{"id":177190,"date":"2026-08-13T09:20:11","date_gmt":"2026-08-13T09:20:11","guid":{"rendered":"https:\/\/pabau.com\/?p=177190"},"modified":"2026-08-13T09:20:13","modified_gmt":"2026-08-13T09:20:13","slug":"cpt-code-21195","status":"publish","type":"post","link":"https:\/\/pabau.com\/fr\/procedure-codes\/cpt-code-21195\/","title":{"rendered":"CPT Code 21195: Mandibular reconstruction, sagittal split"},"content":{"rendered":"\n<script type=\"application\/ld+json\">{\"@context\":\"https:\/\/schema.org\",\"@type\":\"MedicalWebPage\",\"headline\":\"CPT Code 21195: Mandibular reconstruction, sagittal split, without fixation\",\"description\":\"CPT Code 21195 describes reconstruction of mandibular rami and\/or body via sagittal split osteotomy without internal rigid fixation. Reference guide covering RVU values, Medicare reimbursement, modifiers, ICD-10 crosswalk, and billing guidelines.\",\"url\":\"https:\/\/pabau.com\/procedure-codes\/cpt-code-21195\/\",\"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\":\"2026-08-07\"}<\/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 21195 covers reconstruction of the mandibular rami or body by sagittal split osteotomy, performed without internal rigid 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 differs from CPT 21196 by the absence of plates and screws, since wire or intermaxillary fixation holds the repositioned jaw instead.<\/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>Most commercial payers require prior authorization, so pair the claim with a diagnosis code such as M26.19 for prognathism or retrognathism.<\/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>ICD-10-CM does not separate prognathism from retrognathism, so the operative report has to carry the clinical detail the code cannot.<\/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 tracks authorizations, links diagnosis codes to claims, and cuts denials on orthognathic surgery billing.<\/p>\n                        <\/div>\n                                                <\/div>\n        <\/div>\n    \n\n\n<p class=\"wp-block-paragraph\"><strong>CPT Code 21195<\/strong> covers reconstruction of the mandibular rami and\/or body by sagittal split osteotomy, performed without internal rigid fixation. <\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Oral and maxillofacial surgeons report it when wire or intermaxillary fixation holds the repositioned jaw, rather than plates and screws.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Denials on this code cluster around three problems. Prior authorization is missing, the diagnosis code does not establish medical necessity, or the operative report actually describes CPT 21196. Each one is preventable before the claim leaves the practice.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">This guide covers the official descriptor, the RVU components, Medicare payment rules, modifiers, the ICD-10 crosswalk, and the documentation that keeps these claims clean.<\/p>\n\n\n\n<figure class=\"wp-block-embed is-type-video is-provider-youtube wp-block-embed-youtube wp-embed-aspect-16-9 wp-has-aspect-ratio\"><div class=\"wp-block-embed__wrapper\">\n<iframe title=\"CPT Coding Pitfalls Every Medical Practice Faces\" width=\"800\" height=\"450\" src=\"https:\/\/www.youtube.com\/embed\/vbvV5okdXKg?feature=oembed\" frameborder=\"0\" allow=\"accelerometer; autoplay; clipboard-write; encrypted-media; gyroscope; picture-in-picture; web-share\" referrerpolicy=\"strict-origin-when-cross-origin\" allowfullscreen><\/iframe>\n<\/div><\/figure>\n\n\n\n<h2 id=\"h-what-cpt-code-21195-covers\" class=\"wp-block-heading\">What CPT Code 21195 covers<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">The <a href=\"https:\/\/www.ama-assn.org\/practice-management\/cpt\/cpt-code-set-overview\" target=\"_blank\" rel=\"nofollow noopener\">American Medical Association<\/a> assigns CPT Code 21195 the following official long descriptor:<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Reconstruction of mandibular rami and\/or body, sagittal split; without internal rigid fixation.<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">The code sits in the musculoskeletal system section of the CPT code set, under surgery on the head. In clinical terms, it covers a bilateral sagittal split osteotomy (BSSO) of the mandible. Wire or intermaxillary fixation holds the repositioned bone segments, instead of titanium plates and screws.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Indications include skeletal Class II or Class III malocclusion, mandibular prognathism, retrognathism, and obstructive sleep apnea treated by skeletal jaw advancement.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Oral and maxillofacial surgeons (OMFS) perform the procedure, as do plastic surgeons who specialize in craniofacial reconstruction. Those practices can keep surgical notes, consent records, and billing together in <a href=\"https:\/\/pabau.com\/industry\/plastic-surgery-emr\/\">reconstructive surgery EMR<\/a> tools.<\/p>\n\n\n\n<h3 id=\"h-code-section-and-classification\" class=\"wp-block-heading\">Code section and classification<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">CPT Code 21195 sits in the 21100-21299 range, which covers surgery on the skull, facial bones, and the temporomandibular joint. <\/p>\n\n\n\n<p class=\"wp-block-paragraph\">It is a Category I code, so the procedure is widely performed, clinically validated, and covered under most major payer contracts. Anesthesia is not bundled into it, so the anesthesiologist reports their own code separately.<\/p>\n\n\n\n<h2 id=\"h-sagittal-split-osteotomy-and-why-fixation-decides-the-code\" class=\"wp-block-heading\">Sagittal split osteotomy and why fixation decides the code<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">In a sagittal split osteotomy, the surgeon cuts through the mandibular rami on both sides and splits the bone into two segments. The tooth-bearing distal segment then moves forward for an advancement, or back for a setback, correcting the skeletal discrepancy.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">CPT Code 21195 applies when the surgeon secures those segments without internal rigid fixation, meaning no plates and no screws. <\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Intermaxillary fixation (IMF) wires or elastic bands hold the jaw in the corrected position while the bone heals over several weeks. Some surgeons prefer this for particular patient profiles, or when the plan calls for a period of jaw immobilization.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Mixing this up with CPT 21196 is the most common coding error in the family. The two codes are mutually exclusive for the same operative session on the same side. <\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Reading the operative report for the fixation method before you pick a code prevents most audits here. <a href=\"https:\/\/pabau.com\/features\/patient-intake-software\/\">Digital clinical forms<\/a> can capture the surgical approach at the point of care, so the detail reaches the coder.<\/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-21195\/digital-forms.webp\" alt=\"Pabau medical form builder showing a template library and a form preview\"\/><figcaption class=\"wp-element-caption\"><em>Pabau&rsquo;s form builder holds a surgical checklist that records the planned fixation method, so your coder sees it before billing.<\/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-cpt-21195-vs-cpt-21196-key-differences\" class=\"wp-block-heading\">CPT 21195 vs. CPT 21196: Key differences<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">These two codes describe the same surgical approach and differ on a single clinical variable. Both cover sagittal split osteotomy of the mandibular rami. The fixation method used at the end of the procedure decides which one you report.<\/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\">Feature<\/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\">CPT Code 21195<\/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\">CPT 21196<\/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\">Full descriptor<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Reconstruction of mandibular rami and\/or body, sagittal split; without internal rigid fixation<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Reconstruction of mandibular rami and\/or body, sagittal split; with internal rigid fixation<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Fixation method<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Wire or intermaxillary fixation (IMF)<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Titanium plates and screws (rigid fixation)<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Recovery expectation<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Jaw typically wired shut for 4-6 weeks<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Jaw mobile sooner; plates maintain position<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Common usage context<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Surgeon preference, patient profile, or clinical protocol requiring IMF<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Most contemporary OMFS practices; faster patient recovery<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Work RVU (approximate)<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Verify current year via CMS MPFS<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Higher; rigid fixation adds operative time and complexity<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Mutual exclusivity<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Cannot be billed with 21196 for the same site in the same session<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Cannot be billed with 21195 for the same site in the same session<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n\n\n<p class=\"wp-block-paragraph\">When the operative note is vague about fixation, query the surgeon before the claim goes out. A query takes a few minutes, while reworking a denied claim takes far longer.<\/p>\n\n\n\n<h2 id=\"h-rvu-components-and-how-payment-is-calculated\" class=\"wp-block-heading\">RVU components and how payment is calculated<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Relative Value Units (RVUs) are the basis of Medicare payment under the Resource-Based Relative Value Scale (RBRVS). Three components combine into the total RVU used to calculate reimbursement. <\/p>\n\n\n\n<p class=\"wp-block-paragraph\">The Centers for Medicare and Medicaid Services (<a href=\"https:\/\/www.cms.gov\/medicare\/physician-fee-schedule\/search\/overview\" target=\"_blank\" rel=\"nofollow noopener\">CMS<\/a>) updates the values every year. Check the Medicare Physician Fee Schedule (MPFS) lookup tool for the payment year you are billing.<\/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\">What It Measures<\/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\">Source for Current Values<\/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\">Physician time, effort, skill, and stress involved in performing the procedure<\/td>\n<td style=\"padding:12px 16px;color:#374151\">CMS MPFS lookup tool; verify annually<\/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 (PE RVU)<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Overhead costs: staff, supplies, equipment, facility expense<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Facility and non-facility rates differ; check both<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Malpractice RVU (MP RVU)<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Professional liability insurance cost allocation for the procedure<\/td>\n<td style=\"padding:12px 16px;color:#374151\">CMS MPFS lookup tool; verify annually<\/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\">Sum of wRVU + PE RVU + MP RVU, adjusted by GPCI<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Apply Medicare conversion factor (CF) to calculate payment<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n\n\n<p class=\"wp-block-paragraph\">Medicare pays <strong>[(wRVU \u00d7 work GPCI) + (PE RVU \u00d7 PE GPCI) + (MP RVU \u00d7 MP GPCI)] \u00d7 conversion factor<\/strong>. The brackets matter, because the conversion factor multiplies the whole adjusted sum rather than the malpractice term alone.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">The Geographic Practice Cost Index (GPCI) adjusts for regional cost differences. A practice in Manhattan is paid a different amount than one in rural Mississippi for the same code. Pull the current-year RVUs and your locality&rsquo;s GPCI values from the MPFS lookup tool before you set a charge master.<\/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>Pull RVU values from the CMS MPFS lookup tool each October, when the proposed rule publishes. Check them again in January, when the final rule takes effect. Coding teams that work from the prior year&rsquo;s values through Q1 frequently underbill or set incorrect charge masters before catching the discrepancy at audit.<\/p>\n            <\/div>\n        <\/div>\n    \n\n\n<h2 id=\"h-medicare-reimbursement-and-coverage-rules\" class=\"wp-block-heading\">Medicare reimbursement and coverage rules<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Medicare covers orthognathic surgery more narrowly than commercial plans do. Part B pays for reconstructive jaw surgery when the record shows a functional indication, such as a skeletal deformity affecting mastication or the airway. Purely cosmetic correction does not meet the medical necessity standard.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Payment differs between facility and non-facility settings. When the procedure is done in a hospital or an ambulatory surgical center (ASC), the facility rate applies. <\/p>\n\n\n\n<p class=\"wp-block-paragraph\">In the rare non-facility case, the rate includes practice expense overhead. Pull current-year amounts from the MPFS lookup tool, since the rates change every January.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Key Medicare billing considerations for this code:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Submit the claim on a CMS-1500 form with the correct place of service code, 21 for inpatient hospital or 24 for an ASC<\/li>\n\n\n\n<li>Medicare needs an operative report that states the surgical technique and the fixation method used<\/li>\n\n\n\n<li>GPCI adjustments apply, so practices in high-cost localities receive proportionally higher reimbursement<\/li>\n\n\n\n<li>A Local Coverage Determination may apply in your MAC jurisdiction, so check CMS resources before billing<\/li>\n\n\n\n<li>Medicare Advantage plans can add prior authorization requirements that traditional Medicare does not impose<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">Commercial rates vary widely from Medicare. Most private payers negotiate a percentage of the Medicare fee schedule, often 110% to 160% for surgical procedures in this range. <\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Contract terms still differ by region and payer. Practices working across several contracts need a <a href=\"https:\/\/pabau.com\/blog\/what-is-medical-billing\/\">medical billing<\/a> process that tracks payment by payer and flags underpayments.<\/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-21195\/automate-claims-through-healthcode.webp\" alt=\"Pabau checkout screen with a completed invoice billed to an insurer\"\/><figcaption class=\"wp-element-caption\"><em>Pabau records the payer on each invoice at checkout, so insurance balances and patient balances stay separate in one billing record.<\/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-modifiers-that-apply-to-this-procedure\" class=\"wp-block-heading\">Modifiers that apply to this procedure<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Modifier selection depends on the operative circumstances. The table below covers the modifiers most often applied to CPT Code 21195, and when each one is appropriate.<\/p>\n\n\n\n<table style=\"width:100%;border-collapse:separate;border-spacing:0;border-radius:12px;overflow:hidden;font-size:15px;line-height:1.5;margin:1.5em 0 2em;box-shadow:0 2px 12px rgba(0,0,0,0.08)\">\n<thead>\n<tr>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Modifier<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Name<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">When to Use<\/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\">Increased procedural services<\/td>\n<td style=\"padding:12px 16px;color:#374151\">When the procedure is substantially more difficult than typical due to patient anatomy, prior surgery, or unusual complexity. Requires a detailed operative note explaining the increased effort. Payer documentation requirements vary.<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\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\">The sagittal split is almost always performed bilaterally. Whether -50 applies depends on the bilateral indicator CMS assigns, so verify it against current MPFS data. Some payers bundle bilateral work into the base code.<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">-51<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Multiple procedures<\/td>\n<td style=\"padding:12px 16px;color:#374151\">When the procedure is performed alongside another distinct surgical procedure at the same session. The primary procedure is listed first without -51, and secondary procedures carry the modifier.<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">-62<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Two surgeons<\/td>\n<td style=\"padding:12px 16px;color:#374151\">When the procedure requires two surgeons working simultaneously, each performing a distinct part of the operation. Both surgeons append -62 to their claims. Documentation must support the necessity of co-surgery.<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\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\">When an assistant surgeon participates. The assistant bills the code with -80, and Medicare pays assistant surgery at 16% of the primary surgeon&rsquo;s fee for eligible codes.<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">-RT \/ -LT<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Right side \/ Left side<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Used when billing the procedure separately for each side rather than with modifier -50. Side-specific modifiers help with NCCI edit compliance and payer adjudication on bilateral claims.<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n\n\n<p class=\"wp-block-paragraph\">Check the bilateral indicator for CPT Code 21195 in the current MPFS data table before you apply -50. That indicator governs whether Medicare pays 150% of the single-procedure fee, 100%, or something else. <\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Payers also differ on what they expect, so keep each contract&rsquo;s modifier rules where coders will see them, inside your <a href=\"https:\/\/pabau.com\/blog\/practice-management-software\/\">practice management software<\/a>.<\/p>\n\n\n\n<h2 id=\"h-icd-10-diagnosis-codes-that-support-the-claim\" class=\"wp-block-heading\">ICD-10 diagnosis codes that support the claim<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Every claim for CPT Code 21195 needs at least one ICD-10-CM diagnosis code that establishes medical necessity. Prognathism and retrognathism are the primary indications, and malocclusion or sleep apnea codes apply in the right clinical context.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">ICD-10-CM does not give prognathism and retrognathism separate codes. Both index to M26.19, so the clinical distinction lives in the operative report and the necessity letter rather than in the code itself.<\/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\">Clinical Context<\/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\">M26.19<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Unspecified anomaly of jaw-cranial base relationship<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Covers mandibular prognathism (Class III) and retrognathism (Class II). The operative report carries the clinical detail<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">M26.4<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Malocclusion, unspecified<\/td>\n<td style=\"padding:12px 16px;color:#374151\">When the documented indication is malocclusion rather than a specific skeletal jaw anomaly<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">M26.212<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Malocclusion, Angle&rsquo;s Class II<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Class II skeletal or dental relationship with mandibular deficiency<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">M26.213<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Malocclusion, Angle&rsquo;s Class III<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Class III skeletal or dental relationship with mandibular excess<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\"><a href=\"https:\/\/pabau.com\/diagnostic-codes\/icd-10-code-g4733\/\">G47.33<\/a><\/td>\n<td style=\"padding:12px 16px;color:#374151\">Obstructive sleep apnea (adult)<\/td>\n<td style=\"padding:12px 16px;color:#374151\">When jaw advancement treats obstructive sleep apnea, which strengthens the medical necessity argument<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n\n\n<p class=\"wp-block-paragraph\">Verify each code against the current fiscal year release before billing, and confirm LCD coverage criteria with CMS or the payer. Use the most specific code the documentation supports. <\/p>\n\n\n\n<p class=\"wp-block-paragraph\">M26.19 is an unspecified code, so it fits when the record does not name a more precise anomaly. Capturing the diagnosis at consultation and carrying it through to the claim keeps both documents consistent.<\/p>\n\n\n\n<h2 id=\"h-prior-authorization-and-medical-necessity\" class=\"wp-block-heading\">Prior authorization and medical necessity<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Most commercial payers require prior authorization (PA) for orthognathic surgery, and CPT Code 21195 is no exception. This is one of the most authorization-heavy categories in oral surgery billing. Requirements vary by payer, plan type, and state, so verify with the insurer before you schedule the procedure.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">A standard medical necessity submission usually includes:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Cephalometric analysis and measurements demonstrating the skeletal discrepancy<\/li>\n\n\n\n<li>Orthodontic records confirming pre-surgical orthodontic treatment is complete or in progress<\/li>\n\n\n\n<li>Clinical photographs documenting the facial and occlusal findings<\/li>\n\n\n\n<li>Panoramic and periapical radiographs<\/li>\n\n\n\n<li>A letter of medical necessity from the surgeon, describing the functional impairment and the surgical plan<\/li>\n\n\n\n<li>Sleep study results for sleep apnea indications, plus evidence of CPAP failure where that applies<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">Payers deny these claims most often for thin medical necessity documentation, or by calling the procedure cosmetic. A complete packet with the first submission avoids most appeals.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">A reusable <a href=\"https:\/\/pabau.com\/templates\/medical-prior-authorization-form\/\">prior authorization form<\/a> keeps the same fields in front of staff for every case. <a href=\"https:\/\/pabau.com\/blog\/hipaa-compliance-software\/\">HIPAA-compliant software<\/a> then keeps the approval attached to the patient record.<\/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>Attach the cephalometric analysis and the surgical treatment plan to the PA submission as a PDF. Payers that deny a first submission for &lsquo;insufficient documentation&rsquo; often approve on appeal once those records arrive. Building a reusable PA packet for this code removes that round trip.<\/p>\n            <\/div>\n        <\/div>\n    \n\n\n<h2 id=\"h-billing-guidelines-and-common-coding-errors\" class=\"wp-block-heading\">Billing guidelines and common coding errors<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Denials on this code follow predictable patterns. Three billing decisions account for most of them.<\/p>\n\n\n\n<h3 id=\"h-ncci-bundling-edits\" class=\"wp-block-heading\">NCCI bundling edits<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">The National Correct Coding Initiative (NCCI) publishes quarterly edits that define which codes cannot be billed together without a modifier. CMS maintains the <a href=\"https:\/\/www.cms.gov\/medicare\/coding-billing\/national-correct-coding-initiative-ncci-edits\" target=\"_blank\" rel=\"nofollow noopener\">NCCI edit files<\/a> and refreshes them every quarter, so treat any bundling list you have saved as provisional.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Review the edits before reporting a secondary code at the same operative session, especially for adjacent structures such as chin or maxillary osteotomy. <\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Interdental fixation carries its own code, <a href=\"https:\/\/pabau.com\/procedure-codes\/cpt-code-21110\/\">CPT 21110<\/a>, and interdental wiring is reported with <a href=\"https:\/\/pabau.com\/procedure-codes\/cpt-code-21497\/\">CPT 21497<\/a>. Both are routinely bundled into the osteotomy, so check before you add either one.<\/p>\n\n\n\n<h3 id=\"h-correct-code-selection-from-the-operative-report\" class=\"wp-block-heading\">Correct code selection from the operative report<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">The operative report has to state the fixation method. When it describes plate and screw fixation, the correct code is CPT 21196. Billing the wrong fixation variant is the most common upcoding or downcoding error in this family. A pre-claim check that compares the report against the code billed catches nearly all of them.<\/p>\n\n\n\n<h3 id=\"h-global-period-considerations\" class=\"wp-block-heading\">Global period considerations<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">CPT Code 21195 carries a 90-day global surgical period under Medicare. Routine post-operative care inside that window is not separately billable. <\/p>\n\n\n\n<p class=\"wp-block-paragraph\">An unrelated evaluation and management (E\/M) visit needs modifier -24, plus documentation showing the visit addressed a separate condition. Drugs given in the office sit outside the surgical package, so an antiemetic reported under <a href=\"https:\/\/pabau.com\/procedure-codes\/hcpcs-code-j0780\/\">J0780<\/a> is still billable.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Rehabilitation delivered by another provider is billed on its own claim. Jaw mobilization work at a <a href=\"https:\/\/pabau.com\/industry\/physical-therapy-emr\/\">physical therapy practice<\/a> does not fall inside the surgeon&rsquo;s global period.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Track global period end dates in the practice management system and flag post-operative visits in the patient record. That prevents both missed revenue and duplicate billing. <\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Post-operative medication orders should point back to the surgical episode, which is straightforward when <a href=\"https:\/\/pabau.com\/features\/prescription-management-software\/\">prescription management<\/a> sits beside the billing record.<\/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-21195\/end-the-paper-chase-and-delight-patients-with-modern-convenience.webp\" alt=\"Pabau prescription sent to a pharmacy with a copy filed in the patient record\"\/><figcaption class=\"wp-element-caption\"><em>Pabau sends post-operative prescriptions to the pharmacy and files a copy in the patient record, which keeps the surgical episode documented.<\/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-related-cpt-codes-in-the-mandibular-reconstruction-family\" class=\"wp-block-heading\">Related CPT codes in the mandibular reconstruction family<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">CPT Code 21195 belongs to a family of codes covering different techniques for reconstructing the mandibular rami and body. Knowing the neighboring codes reduces miscoding and speeds up selection for other operative approaches.<\/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\">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\">21193<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Reconstruction of mandibular rami, without bone graft<\/td>\n<td style=\"padding:12px 16px;color:#374151\">No sagittal split; no bone graft; simpler approach for isolated ramus reconstruction<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">21194<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Reconstruction of mandibular rami with bone graft, each ramus<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Adds autogenous or allograft bone to augment the ramus; higher complexity than 21193<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">21195<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Reconstruction of mandibular rami and\/or body, sagittal split; without internal rigid fixation<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Sagittal split osteotomy, wire\/IMF fixation<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">21196<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Reconstruction of mandibular rami and\/or body, sagittal split; with internal rigid fixation<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Sagittal split osteotomy, plate\/screw fixation; higher wRVU than 21195<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">21198<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Osteotomy, mandible, segmental<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Segmental mandibular osteotomy; different surgical technique from the sagittal split family<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n\n\n<p class=\"wp-block-paragraph\">In bimaxillary surgery, the patient has both mandibular and maxillary osteotomy in one session. The maxillary codes, usually in the 21141-21160 range, are billed alongside 21195 or 21196 with multiple-procedure modifiers.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"> Review NCCI edits for the pair before submitting a combined claim. Cases that need vascularized bone are reported differently again, with codes such as <a href=\"https:\/\/pabau.com\/procedure-codes\/cpt-code-20972\/\">CPT 20972<\/a>.<\/p>\n\n\n\n<h2 id=\"h-how-pabau-keeps-orthognathic-surgery-claims-clean\" class=\"wp-block-heading\">How Pabau keeps orthognathic surgery claims clean<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">In many practices this workflow runs across three places. The authorization sits in an email thread, the operative report lives in the EMR, and the claim goes out from a separate billing system. When a payer asks for the approval or the fixation detail, someone has to go hunting for it.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Practice management software like Pabau keeps those records together. The authorization, the consent, the operative note, and the claim all attach to the same patient record. Your coder can confirm the fixation method before the claim leaves the practice, rather than after a denial arrives.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Built-in <a href=\"https:\/\/pabau.com\/features\/claims-management-software\/\">claims management<\/a> then tracks every submission by payer and flags underpayments against the contracted rate. Your billing team can see which authorizations are still open before the surgery date, so fewer cases reach the operating room without cover.<\/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                    Streamline your oral surgery billing workflow                <\/h3>\n\n                <p class=\"description\">\n                    Pabau helps oral and maxillofacial surgery practices manage CPT claims, track prior authorizations, and reduce denials with built-in claims management and documentation tools.                <\/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\">The code itself is rarely the hard part. CPT Code 21195 has a narrow descriptor, and the operative report either supports it or points to CPT 21196. What decides whether you get paid is the paperwork built around that one sentence in the note.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Two habits carry most of the weight. Confirm the fixation method against the operative report before the claim goes out, and secure the authorization before the surgery date rather than after it. Practices that do both spend far less time in appeals.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Every denied orthognathic claim costs staff hours that nobody reimburses. <a href=\"https:\/\/pabau.com\/book-demo\/\">Book a demo<\/a> to see how Pabau links authorizations, operative documentation, and claims in a single patient record.<\/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 code a complication that arose during surgery?<\/strong> <a href=\"https:\/\/pabau.com\/diagnostic-codes\/icd-10-code-y69\/\">ICD-10 Code Y69<\/a> covers how an unspecified surgical misadventure is documented and reported.<\/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>Need stronger paperwork behind a medical necessity argument?<\/strong> <a href=\"https:\/\/pabau.com\/templates\/diagnosis-letter-from-doctor\/\">Diagnosis letter from doctor<\/a> gives you a free template for confirming a patient diagnosis in writing.<\/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 to tighten up clinical documentation before it reaches billing?<\/strong> <a href=\"https:\/\/pabau.com\/blog\/medical-forms-at-your-healthcare-practice\/\">Medical forms at your healthcare practice<\/a> covers how structured forms cut documentation errors in surgical settings.<\/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>Scheduling a patient who needs pre-operative sign-off?<\/strong> <a href=\"https:\/\/pabau.com\/templates\/dental-clearance-form\/\">Dental clearance form<\/a> sets out what a treating physician confirms before oral surgery goes ahead.<\/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-1786603244801\"><h3 class=\"schema-faq-question\">What is CPT Code 21195?<\/h3> <p class=\"schema-faq-answer\">CPT Code 21195 is the billing code for reconstruction of the mandibular rami and\/or body via sagittal split osteotomy without internal rigid fixation. Oral and maxillofacial surgeons use it when wire or intermaxillary fixation holds the repositioned jaw segments in place. Titanium plates and screws are not used.<\/p> <\/div> <div class=\"schema-faq-section\" id=\"faq-question-1786603244802\"><h3 class=\"schema-faq-question\">How do CPT 21195 and CPT 21196 differ?<\/h3> <p class=\"schema-faq-answer\">CPT 21196 describes the same sagittal split osteotomy but with internal rigid fixation (plates and screws). CPT Code 21195 applies when no rigid internal fixation is used. The two codes are mutually exclusive for the same operative site in the same session. The fixation method described in the operative report determines which code is correct.<\/p> <\/div> <div class=\"schema-faq-section\" id=\"faq-question-1786603244803\"><h3 class=\"schema-faq-question\">What ICD-10 codes are used with CPT Code 21195?<\/h3> <p class=\"schema-faq-answer\">M26.19 is the code paired most often with CPT Code 21195, and it covers both mandibular prognathism and retrognathism. ICD-10-CM does not separate the two. Malocclusion codes M26.4, M26.212 for Angle&rsquo;s Class II, and M26.213 for Angle&rsquo;s Class III apply depending on the documented indication. G47.33 supports medical necessity for sleep apnea. Always verify codes against the current ICD-10-CM fiscal year release.<\/p> <\/div> <div class=\"schema-faq-section\" id=\"faq-question-1786603244804\"><h3 class=\"schema-faq-question\">What modifiers apply to CPT Code 21195?<\/h3> <p class=\"schema-faq-answer\">Common modifiers include -22 for increased complexity, -50 for a bilateral procedure, and -51 when several procedures happen in one session. Co-surgery uses -62, and an assistant surgeon uses -80. Verify the bilateral indicator for CPT Code 21195 in the current MPFS data before applying modifier -50.<\/p> <\/div> <div class=\"schema-faq-section\" id=\"faq-question-1786603244805\"><h3 class=\"schema-faq-question\">Does Medicare cover CPT Code 21195?<\/h3> <p class=\"schema-faq-answer\">Medicare Part B covers CPT Code 21195 when the procedure is medically necessary for a functional indication. Examples include correcting a skeletal deformity that affects mastication, or treating obstructive sleep apnea. Purely cosmetic correction does not qualify. Coverage may also be subject to a Local Coverage Determination (LCD) in the applicable MAC jurisdiction; check CMS LCD resources for your region before billing.<\/p> <\/div> <div class=\"schema-faq-section\" id=\"faq-question-1786603244806\"><h3 class=\"schema-faq-question\">Is prior authorization required for CPT Code 21195?<\/h3> <p class=\"schema-faq-answer\">Most commercial payers require prior authorization for CPT Code 21195. Standard PA submissions include cephalometric analysis, orthodontic records, clinical photographs, radiographs, and a letter of medical necessity. Authorization requirements vary by payer and plan; always verify with the specific insurer before scheduling the procedure. Traditional Medicare does not require prior authorization for this code, though Medicare Advantage plans may apply their own PA requirements.<\/p> <\/div> <div class=\"schema-faq-section\" id=\"faq-question-1786603244807\"><h3 class=\"schema-faq-question\">What is an orthognathic surgery CPT code?<\/h3> <p class=\"schema-faq-answer\">Orthognathic surgery CPT codes cover corrective jaw surgery procedures that reposition the mandible, maxilla, or both to correct skeletal discrepancies. The primary mandibular codes are CPT 21193-21198. CPT Code 21195 and 21196 are the most frequently used for sagittal split mandibular osteotomy. Maxillary (Le Fort) osteotomy procedures use separate CPT codes in the 21141-21160 range.<\/p> <\/div> <\/div>\n","protected":false},"excerpt":{"rendered":"<p>CPT Code 21195 covers reconstruction of the mandibular rami and\/or body by sagittal split osteotomy, performed without internal rigid fixation. Oral and maxillofacial surgeons report it when wire or intermaxillary fixation holds the repositioned jaw, rather than plates and screws. Denials on this code cluster around three problems. Prior authorization is missing, the diagnosis code [&hellip;]<\/p>\n","protected":false},"author":83,"featured_media":177189,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_yoast_wpseo_linkdex":"92","_yoast_wpseo_content_score":"30","_yoast_wpseo_is_cornerstone":"","_yoast_wpseo_keywordsynonyms":"[\"\",\"\",\"\",\"\"]","_yoast_wpseo_focuskw_text_input":"","_seo_original_html":"","footnotes":""},"categories":[1433,1546],"tags":[1233,3367,3368,1826],"class_list":["post-177190","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-billing-codes","category-cpt-codes","tag-medicare-cpt-codes","tag-oral-surgery","tag-oral-surgery-billing","tag-prior-authorization"],"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 21195: RVUs, modifiers, and clean-claim rules<\/title>\n<meta name=\"description\" content=\"CPT Code 21195 covers sagittal split osteotomy without rigid fixation. 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Pair it with M26.19 and confirm fixation before billing.\" \/>\n<meta property=\"og:url\" content=\"https:\/\/pabau.com\/fr\/procedure-codes\/cpt-code-21195\/\" \/>\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=\"2026-08-13T09:20:11+00:00\" \/>\n<meta property=\"article:modified_time\" content=\"2026-08-13T09:20:13+00:00\" \/>\n<meta property=\"og:image\" content=\"https:\/\/pabau.com\/wp-content\/uploads\/2026\/08\/cpt-code-21195.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=\"\u00c9crit par\" \/>\n\t<meta name=\"twitter:data1\" content=\"Anja Dodevska\" \/>\n\t<meta name=\"twitter:label2\" content=\"Dur\u00e9e de lecture estim\u00e9e\" \/>\n\t<meta name=\"twitter:data2\" content=\"15 minutes\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\\\/\\\/schema.org\",\"@graph\":[{\"@type\":\"Article\",\"@id\":\"https:\\\/\\\/pabau.com\\\/fr\\\/procedure-codes\\\/cpt-code-21195\\\/#article\",\"isPartOf\":{\"@id\":\"https:\\\/\\\/pabau.com\\\/fr\\\/procedure-codes\\\/cpt-code-21195\\\/\"},\"author\":{\"name\":\"Anja Dodevska\",\"@id\":\"https:\\\/\\\/pabau.com\\\/fr\\\/#\\\/schema\\\/person\\\/f2e43b25ed02313e8781f0f4507398b9\"},\"headline\":\"CPT Code 21195: Mandibular reconstruction, sagittal split\",\"datePublished\":\"2026-08-13T09:20:11+00:00\",\"dateModified\":\"2026-08-13T09:20:13+00:00\",\"mainEntityOfPage\":{\"@id\":\"https:\\\/\\\/pabau.com\\\/fr\\\/procedure-codes\\\/cpt-code-21195\\\/\"},\"wordCount\":3087,\"publisher\":{\"@id\":\"https:\\\/\\\/pabau.com\\\/fr\\\/#organization\"},\"image\":{\"@id\":\"https:\\\/\\\/pabau.com\\\/fr\\\/procedure-codes\\\/cpt-code-21195\\\/#primaryimage\"},\"thumbnailUrl\":\"https:\\\/\\\/pabau.com\\\/wp-content\\\/uploads\\\/2026\\\/08\\\/cpt-code-21195.webp\",\"keywords\":[\"Medicare CPT codes\",\"Oral surgery\",\"Oral Surgery Billing\",\"Prior authorization\"],\"articleSection\":[\"Billing Codes\",\"CPT Codes\"],\"inLanguage\":\"fr-FR\"},{\"@type\":[\"WebPage\",\"FAQPage\"],\"@id\":\"https:\\\/\\\/pabau.com\\\/fr\\\/procedure-codes\\\/cpt-code-21195\\\/\",\"url\":\"https:\\\/\\\/pabau.com\\\/fr\\\/procedure-codes\\\/cpt-code-21195\\\/\",\"name\":\"CPT Code 21195: RVUs, modifiers, and clean-claim rules\",\"isPartOf\":{\"@id\":\"https:\\\/\\\/pabau.com\\\/fr\\\/#website\"},\"primaryImageOfPage\":{\"@id\":\"https:\\\/\\\/pabau.com\\\/fr\\\/procedure-codes\\\/cpt-code-21195\\\/#primaryimage\"},\"image\":{\"@id\":\"https:\\\/\\\/pabau.com\\\/fr\\\/procedure-codes\\\/cpt-code-21195\\\/#primaryimage\"},\"thumbnailUrl\":\"https:\\\/\\\/pabau.com\\\/wp-content\\\/uploads\\\/2026\\\/08\\\/cpt-code-21195.webp\",\"datePublished\":\"2026-08-13T09:20:11+00:00\",\"dateModified\":\"2026-08-13T09:20:13+00:00\",\"description\":\"CPT Code 21195 covers sagittal split osteotomy without rigid fixation. 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