maxillofacial session?<\/strong> <a href=\"https:\/\/pabau.com\/procedure-codes\/cpt-code-21215\/\">21215<\/a> sets out the documentation and fee schedule detail for mandibular bone grafting.<\/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 a head injury alongside the facial fracture?<\/strong> <a href=\"https:\/\/pabau.com\/diagnostic-codes\/icd-10-code-s066x1d\/\">S06.6X1D<\/a> explains the seventh characters and the loss-of-consciousness detail payers look for.<\/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>Want the Medicare rules behind these RVU figures?<\/strong> <a href=\"https:\/\/pabau.com\/blog\/medicare-billing\/\">Medicare billing<\/a> walks through enrollment, claim submission, and the reimbursement cycle.<\/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-1786714623437\"><h3 class=\"schema-faq-question\">What is CPT code 21432 used for?<\/h3> <p class=\"schema-faq-answer\">CPT code 21432 reports open treatment of craniofacial separation (LeFort III type), with wiring and\/or internal fixation. It applies when a LeFort III fracture has separated the midface from the skull base and the surgeon opens the fracture to reduce it. The segments are then stabilized with wires, miniplates, or screws. Fixation is part of the descriptor, so an open repair without it does not meet the definition.<\/p> <\/div> <div class=\"schema-faq-section\" id=\"faq-question-1786714623438\"><h3 class=\"schema-faq-question\">What is the reimbursement rate for CPT 21432?<\/h3> <p class=\"schema-faq-answer\">CPT 21432 carries 20.12 total RVUs in 2026, made up of 8.60 work, 9.93 practice expense, and 1.59 malpractice. At the CY2026 conversion factor of $33.4009 for non-QP clinicians, that is about $672.03 nationally. Qualifying APM participants are paid at $33.5675. Your locality figure will differ once the GPCI is applied, so verify in the CMS PFS lookup tool before contracting.<\/p> <\/div> <div class=\"schema-faq-section\" id=\"faq-question-1786714623439\"><h3 class=\"schema-faq-question\">What ICD-10 codes are used with CPT 21432?<\/h3> <p class=\"schema-faq-answer\">The diagnosis that supports CPT 21432 is a LeFort III fracture, coded S02.413 with a seventh character. Use S02.413A for an initial encounter with a closed fracture and S02.413B for an open fracture. Subsequent encounters take D, G, or K depending on healing. S02.411 and S02.412 describe LeFort I and LeFort II fractures and pair with different CPT ladders.<\/p> <\/div> <div class=\"schema-faq-section\" id=\"faq-question-1786714623443\"><h3 class=\"schema-faq-question\">Is 21430 a valid CPT code?<\/h3> <p class=\"schema-faq-answer\">No. 21430 is not a valid CPT code, and claims reporting it will reject. Closed treatment of a nasomaxillary complex fracture (LeFort II type) is CPT 21345. The LeFort III range begins at 21431 for closed treatment and runs to 21436. If a coding sheet or template in your system still lists 21430, correct it before the next claim batch goes out.<\/p> <\/div> <div class=\"schema-faq-section\" id=\"faq-question-1786714623440\"><h3 class=\"schema-faq-question\">What is the difference between CPT 21432, 21433, 21435, and 21436?<\/h3> <p class=\"schema-faq-answer\">All four describe open treatment of a LeFort III craniofacial separation, and the complexity finding separates them. 21432 is the uncomplicated repair with wiring or internal fixation. 21433 covers a complicated repair through multiple surgical approaches. 21435 covers a complicated repair using internal or external fixation such as a head cap, halo, or intermaxillary fixation. 21436 is the one that includes bone grafting.<\/p> <\/div> <div class=\"schema-faq-section\" id=\"faq-question-1786714623441\"><h3 class=\"schema-faq-question\">What is the global period for CPT 21432?<\/h3> <p class=\"schema-faq-answer\">CPT 21432 has a 090 global surgery indicator, which means a 90-day major surgery global period. Routine post-operative care inside that window is bundled into the surgical fee. Separately billable services need the right modifier. Use 24 for an unrelated E\/M visit, 78 for a return to the OR for a complication, and 79 for an unrelated procedure.<\/p> <\/div> <div class=\"schema-faq-section\" id=\"faq-question-1786714623442\"><h3 class=\"schema-faq-question\">Does CPT 21432 require prior authorization?<\/h3> <p class=\"schema-faq-answer\">Medicare does not typically require prior authorization for CPT 21432, but many commercial and Medicaid plans do for elective craniofacial surgery. Requirements vary by payer and plan year. Emergency craniofacial repair is generally exempt when the emergent nature is documented in the record. Always confirm with the specific payer before an elective case is scheduled.<\/p> <\/div> <\/div>\n\n\n\n<p class=\"wp-block-paragraph\"><\/p>\n","protected":false},"excerpt":{"rendered":"<p>CPT code 21432 describes the open treatment of craniofacial separation (LeFort III type); with wiring and\/or internal fixation. That is the descriptor published by the American Medical Association&#8217;s CPT Editorial Panel in the AMA CPT code set. Two elements of it carry the whole code. The injury must be a LeFort III craniofacial separation, and [&hellip;]<\/p>\n","protected":false},"author":83,"featured_media":180629,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_yoast_wpseo_linkdex":"84","_yoast_wpseo_content_score":"30","_yoast_wpseo_is_cornerstone":"","_yoast_wpseo_keywordsynonyms":"[\"\",\"\",\"\",\"\"]","_yoast_wpseo_focuskw_text_input":"","_seo_original_html":"","footnotes":""},"categories":[1433,1546,1869],"tags":[1162,1602,2614,2775,1236,3368],"class_list":["post-180632","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-facial-trauma-documentation","tag-fracture-management","tag-medicare-reimbursement","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 21432: LeFort III Repair, RVUs, and Modifiers<\/title>\n<meta name=\"description\" content=\"CPT 21432 covers open LeFort III repair with wiring or internal fixation. It carries 20.12 RVUs, about $672, and a 90-day global period.\" \/>\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-21432\/\" \/>\n<meta property=\"og:locale\" content=\"es_ES\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"CPT Code 21432: LeFort III Repair, RVUs, and Modifiers\" \/>\n<meta property=\"og:description\" content=\"CPT 21432 covers open LeFort III repair with wiring or internal fixation. It carries 20.12 RVUs, about $672, and a 90-day global period.\" \/>\n<meta property=\"og:url\" content=\"https:\/\/pabau.com\/es\/procedure-codes\/cpt-code-21432\/\" \/>\n<meta property=\"og:site_name\" content=\"Pabau\" \/>\n<meta property=\"article:publisher\" content=\"https:\/\/www.facebook.com\/Pabau\/\" \/>\n<meta property=\"article:published_time\" content=\"2026-08-17T08:39:07+00:00\" \/>\n<meta property=\"article:modified_time\" content=\"2026-08-17T08:39:09+00:00\" \/>\n<meta property=\"og:image\" content=\"https:\/\/pabau.com\/wp-content\/uploads\/2026\/08\/cpt-code-21432.webp\" \/>\n\t<meta property=\"og:image:width\" content=\"1200\" \/>\n\t<meta property=\"og:image:height\" content=\"630\" \/>\n\t<meta property=\"og:image:type\" content=\"image\/webp\" \/>\n<meta name=\"author\" content=\"Anja Dodevska\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:creator\" content=\"@pabaucrm\" \/>\n<meta name=\"twitter:site\" content=\"@pabaucrm\" \/>\n<meta name=\"twitter:label1\" content=\"Escrito por\" \/>\n\t<meta name=\"twitter:data1\" content=\"Anja Dodevska\" \/>\n\t<meta name=\"twitter:label2\" content=\"Tiempo de lectura\" \/>\n\t<meta name=\"twitter:data2\" content=\"15 minutos\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\\\/\\\/schema.org\",\"@graph\":[{\"@type\":\"Article\",\"@id\":\"https:\\\/\\\/pabau.com\\\/es\\\/procedure-codes\\\/cpt-code-21432\\\/#article\",\"isPartOf\":{\"@id\":\"https:\\\/\\\/pabau.com\\\/es\\\/procedure-codes\\\/cpt-code-21432\\\/\"},\"author\":{\"name\":\"Anja Dodevska\",\"@id\":\"https:\\\/\\\/pabau.com\\\/es\\\/#\\\/schema\\\/person\\\/f2e43b25ed02313e8781f0f4507398b9\"},\"headline\":\"CPT code 21432: Open treatment of craniofacial separation (LeFort III)\",\"datePublished\":\"2026-08-17T08:39:07+00:00\",\"dateModified\":\"2026-08-17T08:39:09+00:00\",\"mainEntityOfPage\":{\"@id\":\"https:\\\/\\\/pabau.com\\\/es\\\/procedure-codes\\\/cpt-code-21432\\\/\"},\"wordCount\":3033,\"publisher\":{\"@id\":\"https:\\\/\\\/pabau.com\\\/es\\\/#organization\"},\"image\":{\"@id\":\"https:\\\/\\\/pabau.com\\\/es\\\/procedure-codes\\\/cpt-code-21432\\\/#primaryimage\"},\"thumbnailUrl\":\"https:\\\/\\\/pabau.com\\\/wp-content\\\/uploads\\\/2026\\\/08\\\/cpt-code-21432.webp\",\"keywords\":[\"CPT Codes\",\"Cpt Modifiers\",\"Facial trauma documentation\",\"Fracture management\",\"Medicare reimbursement\",\"Oral Surgery Billing\"],\"articleSection\":[\"Billing Codes\",\"CPT Codes\",\"United States\"],\"inLanguage\":\"es\"},{\"@type\":[\"WebPage\",\"FAQPage\"],\"@id\":\"https:\\\/\\\/pabau.com\\\/es\\\/procedure-codes\\\/cpt-code-21432\\\/\",\"url\":\"https:\\\/\\\/pabau.com\\\/es\\\/procedure-codes\\\/cpt-code-21432\\\/\",\"name\":\"CPT Code 21432: LeFort III Repair, RVUs, and Modifiers\",\"isPartOf\":{\"@id\":\"https:\\\/\\\/pabau.com\\\/es\\\/#website\"},\"primaryImageOfPage\":{\"@id\":\"https:\\\/\\\/pabau.com\\\/es\\\/procedure-codes\\\/cpt-code-21432\\\/#primaryimage\"},\"image\":{\"@id\":\"https:\\\/\\\/pabau.com\\\/es\\\/procedure-codes\\\/cpt-code-21432\\\/#primaryimage\"},\"thumbnailUrl\":\"https:\\\/\\\/pabau.com\\\/wp-content\\\/uploads\\\/2026\\\/08\\\/cpt-code-21432.webp\",\"datePublished\":\"2026-08-17T08:39:07+00:00\",\"dateModified\":\"2026-08-17T08:39:09+00:00\",\"description\":\"CPT 21432 covers open LeFort III repair with wiring or internal fixation. 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The segments are then stabilized with wires, miniplates, or screws. Fixation is part of the descriptor, so an open repair without it does not meet the definition.\",\"inLanguage\":\"es\"},\"inLanguage\":\"es\"},{\"@type\":\"Question\",\"@id\":\"https:\\\/\\\/pabau.com\\\/es\\\/procedure-codes\\\/cpt-code-21432\\\/#faq-question-1786714623438\",\"position\":2,\"url\":\"https:\\\/\\\/pabau.com\\\/es\\\/procedure-codes\\\/cpt-code-21432\\\/#faq-question-1786714623438\",\"name\":\"What is the reimbursement rate for CPT 21432?\",\"answerCount\":1,\"acceptedAnswer\":{\"@type\":\"Answer\",\"text\":\"CPT 21432 carries 20.12 total RVUs in 2026, made up of 8.60 work, 9.93 practice expense, and 1.59 malpractice. At the CY2026 conversion factor of $33.4009 for non-QP clinicians, that is about $672.03 nationally. Qualifying APM participants are paid at $33.5675. Your locality figure will differ once the GPCI is applied, so verify in the CMS PFS lookup tool before contracting.\",\"inLanguage\":\"es\"},\"inLanguage\":\"es\"},{\"@type\":\"Question\",\"@id\":\"https:\\\/\\\/pabau.com\\\/es\\\/procedure-codes\\\/cpt-code-21432\\\/#faq-question-1786714623439\",\"position\":3,\"url\":\"https:\\\/\\\/pabau.com\\\/es\\\/procedure-codes\\\/cpt-code-21432\\\/#faq-question-1786714623439\",\"name\":\"What ICD-10 codes are used with CPT 21432?\",\"answerCount\":1,\"acceptedAnswer\":{\"@type\":\"Answer\",\"text\":\"The diagnosis that supports CPT 21432 is a LeFort III fracture, coded S02.413 with a seventh character. Use S02.413A for an initial encounter with a closed fracture and S02.413B for an open fracture. Subsequent encounters take D, G, or K depending on healing. S02.411 and S02.412 describe LeFort I and LeFort II fractures and pair with different CPT ladders.\",\"inLanguage\":\"es\"},\"inLanguage\":\"es\"},{\"@type\":\"Question\",\"@id\":\"https:\\\/\\\/pabau.com\\\/es\\\/procedure-codes\\\/cpt-code-21432\\\/#faq-question-1786714623443\",\"position\":4,\"url\":\"https:\\\/\\\/pabau.com\\\/es\\\/procedure-codes\\\/cpt-code-21432\\\/#faq-question-1786714623443\",\"name\":\"Is 21430 a valid CPT code?\",\"answerCount\":1,\"acceptedAnswer\":{\"@type\":\"Answer\",\"text\":\"No. 21430 is not a valid CPT code, and claims reporting it will reject. Closed treatment of a nasomaxillary complex fracture (LeFort II type) is CPT 21345. The LeFort III range begins at 21431 for closed treatment and runs to 21436. If a coding sheet or template in your system still lists 21430, correct it before the next claim batch goes out.\",\"inLanguage\":\"es\"},\"inLanguage\":\"es\"},{\"@type\":\"Question\",\"@id\":\"https:\\\/\\\/pabau.com\\\/es\\\/procedure-codes\\\/cpt-code-21432\\\/#faq-question-1786714623440\",\"position\":5,\"url\":\"https:\\\/\\\/pabau.com\\\/es\\\/procedure-codes\\\/cpt-code-21432\\\/#faq-question-1786714623440\",\"name\":\"What is the difference between CPT 21432, 21433, 21435, and 21436?\",\"answerCount\":1,\"acceptedAnswer\":{\"@type\":\"Answer\",\"text\":\"All four describe open treatment of a LeFort III craniofacial separation, and the complexity finding separates them. 21432 is the uncomplicated repair with wiring or internal fixation. 21433 covers a complicated repair through multiple surgical approaches. 21435 covers a complicated repair using internal or external fixation such as a head cap, halo, or intermaxillary fixation. 21436 is the one that includes bone grafting.\",\"inLanguage\":\"es\"},\"inLanguage\":\"es\"},{\"@type\":\"Question\",\"@id\":\"https:\\\/\\\/pabau.com\\\/es\\\/procedure-codes\\\/cpt-code-21432\\\/#faq-question-1786714623441\",\"position\":6,\"url\":\"https:\\\/\\\/pabau.com\\\/es\\\/procedure-codes\\\/cpt-code-21432\\\/#faq-question-1786714623441\",\"name\":\"What is the global period for CPT 21432?\",\"answerCount\":1,\"acceptedAnswer\":{\"@type\":\"Answer\",\"text\":\"CPT 21432 has a 090 global surgery indicator, which means a 90-day major surgery global period. Routine post-operative care inside that window is bundled into the surgical fee. Separately billable services need the right modifier. Use 24 for an unrelated E\\\/M visit, 78 for a return to the OR for a complication, and 79 for an unrelated procedure.\",\"inLanguage\":\"es\"},\"inLanguage\":\"es\"},{\"@type\":\"Question\",\"@id\":\"https:\\\/\\\/pabau.com\\\/es\\\/procedure-codes\\\/cpt-code-21432\\\/#faq-question-1786714623442\",\"position\":7,\"url\":\"https:\\\/\\\/pabau.com\\\/es\\\/procedure-codes\\\/cpt-code-21432\\\/#faq-question-1786714623442\",\"name\":\"Does CPT 21432 require prior authorization?\",\"answerCount\":1,\"acceptedAnswer\":{\"@type\":\"Answer\",\"text\":\"Medicare does not typically require prior authorization for CPT 21432, but many commercial and Medicaid plans do for elective craniofacial surgery. Requirements vary by payer and plan year. Emergency craniofacial repair is generally exempt when the emergent nature is documented in the record. 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Fixation is part of the descriptor, so an open repair without it does not meet the definition.","inLanguage":"es"},"inLanguage":"es"},{"@type":"Question","@id":"https:\/\/pabau.com\/es\/procedure-codes\/cpt-code-21432\/#faq-question-1786714623438","position":2,"url":"https:\/\/pabau.com\/es\/procedure-codes\/cpt-code-21432\/#faq-question-1786714623438","name":"What is the reimbursement rate for CPT 21432?","answerCount":1,"acceptedAnswer":{"@type":"Answer","text":"CPT 21432 carries 20.12 total RVUs in 2026, made up of 8.60 work, 9.93 practice expense, and 1.59 malpractice. At the CY2026 conversion factor of $33.4009 for non-QP clinicians, that is about $672.03 nationally. Qualifying APM participants are paid at $33.5675. Your locality figure will differ once the GPCI is applied, so verify in the CMS PFS lookup tool before contracting.","inLanguage":"es"},"inLanguage":"es"},{"@type":"Question","@id":"https:\/\/pabau.com\/es\/procedure-codes\/cpt-code-21432\/#faq-question-1786714623439","position":3,"url":"https:\/\/pabau.com\/es\/procedure-codes\/cpt-code-21432\/#faq-question-1786714623439","name":"What ICD-10 codes are used with CPT 21432?","answerCount":1,"acceptedAnswer":{"@type":"Answer","text":"The diagnosis that supports CPT 21432 is a LeFort III fracture, coded S02.413 with a seventh character. Use S02.413A for an initial encounter with a closed fracture and S02.413B for an open fracture. Subsequent encounters take D, G, or K depending on healing. S02.411 and S02.412 describe LeFort I and LeFort II fractures and pair with different CPT ladders.","inLanguage":"es"},"inLanguage":"es"},{"@type":"Question","@id":"https:\/\/pabau.com\/es\/procedure-codes\/cpt-code-21432\/#faq-question-1786714623443","position":4,"url":"https:\/\/pabau.com\/es\/procedure-codes\/cpt-code-21432\/#faq-question-1786714623443","name":"Is 21430 a valid CPT code?","answerCount":1,"acceptedAnswer":{"@type":"Answer","text":"No. 21430 is not a valid CPT code, and claims reporting it will reject. Closed treatment of a nasomaxillary complex fracture (LeFort II type) is CPT 21345. The LeFort III range begins at 21431 for closed treatment and runs to 21436. If a coding sheet or template in your system still lists 21430, correct it before the next claim batch goes out.","inLanguage":"es"},"inLanguage":"es"},{"@type":"Question","@id":"https:\/\/pabau.com\/es\/procedure-codes\/cpt-code-21432\/#faq-question-1786714623440","position":5,"url":"https:\/\/pabau.com\/es\/procedure-codes\/cpt-code-21432\/#faq-question-1786714623440","name":"What is the difference between CPT 21432, 21433, 21435, and 21436?","answerCount":1,"acceptedAnswer":{"@type":"Answer","text":"All four describe open treatment of a LeFort III craniofacial separation, and the complexity finding separates them. 21432 is the uncomplicated repair with wiring or internal fixation. 21433 covers a complicated repair through multiple surgical approaches. 21435 covers a complicated repair using internal or external fixation such as a head cap, halo, or intermaxillary fixation. 21436 is the one that includes bone grafting.","inLanguage":"es"},"inLanguage":"es"},{"@type":"Question","@id":"https:\/\/pabau.com\/es\/procedure-codes\/cpt-code-21432\/#faq-question-1786714623441","position":6,"url":"https:\/\/pabau.com\/es\/procedure-codes\/cpt-code-21432\/#faq-question-1786714623441","name":"What is the global period for CPT 21432?","answerCount":1,"acceptedAnswer":{"@type":"Answer","text":"CPT 21432 has a 090 global surgery indicator, which means a 90-day major surgery global period. Routine post-operative care inside that window is bundled into the surgical fee. Separately billable services need the right modifier. Use 24 for an unrelated E\/M visit, 78 for a return to the OR for a complication, and 79 for an unrelated procedure.","inLanguage":"es"},"inLanguage":"es"},{"@type":"Question","@id":"https:\/\/pabau.com\/es\/procedure-codes\/cpt-code-21432\/#faq-question-1786714623442","position":7,"url":"https:\/\/pabau.com\/es\/procedure-codes\/cpt-code-21432\/#faq-question-1786714623442","name":"Does CPT 21432 require prior authorization?","answerCount":1,"acceptedAnswer":{"@type":"Answer","text":"Medicare does not typically require prior authorization for CPT 21432, but many commercial and Medicaid plans do for elective craniofacial surgery. Requirements vary by payer and plan year. Emergency craniofacial repair is generally exempt when the emergent nature is documented in the record. Always confirm with the specific payer before an elective case is scheduled.","inLanguage":"es"},"inLanguage":"es"}]}},"yoast":{"focus_keyword":"CPT code 21432","seo_title":"CPT Code 21432: LeFort III Repair, RVUs, and Modifiers","meta_description":"CPT 21432 covers open LeFort III repair with wiring or internal fixation. It carries 20.12 RVUs, about $672, and a 90-day global period.","content_score":"30","is_cornerstone":"","related_keyphrases":[{"keyword":"maxillofacial fracture CPT codes","score":61},{"keyword":"facial fracture surgery Medicare reimbursement","score":56},{"keyword":"CPT 21432 modifier","score":61}]},"_links":{"self":[{"href":"https:\/\/pabau.com\/es\/wp-json\/wp\/v2\/posts\/180632","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/pabau.com\/es\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/pabau.com\/es\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/pabau.com\/es\/wp-json\/wp\/v2\/users\/83"}],"replies":[{"embeddable":true,"href":"https:\/\/pabau.com\/es\/wp-json\/wp\/v2\/comments?post=180632"}],"version-history":[{"count":4,"href":"https:\/\/pabau.com\/es\/wp-json\/wp\/v2\/posts\/180632\/revisions"}],"predecessor-version":[{"id":181182,"href":"https:\/\/pabau.com\/es\/wp-json\/wp\/v2\/posts\/180632\/revisions\/181182"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/pabau.com\/es\/wp-json\/wp\/v2\/media\/180629"}],"wp:attachment":[{"href":"https:\/\/pabau.com\/es\/wp-json\/wp\/v2\/media?parent=180632"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/pabau.com\/es\/wp-json\/wp\/v2\/categories?post=180632"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/pabau.com\/es\/wp-json\/wp\/v2\/tags?post=180632"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}