{"id":175542,"date":"2026-08-11T12:10:12","date_gmt":"2026-08-11T12:10:12","guid":{"rendered":"https:\/\/pabau.com\/?p=175542"},"modified":"2026-08-11T14:37:31","modified_gmt":"2026-08-11T14:37:31","slug":"cpt-code-21346","status":"publish","type":"post","link":"https:\/\/pabau.com\/nl\/procedure-codes\/cpt-code-21346\/","title":{"rendered":"CPT Code 21346: Nasomaxillary fracture open treatment billing guide"},"content":{"rendered":"\n<script type=\"application\/ld+json\">{\"@context\":\"https:\/\/schema.org\",\"@type\":\"MedicalWebPage\",\"headline\":\"CPT Code 21346: Nasomaxillary fracture open treatment billing guide\",\"description\":\"CPT Code 21346 covers open treatment of nasomaxillary complex fracture (LeFort II type) with wiring and\/or local fixation. Find reimbursement rates, RVUs, modifiers, and documentation requirements.\",\"url\":\"https:\/\/pabau.com\/procedure-codes\/cpt-code-21346\/\",\"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\":\"2026-08-11\",\"dateModified\":\"2026-08-11\"}<\/script>\n\n\n        <div id=\"key_takeaways\">\n            <div class=\"header\">\n                                    <img decoding=\"async\" src=\"https:\/\/pabau.com\/wp-content\/uploads\/2025\/12\/Key-Takeaways-Icon.svg\" alt=\"Key takeaways\" height=\"42\" width=\"42\">\n                                <h3>Key takeaways<\/h3>\n            <\/div>\n            <div class=\"list\">\n                                                            <div class=\"item\">\n                            <div>\n                                <svg width=\"20\" height=\"27\" viewBox=\"0 0 20 27\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                                    <path\n                                        d=\"M18.6223 14.3857C19.1246 13.8975 19.1246 13.1045 18.6223 12.6162L12.1938 6.36621C11.6915 5.87793 10.8759 5.87793 10.3737 6.36621C9.87143 6.85449 9.87143 7.64746 10.3737 8.13574L14.6125 12.2529H2.28571C1.57455 12.2529 1 12.8115 1 13.5029C1 14.1943 1.57455 14.7529 2.28571 14.7529H14.6085L10.3777 18.8701C9.87545 19.3584 9.87545 20.1514 10.3777 20.6396C10.8799 21.1279 11.6955 21.1279 12.1978 20.6396L18.6263 14.3896L18.6223 14.3857Z\"\n                                        fill=\"#3D3D46\" \/>\n                                <\/svg>\n                            <\/div>\n                            <p>CPT Code 21346 describes open treatment of a nasomaxillary complex fracture, LeFort II type, with wiring and\/or local 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>Medicare pays facility and non-facility settings at different rates, so check the current CMS Physician Fee Schedule for your locality.<\/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>A 90-day global surgery period applies, so post-operative E&#038;M visits inside that window are bundled unless a separate modifier applies.<\/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>Code selection turns on access and approach. 21345 is closed, 21346 is open, 21347 needs multiple approaches, and 21348 adds a bone graft.<\/p>\n                        <\/div>\n                                                                                <div class=\"item\">\n                            <div>\n                                <svg width=\"20\" height=\"27\" viewBox=\"0 0 20 27\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                                    <path\n                                        d=\"M18.6223 14.3857C19.1246 13.8975 19.1246 13.1045 18.6223 12.6162L12.1938 6.36621C11.6915 5.87793 10.8759 5.87793 10.3737 6.36621C9.87143 6.85449 9.87143 7.64746 10.3737 8.13574L14.6125 12.2529H2.28571C1.57455 12.2529 1 12.8115 1 13.5029C1 14.1943 1.57455 14.7529 2.28571 14.7529H14.6085L10.3777 18.8701C9.87545 19.3584 9.87545 20.1514 10.3777 20.6396C10.8799 21.1279 11.6955 21.1279 12.1978 20.6396L18.6263 14.3896L18.6223 14.3857Z\"\n                                        fill=\"#3D3D46\" \/>\n                                <\/svg>\n                            <\/div>\n                            <p>Practice management software like Pabau lets you attach the CPT code at the point of care, so unbundling errors surface earlier.<\/p>\n                        <\/div>\n                                                <\/div>\n        <\/div>\n    \n\n\n<p class=\"wp-block-paragraph\">CPT Code 21346 describes open treatment of a nasomaxillary complex fracture of the LeFort II type, with wiring and\/or local fixation. The code is maintained by the <a href=\"https:\/\/www.ama-assn.org\/practice-management\/cpt\/cpt-code-set-overview\" target=\"_blank\" rel=\"nofollow noopener\">American Medical Association<\/a> and sits under fracture and dislocation procedures on the head. It is billable and specific, and valid for HIPAA-covered electronic transactions.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">This reference covers the descriptor, the procedure itself, Medicare reimbursement, RVUs, modifiers, ICD-10 pairing, the global period, and documentation. It also sets out how 21346 differs from the three codes around it.<\/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-procedure-description-what-surgeons-do-under-cpt-21346\" class=\"wp-block-heading\">Procedure description: What surgeons do under CPT 21346<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">A LeFort II fracture involves the midface as a pyramidal segment, separating the central midface from the cranial base. It is a high-energy injury pattern, most often from motor vehicle collisions and other significant facial trauma. Open treatment under CPT 21346 means the surgeon reaches the fracture site through incisions rather than closed-reduction techniques.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">The procedure typically involves the following steps, in order:<\/p>\n\n\n\n<ol class=\"wp-block-list\">\n<li><strong>Incision and exposure:<\/strong> Coronal, infraorbital, or intraoral incisions expose the fracture sites along the nasomaxillary buttress and orbital rims.<\/li>\n\n\n\n<li><strong>Fracture identification and disimpaction:<\/strong> The pyramidal midface segment is mobilized and reduced to anatomic position.<\/li>\n\n\n\n<li><strong>Wiring and\/or local fixation:<\/strong> Interdental wiring (arch bars), circumzygomatic wiring, or local bone plates secure the fragment. The &#8220;and\/or&#8221; in the descriptor is deliberate. Either technique alone qualifies, and so does a combination.<\/li>\n\n\n\n<li><strong>Wound closure:<\/strong> Incisions are closed in layers, and nasal packing may be placed.<\/li>\n<\/ol>\n\n\n\n<p class=\"wp-block-paragraph\">The coding distinction that matters is access. Open treatment requires direct visualization and physical access to the fracture. If the surgeon reduces the fracture without an incision, a closed-treatment code applies instead.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Oral and maxillofacial surgeons and ENT specialists bill this code most often. A purpose-built <a href=\"https:\/\/pabau.com\/industry\/plastic-surgery-emr\/\">plastic surgery EMR<\/a> keeps their procedure notes and claims in one record, so coding does not depend on a separate handoff.<\/p>\n\n\n\n<h2 id=\"h-icd-10-codes-that-support-medical-necessity-for-cpt-code-21346\" class=\"wp-block-heading\">ICD-10 codes that support medical necessity for CPT Code 21346<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Every claim for CPT 21346 needs a paired ICD-10-CM diagnosis code that establishes medical necessity. Payer systems run automated edits matching the procedure code against the diagnosis code. A mismatch or an unsupported diagnosis triggers a denial. Check pairings with your Medicare Administrative Contractor (MAC) or a <a href=\"https:\/\/crosscoder.com\/\" target=\"_blank\" rel=\"nofollow noopener\">CPT-to-ICD-10 crosswalk tool<\/a> before submission, because local coverage determinations can apply.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">The table below lists the ICD-10-CM codes most commonly paired with CPT 21346. Facial soft-tissue injuries often accompany these fractures, and a code like <a href=\"https:\/\/pabau.com\/diagnostic-codes\/icd-10-code-s01111d\/\">S01.111D<\/a> covers the follow-up encounter for a periocular laceration.<\/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\">Encounter type<\/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\">S02.400A<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Malar fracture, unspecified, initial encounter<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Initial (A)<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">S02.40XA<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Fracture of malar, maxillary and zygoma bones, unspecified, initial encounter<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Initial (A)<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">S02.411A<\/td>\n<td style=\"padding:12px 16px;color:#374151\">LeFort I fracture, initial encounter<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Initial (A) &mdash; use only if LeFort I is confirmed<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">S02.412A<\/td>\n<td style=\"padding:12px 16px;color:#374151\">LeFort II fracture, initial encounter<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Initial (A) &mdash; primary pairing for CPT 21346<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">S02.412D<\/td>\n<td style=\"padding:12px 16px;color:#374151\">LeFort II fracture, subsequent encounter<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Subsequent (D) &mdash; post-op visits inside the global period<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">S02.412S<\/td>\n<td style=\"padding:12px 16px;color:#374151\">LeFort II fracture, sequela<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Sequela (S) &mdash; late effects or complications<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n\n\n<p class=\"wp-block-paragraph\">Use the 7th-character suffix correctly. &#8220;A&#8221; marks the initial surgical encounter, &#8220;D&#8221; marks subsequent encounters, and &#8220;S&#8221; marks sequela. Misapplying the 7th character is a common denial trigger. Medical necessity stays payer-specific, so confirm with the patient&#8217;s MAC or payer LCD before submitting.<\/p>\n\n\n\n<h2 id=\"h-cpt-code-21346-reimbursement-medicare-facility-and-non-facility-rates\" class=\"wp-block-heading\">CPT Code 21346 reimbursement: Medicare facility and non-facility rates<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Medicare reimbursement for CPT 21346 varies by setting and by locality. The setting is facility or non-facility, and locality is handled through the Geographic Practice Cost Index (GPCI). The figures below reflect the 2025 Medicare Physician Fee Schedule (MPFS) national average. Verify current rates for your locality with the <a href=\"https:\/\/www.cms.gov\/medicare\/physician-fee-schedule\/search\/overview\" target=\"_blank\" rel=\"nofollow noopener\">CMS fee schedule lookup<\/a>, because they change with each annual update.<\/p>\n\n\n\n<table style=\"width:100%;border-collapse:separate;border-spacing:0;border-radius:12px;overflow:hidden;font-size:15px;line-height:1.5;margin:1.5em 0 2em;box-shadow:0 2px 12px rgba(0,0,0,0.08)\">\n<thead>\n<tr>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Setting<\/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\">Approximate national rate<\/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\">Facility (hospital\/ASC)<\/td>\n<td style=\"padding:12px 16px;color:#374151\">~$750-$900<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Lower physician rate, because the facility bills separately for overhead<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Non-facility (office)<\/td>\n<td style=\"padding:12px 16px;color:#374151\">~$1,200-$1,500<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Higher rate, because the physician absorbs practice overhead<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n\n\n<p class=\"wp-block-paragraph\">These are national averages, offered for orientation only. Your actual allowed amount will differ with locality GPCI adjustments. Private payers negotiate their own fee schedules independently of MPFS, and commercial rates for CPT 21346 are often higher. Comparing your own <a href=\"https:\/\/pabau.com\/procedure-codes\/bupa-procedure-codes-fee-schedule\/\">fee schedules<\/a> per code can surface patterns worth raising in contract talks.<\/p>\n\n\n\n<h2 id=\"h-relative-value-units-rvus-for-cpt-21346\" class=\"wp-block-heading\">Relative value units (RVUs) for CPT 21346<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">RVUs are the building blocks of Medicare physician payment. The total RVU for a code is multiplied by the CMS conversion factor, roughly $32.35 for CY 2025, and then by the locality GPCI.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Use an <a href=\"https:\/\/fastrvu.com\/tools\/rvu-lookup\" target=\"_blank\" rel=\"nofollow noopener\">RVU lookup tool<\/a> to verify current values for your MAC locality. The figures below are 2025 MPFS national values, so confirm the current year before using them in compensation models.<\/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\">Facility value (approx.)<\/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\">Non-facility value (approx.)<\/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\">~23.00<\/td>\n<td style=\"padding:12px 16px;color:#374151\">~23.00<\/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\">~5.00<\/td>\n<td style=\"padding:12px 16px;color:#374151\">~16.00<\/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\">~2.00<\/td>\n<td style=\"padding:12px 16px;color:#374151\">~2.50<\/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\">~30.00<\/td>\n<td style=\"padding:12px 16px;color:#374151\">~41.50<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n\n\n<p class=\"wp-block-paragraph\">The work RVU reflects physician time and complexity, and it stays constant regardless of setting. The practice expense RVU is much higher in the non-facility setting, because the physician carries the overhead directly. That difference is what separates the hospital and office rates in the table above.<\/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>Verify your RVU values each January. CMS updates the MPFS annually, and RVU values for surgical codes can shift meaningfully. Pull the new fee schedule data file from the CMS website before your first Q1 claim submission.<\/p>\n            <\/div>\n        <\/div>\n    \n\n\n<h2 id=\"h-common-modifiers-for-cpt-code-21346\" class=\"wp-block-heading\">Common modifiers for CPT Code 21346<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Modifiers tell the payer that a claim has been altered, or that specific circumstances apply. Applying the wrong modifier to CPT 21346 is a common denial cause. In some cases it is also a fraud and abuse flag. Check your MAC&#8217;s published guidance for modifier-specific policies.<\/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\">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 scenario<\/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\">Comminuted fracture needing substantially more operative time, with documentation of the added 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\">-51<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Multiple procedures<\/td>\n<td style=\"padding:12px 16px;color:#374151\">CPT 21346 billed alongside another procedure in the same session, such as an alveolar ridge repair under <a href=\"https:\/\/pabau.com\/procedure-codes\/cpt-code-21445\/\">21445<\/a><\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">-62<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Two surgeons<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Oral surgeon and neurosurgeon each perform distinct portions of the same operative session<\/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\">A second surgeon assists throughout, typically at 16% of the primary surgeon&#8217;s allowed amount<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">-78<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Unplanned return to OR<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Patient returns to the operating room during the global period for a related complication<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">-79<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Unrelated procedure during global period<\/td>\n<td style=\"padding:12px 16px;color:#374151\">A completely separate, unrelated surgical procedure performed within the 90-day global window<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n\n\n<p class=\"wp-block-paragraph\">Modifier -22 requires documentation that the procedure took substantially more time or effort than typical. A single sentence in the operative report is not enough. Name the complication, the extra time it took, and the outcome.<\/p>\n\n\n\n<h2 id=\"h-global-surgery-package-and-post-op-period-for-cpt-21346\" class=\"wp-block-heading\">Global surgery package and post-op period for CPT 21346<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">CPT 21346 carries a 90-day global surgery period under Medicare. Services provided in the 90 days after the procedure date fall inside the global package. They cannot be billed separately if they relate to the original surgery.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">The following services are bundled into the global package and cannot be billed independently inside the 90-day window:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>All post-operative E&amp;M visits related to the fracture repair<\/li>\n\n\n\n<li>Wound checks and suture removal<\/li>\n\n\n\n<li>Routine follow-up imaging review discussed at post-op appointments<\/li>\n\n\n\n<li>Complications directly related to the surgery, with modifier -78 if a return to the OR is needed<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">Some services can still be billed during the global period. Unrelated diagnoses take modifier -24 on the E&amp;M, new injuries stand on their own, and unrelated surgical procedures take modifier -79. Pre-operative E&amp;M visits on the day of surgery are generally bundled, unless they address a separate condition.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Physical therapy for restricted jaw opening is generally billed separately from the fracture repair. Practices running rehab in-house on a <a href=\"https:\/\/pabau.com\/industry\/physical-therapy-emr\/\">physical therapy EMR<\/a> can keep those visits on the same patient record.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Check the global period designation for CPT 21346 in the CMS MPFS data file, in the &#8220;Glob Days&#8221; column, before billing. Some private payers do not follow the standard 90-day period.<\/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-21346\/digital-forms.webp\" alt=\"Pabau medical form builder with a template library and patient-facing form preview\"\/><figcaption class=\"wp-element-caption\"><em>Pabau&#8217;s form builder turns the documentation checklist below into reusable fields, so every operative note captures what the code needs.<\/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-documentation-requirements-for-cpt-code-21346-billing\" class=\"wp-block-heading\">Documentation requirements for CPT Code 21346 billing<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Insufficient documentation is the leading cause of post-payment audit clawbacks for surgical codes in this range. The operative report has to do more than confirm the procedure happened. It has to support the specific CPT code selected. Coders and auditors look for the elements below before approving 21346.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Practices using <a href=\"https:\/\/pabau.com\/features\/patient-intake-software\/\">digital forms<\/a> for operative documentation can make these elements mandatory fields, so they are the same on every procedure note.<\/p>\n\n\n\n<div style=\"height:20px\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Fracture characterization:<\/strong> The record must describe the fracture as a nasomaxillary complex fracture with LeFort II classification. Imaging reports should be referenced or attached.<\/li>\n\n\n\n<li><strong>Surgical approach:<\/strong> Identify the specific incisions used, and confirm that open access was achieved.<\/li>\n\n\n\n<li><strong>Reduction technique:<\/strong> Document the disimpaction maneuver, the instruments used, and confirmation of anatomic alignment.<\/li>\n\n\n\n<li><strong>Fixation method:<\/strong> Specify whether wiring, local fixation, or both were used. The descriptor permits either, but the record must name the technique actually employed.<\/li>\n\n\n\n<li><strong>Pre-operative evaluation:<\/strong> Include a pre-op note confirming surgical necessity, patient consent, and anesthesia assessment.<\/li>\n\n\n\n<li><strong>Surgeon identity:<\/strong> Name the primary surgeon, plus any co-surgeons or assistants, if modifiers -62 or -80 are appended.<\/li>\n<\/ul>\n\n\n\n<h2 id=\"h-how-cpt-code-21346-differs-from-adjacent-codes-21345-21346-21347-21348\" class=\"wp-block-heading\">How CPT Code 21346 differs from adjacent codes (21345, 21346, 21347, 21348)<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">The nasomaxillary complex fracture range holds four codes, and selection turns on two things. The first is whether treatment was open or closed. The second is how many open approaches the repair needed, and whether a bone graft was harvested. Malar and zygomatic fractures sit in a neighboring family, where <a href=\"https:\/\/pabau.com\/procedure-codes\/cpt-code-21355\/\">21355<\/a> covers percutaneous treatment.<\/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\">Treatment type<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Fixation method<\/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\">21345<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Closed<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Interdental wire, denture, or splint fixation<\/td>\n<td style=\"padding:12px 16px;color:#374151\">No incision. The reduced fracture is held with wires, a denture, or a splint<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">21346<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Open<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Wiring and\/or local fixation<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Open access to the fracture, secured through a single approach<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">21347<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Open<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Wiring and\/or local fixation<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Requires multiple open approaches to reduce and fix 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\">21348<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Open<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Wiring and\/or local fixation, plus bone grafting<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Includes the bone graft and the work of obtaining it<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n\n\n<p class=\"wp-block-paragraph\">Start with access. If the surgeon reduced the fracture without an incision and held it with interdental wires, a denture, or a splint, the code is 21345. If incisions were made, count the approaches.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">One open approach with wiring or local fixation is 21346, and two or more separate approaches move the claim to 21347. The same multiple-approach logic separates <a href=\"https:\/\/pabau.com\/procedure-codes\/cpt-code-21470\/\">21470<\/a> from the simpler mandible codes. If the repair also needed a bone graft, 21348 covers both the graft and the harvest.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Billing 21346 when the note documents multiple approaches or a bone graft is a downcode, and it costs the practice revenue on every claim.<\/p>\n\n\n\n<h2 id=\"h-cpt-code-21346-billing-guidelines-and-common-coding-errors\" class=\"wp-block-heading\">CPT Code 21346 billing guidelines and common coding errors<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Most denials for CPT 21346 fall into three categories. Documentation falls short, the wrong code is picked from the adjacent range, or a modifier is misused. The guidelines below cut claim failure rates for practices billing this code.<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Do not unbundle:<\/strong> NCCI edits restrict certain codes from being billed with 21346 in the same session. Run claims through an NCCI edit checker first, especially when a second facial fracture code such as <a href=\"https:\/\/pabau.com\/procedure-codes\/cpt-code-21407\/\">21407<\/a> appears on the same claim. A separate graft code alongside 21348 is unbundling, because 21348 already includes obtaining the graft.<\/li>\n\n\n\n<li><strong>Match the operative report language to the code:<\/strong> A dictated &#8220;closed reduction&#8221; anywhere in the note will draw a denial or an audit. The documentation has to support open access without ambiguity.<\/li>\n\n\n\n<li><strong>Confirm LeFort II classification in the diagnosis:<\/strong> ICD-10-CM code S02.412A should anchor every 21346 claim. A generic maxillary fracture code without LeFort classification creates a mismatch.<\/li>\n\n\n\n<li><strong>Track the global period date:<\/strong> The clock starts on the day of surgery. Post-op visits billed inside 90 days need modifier -24 if they are unrelated, or they will be bundled and denied automatically.<\/li>\n\n\n\n<li><strong>Prior authorization:<\/strong> Many commercial payers require pre-authorization for surgical codes at this complexity. Get it and document it before the procedure.<\/li>\n<\/ul>\n\n\n\n<h2 id=\"h-how-pabau-supports-surgical-billing-for-cpt-21346\" class=\"wp-block-heading\">How Pabau supports surgical billing for CPT 21346<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Managing CPT 21346 claims by hand gets expensive fast. Every payer has its own modifier rules, and the global period has to be tracked per patient. Practice management software like Pabau attaches procedure codes at the point of care. Its <a href=\"https:\/\/pabau.com\/features\/claims-management-software\/\">claims management software<\/a> hands the billing team a pre-populated claim, instead of an encounter to reconstruct.<\/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-21346\/fully-integrated-with-pabau-billing.webp\" alt=\"Pabau billing screen matching insurer remittances against paid and unpaid claim lines\"\/><figcaption class=\"wp-element-caption\"><em>Pabau matches remittances line by line, so you can see which surgical claims were paid short before the money is written off.<\/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\">Operative note templates in Pabau can make the checklist above mandatory before a note is closed. Fracture classification, surgical approach, and fixation method all have to be filled in. That keeps the operative note and the claim in step. <a href=\"https:\/\/pabau.com\/features\/ai-medical-scribe\/\">AI-assisted documentation<\/a> speeds up post-operative note completion, which shortens the wait between procedure and 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-21346\/creating-treatment-notes-with-echo-ai.webp\" alt=\"Creating treatment notes with Pabau Scribe from a dictated consultation\"\/><figcaption class=\"wp-element-caption\"><em>Pabau Scribe, our AI scribe, drafts the note from your dictation, so the operative detail is captured before the claim goes out.<\/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\">Procedure-level reporting in Pabau surfaces utilization trends by CPT code. Practice managers can see:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Which codes are being denied<\/li>\n\n\n\n<li>Which modifiers are triggering payer edits<\/li>\n\n\n\n<li>Where reimbursement is underperforming against contracted rates<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">That reporting is one piece of a wider setup. A broader look at <a href=\"https:\/\/pabau.com\/blog\/practice-management-software\/\">practice management software<\/a> shows where a surgical workflow leaks revenue on codes like 21346.<\/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 surgical billing from documentation to claim submission                <\/h3>\n\n                <p class=\"description\">\n                    Pabau helps oral and maxillofacial surgery practices attach CPT codes at the point of care. Global periods are tracked automatically, and missing documentation surfaces before claims go out.                <\/p>\n\n                <div class=\"button-group\">\n                    <a href=\"\/book-demo\/\" class=\"btn btn-scale-effect btn-cta-color btn-md\">\n                        <span class=\"btn-text\">Book a demo<\/span>\n                        <div class=\"btn-icon btn-icon-right\" aria-hidden=\"true\">\n                            <svg\n                                width=\"14\"\n                                height=\"12\"\n                                viewBox=\"0 0 14 12\"\n                                fill=\"none\"\n                                xmlns=\"http:\/\/www.w3.org\/2000\/svg\"\n                            >\n                                <path\n                                    d=\"M0.75 4.77295C0.335786 4.77295 0 5.10874 0 5.52295C0 5.93716 0.335786 6.27295 0.75 6.27295V5.52295V4.77295ZM13.2803 6.05328C13.5732 5.76039 13.5732 5.28551 13.2803 4.99262L8.50736 0.219648C8.21447 -0.073245 7.73959 -0.073245 7.4467 0.219648C7.15381 0.512542 7.15381 0.987415 7.4467 1.28031L11.6893 5.52295L7.4467 9.76559C7.15381 10.0585 7.15381 10.5334 7.4467 10.8263C7.73959 11.1191 8.21447 11.1191 8.50736 10.8263L13.2803 6.05328ZM0.75 5.52295V6.27295L12.75 6.27295V5.52295V4.77295L0.75 4.77295V5.52295Z\"\n                                    fill=\"currentColor\"\n                                ><\/path>\n                            <\/svg>\n                        <\/div>\n                    <\/a>\n                <\/div>\n            <\/div>\n\n            <div class=\"right-side\">\n                <img decoding=\"async\"\n                    src=\"https:\/\/pabau.com\/wp-content\/uploads\/2026\/01\/Home-Page-Concept-4.webp\"\n                    alt=\"Pabau claims management dashboard for surgical practices\"\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 billing risk on CPT Code 21346 sits in two places. One is code selection inside a range of four near-identical descriptors. The other is documentation that supports open LeFort II treatment with wiring or local fixation, without ambiguity. Get either wrong and every claim carries the error until an audit finds it.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Decide the code from the operative note, at the point the note is written. The surgeon already knows how many approaches were used and whether a graft was taken. Capturing that at the time removes the guesswork later. <a href=\"https:\/\/pabau.com\/book-demo\/\">Book a demo<\/a> to see how Pabau keeps surgical documentation and claims on one 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>Chasing prior authorization before surgery?<\/strong> <a href=\"https:\/\/pabau.com\/templates\/medical-prior-authorization-form\/\">Medical prior authorization form<\/a> gives you a reusable request template for high-complexity surgical codes.<\/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>Standardizing your operative note structure?<\/strong> <a href=\"https:\/\/pabau.com\/templates\/medical-notes\/\">Medical notes template<\/a> sets out the sections a coder needs to see in every procedure record.<\/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 post-operative suture removal?<\/strong> <a href=\"https:\/\/pabau.com\/procedure-codes\/cpt-code-15851\/\">15851<\/a> explains how removal under anesthesia is coded and when it stands on its own.<\/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>Repairing an alveolar ridge fracture in the same session?<\/strong> <a href=\"https:\/\/pabau.com\/procedure-codes\/cpt-code-21445\/\">21445<\/a> sets out the descriptor and the modifier rules for that repair.<\/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 see how AI is changing surgical documentation?<\/strong> <a href=\"https:\/\/pabau.com\/blog\/benefits-of-ai-scribe-for-physicians\/\">Benefits of AI scribes for physicians<\/a> covers how automated notes cut post-operative documentation time.<\/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-1786435285788\"><h3 class=\"schema-faq-question\">What does CPT Code 21346 describe?<\/h3> <p class=\"schema-faq-answer\">CPT Code 21346 is the AMA procedure code for open treatment of a nasomaxillary complex fracture, LeFort II type. The fixation is wiring and\/or local fixation. It covers the whole surgical encounter, from exposing the fracture through an incision to reducing the pyramidal midface segment. Securing the fragment with wires, arch bars, or local bone plates is included.<\/p> <\/div> <div class=\"schema-faq-section\" id=\"faq-question-1786435285789\"><h3 class=\"schema-faq-question\">What is the Medicare reimbursement rate for CPT 21346?<\/h3> <p class=\"schema-faq-answer\">Medicare national average rates are roughly $750-$900 in a facility setting and $1,200-$1,500 in a non-facility setting. Those figures are based on 2025 MPFS values. Actual rates vary with the locality GPCI adjustment. Verify current allowed amounts with the CMS Physician Fee Schedule lookup for your MAC locality, because rates are updated annually.<\/p> <\/div> <div class=\"schema-faq-section\" id=\"faq-question-1786435285790\"><h3 class=\"schema-faq-question\">What modifiers apply to CPT Code 21346?<\/h3> <p class=\"schema-faq-answer\">Five modifiers come up most often. Modifier -22 covers increased complexity and significantly more operative time. Modifier -51 marks multiple procedures in one session, and -62 marks two surgeons performing distinct portions. Modifier -78 covers an unplanned return to the OR for a related complication. Modifier -79 covers an unrelated procedure during the global period. Every choice must be supported by specific documentation in the operative report.<\/p> <\/div> <div class=\"schema-faq-section\" id=\"faq-question-1786435285791\"><h3 class=\"schema-faq-question\">Which ICD-10 codes support medical necessity for CPT 21346?<\/h3> <p class=\"schema-faq-answer\">The primary ICD-10-CM pairing is S02.412A, LeFort II fracture, initial encounter for closed fracture. S02.40XA covers a fracture of malar, maxillary and zygoma bones, unspecified, initial encounter. It is also commonly paired when the operative note documents LeFort classification but the fracture code is broader. Medical necessity is payer-specific. Confirm with your MAC&#8217;s local coverage determination.<\/p> <\/div> <div class=\"schema-faq-section\" id=\"faq-question-1786435285792\"><h3 class=\"schema-faq-question\">What is the global period for CPT Code 21346?<\/h3> <p class=\"schema-faq-answer\">CPT 21346 carries a 90-day global surgery period under Medicare. Post-operative E&amp;M visits related to the procedure are bundled and cannot be billed separately within this window. Unrelated services during the global period need modifier -24 for an unrelated E&amp;M, or -79 for an unrelated surgical procedure.<\/p> <\/div> <div class=\"schema-faq-section\" id=\"faq-question-1786435285793\"><h3 class=\"schema-faq-question\">How do CPT codes 21345, 21346, 21347, and 21348 differ?<\/h3> <p class=\"schema-faq-answer\">21345 is closed treatment, with interdental wire fixation or fixation of a denture or splint. 21346 is open treatment with wiring and\/or local fixation. 21347 is open treatment that requires multiple open approaches. 21348 is open treatment with bone grafting, and it includes obtaining the graft. The operative report must document the access, the number of approaches, and any graft.<\/p> <\/div> <div class=\"schema-faq-section\" id=\"faq-question-1786435285794\"><h3 class=\"schema-faq-question\">What are the RVUs for CPT Code 21346?<\/h3> <p class=\"schema-faq-answer\">CPT 21346 carries roughly 23.00 work RVUs, reflecting the physician time and complexity of open facial fracture repair. Total RVUs are about 30.00 in a facility setting and 41.50 in a non-facility setting. The difference is driven by the practice expense component. Verify current values annually against the CMS MPFS data file or an RVU lookup tool.<\/p> <\/div> <\/div>\n","protected":false},"excerpt":{"rendered":"<p>CPT Code 21346 describes open treatment of a nasomaxillary complex fracture of the LeFort II type, with wiring and\/or local fixation. The code is maintained by the American Medical Association and sits under fracture and dislocation procedures on the head. It is billable and specific, and valid for HIPAA-covered electronic transactions. This reference covers the [&hellip;]<\/p>\n","protected":false},"author":82,"featured_media":175540,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_yoast_wpseo_linkdex":"77","_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":[1162,1602,2775,3367,3368],"class_list":["post-175542","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-billing-codes","category-cpt-codes","tag-cpt-codes","tag-cpt-modifiers","tag-fracture-management","tag-oral-surgery","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 21346: Reimbursement, RVUs and Modifiers<\/title>\n<meta name=\"description\" content=\"CPT 21346 covers open LeFort II fracture repair with wiring or local fixation. Facility rates run $750-$900, on 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\/nl\/procedure-codes\/cpt-code-21346\/\" \/>\n<meta property=\"og:locale\" content=\"nl_NL\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"CPT Code 21346: Reimbursement, RVUs and Modifiers\" \/>\n<meta property=\"og:description\" content=\"CPT 21346 covers open LeFort II fracture repair with wiring or local fixation. Facility rates run $750-$900, on a 90-day global period.\" \/>\n<meta property=\"og:url\" content=\"https:\/\/pabau.com\/nl\/procedure-codes\/cpt-code-21346\/\" \/>\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=\"2026-08-11T12:10:12+00:00\" \/>\n<meta property=\"article:modified_time\" content=\"2026-08-11T14:37:31+00:00\" \/>\n<meta property=\"og:image\" content=\"https:\/\/pabau.com\/wp-content\/uploads\/2026\/08\/cpt-code-21346.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=\"Maja Popovska\" \/>\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=\"Geschreven door\" \/>\n\t<meta name=\"twitter:data1\" content=\"Maja Popovska\" \/>\n\t<meta name=\"twitter:label2\" content=\"Geschatte leestijd\" \/>\n\t<meta name=\"twitter:data2\" content=\"13 minuten\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\\\/\\\/schema.org\",\"@graph\":[{\"@type\":\"Article\",\"@id\":\"https:\\\/\\\/pabau.com\\\/nl\\\/procedure-codes\\\/cpt-code-21346\\\/#article\",\"isPartOf\":{\"@id\":\"https:\\\/\\\/pabau.com\\\/nl\\\/procedure-codes\\\/cpt-code-21346\\\/\"},\"author\":{\"name\":\"Maja Popovska\",\"@id\":\"https:\\\/\\\/pabau.com\\\/nl\\\/#\\\/schema\\\/person\\\/b00aec1dd379f0ddcf6137d78e2a21db\"},\"headline\":\"CPT Code 21346: Nasomaxillary fracture open treatment billing guide\",\"datePublished\":\"2026-08-11T12:10:12+00:00\",\"dateModified\":\"2026-08-11T14:37:31+00:00\",\"mainEntityOfPage\":{\"@id\":\"https:\\\/\\\/pabau.com\\\/nl\\\/procedure-codes\\\/cpt-code-21346\\\/\"},\"wordCount\":2663,\"publisher\":{\"@id\":\"https:\\\/\\\/pabau.com\\\/nl\\\/#organization\"},\"image\":{\"@id\":\"https:\\\/\\\/pabau.com\\\/nl\\\/procedure-codes\\\/cpt-code-21346\\\/#primaryimage\"},\"thumbnailUrl\":\"https:\\\/\\\/pabau.com\\\/wp-content\\\/uploads\\\/2026\\\/08\\\/cpt-code-21346.webp\",\"keywords\":[\"CPT Codes\",\"Cpt Modifiers\",\"Fracture management\",\"Oral surgery\",\"Oral Surgery Billing\"],\"articleSection\":[\"Billing Codes\",\"CPT Codes\"],\"inLanguage\":\"nl-NL\"},{\"@type\":[\"WebPage\",\"FAQPage\"],\"@id\":\"https:\\\/\\\/pabau.com\\\/nl\\\/procedure-codes\\\/cpt-code-21346\\\/\",\"url\":\"https:\\\/\\\/pabau.com\\\/nl\\\/procedure-codes\\\/cpt-code-21346\\\/\",\"name\":\"CPT Code 21346: Reimbursement, RVUs and Modifiers\",\"isPartOf\":{\"@id\":\"https:\\\/\\\/pabau.com\\\/nl\\\/#website\"},\"primaryImageOfPage\":{\"@id\":\"https:\\\/\\\/pabau.com\\\/nl\\\/procedure-codes\\\/cpt-code-21346\\\/#primaryimage\"},\"image\":{\"@id\":\"https:\\\/\\\/pabau.com\\\/nl\\\/procedure-codes\\\/cpt-code-21346\\\/#primaryimage\"},\"thumbnailUrl\":\"https:\\\/\\\/pabau.com\\\/wp-content\\\/uploads\\\/2026\\\/08\\\/cpt-code-21346.webp\",\"datePublished\":\"2026-08-11T12:10:12+00:00\",\"dateModified\":\"2026-08-11T14:37:31+00:00\",\"description\":\"CPT 21346 covers open LeFort II fracture repair with wiring or local fixation. 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It combines scheduling, electronic health records, clinical forms, payments, marketing automation, reporting, and patient engagement tools into one secure cloud system to help practices streamline operations and grow their business.\",\"foundingDate\":\"2011-10-20\",\"numberOfEmployees\":{\"@type\":\"QuantitativeValue\",\"minValue\":\"201\",\"maxValue\":\"500\"}},{\"@type\":\"Person\",\"@id\":\"https:\\\/\\\/pabau.com\\\/nl\\\/#\\\/schema\\\/person\\\/b00aec1dd379f0ddcf6137d78e2a21db\",\"name\":\"Maja Popovska\",\"image\":{\"@type\":\"ImageObject\",\"inLanguage\":\"nl-NL\",\"@id\":\"https:\\\/\\\/pabau.com\\\/wp-content\\\/uploads\\\/2026\\\/06\\\/cropped-Maja-Popovska_WP-1-96x96.jpeg\",\"url\":\"https:\\\/\\\/pabau.com\\\/wp-content\\\/uploads\\\/2026\\\/06\\\/cropped-Maja-Popovska_WP-1-96x96.jpeg\",\"contentUrl\":\"https:\\\/\\\/pabau.com\\\/wp-content\\\/uploads\\\/2026\\\/06\\\/cropped-Maja-Popovska_WP-1-96x96.jpeg\",\"caption\":\"Maja Popovska\"},\"description\":\"Maja is a Senior Content Writer at Pabau, where she covers everything from practice management and compliance to medical aesthetics and patient experience. Off the clock: binging true crime docuseries, baking and dreaming about travel.\",\"url\":\"https:\\\/\\\/pabau.com\\\/nl\\\/blog\\\/author\\\/maja-popovska\\\/\"},{\"@type\":\"Question\",\"@id\":\"https:\\\/\\\/pabau.com\\\/nl\\\/procedure-codes\\\/cpt-code-21346\\\/#faq-question-1786435285788\",\"position\":1,\"url\":\"https:\\\/\\\/pabau.com\\\/nl\\\/procedure-codes\\\/cpt-code-21346\\\/#faq-question-1786435285788\",\"name\":\"What does CPT Code 21346 describe?\",\"answerCount\":1,\"acceptedAnswer\":{\"@type\":\"Answer\",\"text\":\"CPT Code 21346 is the AMA procedure code for open treatment of a nasomaxillary complex fracture, LeFort II type. The fixation is wiring and\\\/or local fixation. It covers the whole surgical encounter, from exposing the fracture through an incision to reducing the pyramidal midface segment. Securing the fragment with wires, arch bars, or local bone plates is included.\",\"inLanguage\":\"nl-NL\"},\"inLanguage\":\"nl-NL\"},{\"@type\":\"Question\",\"@id\":\"https:\\\/\\\/pabau.com\\\/nl\\\/procedure-codes\\\/cpt-code-21346\\\/#faq-question-1786435285789\",\"position\":2,\"url\":\"https:\\\/\\\/pabau.com\\\/nl\\\/procedure-codes\\\/cpt-code-21346\\\/#faq-question-1786435285789\",\"name\":\"What is the Medicare reimbursement rate for CPT 21346?\",\"answerCount\":1,\"acceptedAnswer\":{\"@type\":\"Answer\",\"text\":\"Medicare national average rates are roughly $750-$900 in a facility setting and $1,200-$1,500 in a non-facility setting. Those figures are based on 2025 MPFS values. Actual rates vary with the locality GPCI adjustment. Verify current allowed amounts with the CMS Physician Fee Schedule lookup for your MAC locality, because rates are updated annually.\",\"inLanguage\":\"nl-NL\"},\"inLanguage\":\"nl-NL\"},{\"@type\":\"Question\",\"@id\":\"https:\\\/\\\/pabau.com\\\/nl\\\/procedure-codes\\\/cpt-code-21346\\\/#faq-question-1786435285790\",\"position\":3,\"url\":\"https:\\\/\\\/pabau.com\\\/nl\\\/procedure-codes\\\/cpt-code-21346\\\/#faq-question-1786435285790\",\"name\":\"What modifiers apply to CPT Code 21346?\",\"answerCount\":1,\"acceptedAnswer\":{\"@type\":\"Answer\",\"text\":\"Five modifiers come up most often. Modifier -22 covers increased complexity and significantly more operative time. Modifier -51 marks multiple procedures in one session, and -62 marks two surgeons performing distinct portions. Modifier -78 covers an unplanned return to the OR for a related complication. Modifier -79 covers an unrelated procedure during the global period. Every choice must be supported by specific documentation in the operative report.\",\"inLanguage\":\"nl-NL\"},\"inLanguage\":\"nl-NL\"},{\"@type\":\"Question\",\"@id\":\"https:\\\/\\\/pabau.com\\\/nl\\\/procedure-codes\\\/cpt-code-21346\\\/#faq-question-1786435285791\",\"position\":4,\"url\":\"https:\\\/\\\/pabau.com\\\/nl\\\/procedure-codes\\\/cpt-code-21346\\\/#faq-question-1786435285791\",\"name\":\"Which ICD-10 codes support medical necessity for CPT 21346?\",\"answerCount\":1,\"acceptedAnswer\":{\"@type\":\"Answer\",\"text\":\"The primary ICD-10-CM pairing is S02.412A, LeFort II fracture, initial encounter for closed fracture. S02.40XA covers a fracture of malar, maxillary and zygoma bones, unspecified, initial encounter. It is also commonly paired when the operative note documents LeFort classification but the fracture code is broader. Medical necessity is payer-specific. 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Off the clock: binging true crime docuseries, baking and dreaming about travel.","url":"https:\/\/pabau.com\/nl\/blog\/author\/maja-popovska\/"},{"@type":"Question","@id":"https:\/\/pabau.com\/nl\/procedure-codes\/cpt-code-21346\/#faq-question-1786435285788","position":1,"url":"https:\/\/pabau.com\/nl\/procedure-codes\/cpt-code-21346\/#faq-question-1786435285788","name":"What does CPT Code 21346 describe?","answerCount":1,"acceptedAnswer":{"@type":"Answer","text":"CPT Code 21346 is the AMA procedure code for open treatment of a nasomaxillary complex fracture, LeFort II type. The fixation is wiring and\/or local fixation. It covers the whole surgical encounter, from exposing the fracture through an incision to reducing the pyramidal midface segment. Securing the fragment with wires, arch bars, or local bone plates is included.","inLanguage":"nl-NL"},"inLanguage":"nl-NL"},{"@type":"Question","@id":"https:\/\/pabau.com\/nl\/procedure-codes\/cpt-code-21346\/#faq-question-1786435285789","position":2,"url":"https:\/\/pabau.com\/nl\/procedure-codes\/cpt-code-21346\/#faq-question-1786435285789","name":"What is the Medicare reimbursement rate for CPT 21346?","answerCount":1,"acceptedAnswer":{"@type":"Answer","text":"Medicare national average rates are roughly $750-$900 in a facility setting and $1,200-$1,500 in a non-facility setting. Those figures are based on 2025 MPFS values. Actual rates vary with the locality GPCI adjustment. Verify current allowed amounts with the CMS Physician Fee Schedule lookup for your MAC locality, because rates are updated annually.","inLanguage":"nl-NL"},"inLanguage":"nl-NL"},{"@type":"Question","@id":"https:\/\/pabau.com\/nl\/procedure-codes\/cpt-code-21346\/#faq-question-1786435285790","position":3,"url":"https:\/\/pabau.com\/nl\/procedure-codes\/cpt-code-21346\/#faq-question-1786435285790","name":"What modifiers apply to CPT Code 21346?","answerCount":1,"acceptedAnswer":{"@type":"Answer","text":"Five modifiers come up most often. Modifier -22 covers increased complexity and significantly more operative time. Modifier -51 marks multiple procedures in one session, and -62 marks two surgeons performing distinct portions. Modifier -78 covers an unplanned return to the OR for a related complication. Modifier -79 covers an unrelated procedure during the global period. Every choice must be supported by specific documentation in the operative report.","inLanguage":"nl-NL"},"inLanguage":"nl-NL"},{"@type":"Question","@id":"https:\/\/pabau.com\/nl\/procedure-codes\/cpt-code-21346\/#faq-question-1786435285791","position":4,"url":"https:\/\/pabau.com\/nl\/procedure-codes\/cpt-code-21346\/#faq-question-1786435285791","name":"Which ICD-10 codes support medical necessity for CPT 21346?","answerCount":1,"acceptedAnswer":{"@type":"Answer","text":"The primary ICD-10-CM pairing is S02.412A, LeFort II fracture, initial encounter for closed fracture. S02.40XA covers a fracture of malar, maxillary and zygoma bones, unspecified, initial encounter. It is also commonly paired when the operative note documents LeFort classification but the fracture code is broader. Medical necessity is payer-specific. Confirm with your MAC's local coverage determination.","inLanguage":"nl-NL"},"inLanguage":"nl-NL"},{"@type":"Question","@id":"https:\/\/pabau.com\/nl\/procedure-codes\/cpt-code-21346\/#faq-question-1786435285792","position":5,"url":"https:\/\/pabau.com\/nl\/procedure-codes\/cpt-code-21346\/#faq-question-1786435285792","name":"What is the global period for CPT Code 21346?","answerCount":1,"acceptedAnswer":{"@type":"Answer","text":"CPT 21346 carries a 90-day global surgery period under Medicare. Post-operative E&amp;M visits related to the procedure are bundled and cannot be billed separately within this window. Unrelated services during the global period need modifier -24 for an unrelated E&amp;M, or -79 for an unrelated surgical procedure.","inLanguage":"nl-NL"},"inLanguage":"nl-NL"},{"@type":"Question","@id":"https:\/\/pabau.com\/nl\/procedure-codes\/cpt-code-21346\/#faq-question-1786435285793","position":6,"url":"https:\/\/pabau.com\/nl\/procedure-codes\/cpt-code-21346\/#faq-question-1786435285793","name":"How do CPT codes 21345, 21346, 21347, and 21348 differ?","answerCount":1,"acceptedAnswer":{"@type":"Answer","text":"21345 is closed treatment, with interdental wire fixation or fixation of a denture or splint. 21346 is open treatment with wiring and\/or local fixation. 21347 is open treatment that requires multiple open approaches. 21348 is open treatment with bone grafting, and it includes obtaining the graft. The operative report must document the access, the number of approaches, and any graft.","inLanguage":"nl-NL"},"inLanguage":"nl-NL"},{"@type":"Question","@id":"https:\/\/pabau.com\/nl\/procedure-codes\/cpt-code-21346\/#faq-question-1786435285794","position":7,"url":"https:\/\/pabau.com\/nl\/procedure-codes\/cpt-code-21346\/#faq-question-1786435285794","name":"What are the RVUs for CPT Code 21346?","answerCount":1,"acceptedAnswer":{"@type":"Answer","text":"CPT 21346 carries roughly 23.00 work RVUs, reflecting the physician time and complexity of open facial fracture repair. Total RVUs are about 30.00 in a facility setting and 41.50 in a non-facility setting. The difference is driven by the practice expense component. Verify current values annually against the CMS MPFS data file or an RVU lookup tool.","inLanguage":"nl-NL"},"inLanguage":"nl-NL"}]}},"yoast":{"focus_keyword":"cpt code 21346","seo_title":"CPT Code 21346: Reimbursement, RVUs and Modifiers","meta_description":"CPT 21346 covers open LeFort II fracture repair with wiring or local fixation. 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