CPT code 21348: Nasomaxillary Fracture Repair

Key takeaways

CPT 21348 covers open treatment of a nasomaxillary complex fracture, the LeFort II pattern, with bone grafting. In addition, the code includes obtaining the graft.

The LeFort II family runs 21345, 21346, 21347 and 21348. Its own descriptor defines each code, and only 21348 involves a bone graft.

The 2026 Medicare national average is about $948, the same in facility and non-facility settings. Before billing, verify the rate for your locality with the CMS fee schedule lookup tool.

CPT 21348 carries a 90-day global surgery period. The bundle covers most related post-operative E/M visits inside that window unless a modifier supports billing them.

Practice management software like Pabau keeps CPT codes on the treatment record and submits claims from the same system, so no one has to re-key anything.

CPT code 21348 covers open treatment of a nasomaxillary complex fracture, the LeFort II pattern, with bone grafting. The descriptor includes obtaining the graft, so you do not bill the harvest on top. It is one of four LeFort II codes, and its own descriptor defines each one.

This reference covers the 2026 RVU values, Medicare fee schedule, ICD-10 crosswalk and applicable modifiers. It also covers global period rules, bundling edits and the documentation that decides whether a claim pays.

The American Medical Association (AMA) owns and maintains the CPT code set. CPT code 21348 sits in the Fracture and/or Dislocation Procedures on the Head section of the Musculoskeletal System chapter. In practice, knowing what the code covers, which ICD-10 diagnoses pair with it, and when each modifier applies keeps the claim clean.

What is CPT code 21348?

CPT code 21348 describes open treatment of a nasomaxillary complex fracture, the LeFort II pattern, with bone grafting. It covers surgical exposure, reduction and stabilization of the nasomaxillary complex. That is the bony framework connecting the nasal bones to the maxilla. The code also covers harvesting the graft and placing it to restore structural integrity at the fracture site. First-pass rate measures how often a claim is paid without anyone touching it again. Billing compliance asks a narrower question than coding accuracy: can the practice defend this claim on review.

A LeFort II fracture runs in a pyramidal pattern through the nasal bridge, the orbital floors and the maxilla. Four CPT codes describe its treatment, distinguished by how the surgeon treated the fracture. Specifically, only 21348 involves a bone graft, and the descriptor states that the code includes obtaining the graft.

When is CPT 21348 used?

Report CPT 21348 when the surgeon treats a LeFort II fracture through an open approach and places a bone graft in the same session. The graft is what separates this code from the other three in the family. Surgeons usually need it when the fracture leaves a defect that fixation alone cannot bridge.

LeFort II fractures come from high-energy trauma such as motor vehicle collisions, assaults and falls from height. Midface injuries from contact sport often reach sports medicine practices first, which then refer the patient on for open repair.

Clinical indications

• Comminution or bone loss at the nasofrontal or nasomaxillary buttress that leaves a gap in the bony framework.
• Loss of midface height or anterior projection that needs graft support to hold the reduction.
• A delayed or malunited LeFort II fracture where the original fragments no longer meet.
• Devitalized fragments removed during exposure, leaving a segment the surgeon has to reconstruct.

If the surgeon reduces the fracture and holds it with wires or plates without placing a graft, 21348 is the wrong code. Report 21346 for open treatment with wiring or local fixation, and 21347 when the reduction required multiple open approaches. A nasal bone fracture treated closed sits in a different family under CPT code 21320.

CPT 21348 RVU values (2026)

Relative Value Units (RVUs) determine the Medicare payment for this procedure under the Resource-Based Relative Value Scale (RBRVS). The figures below come from the 2026 CMS relative value files. Check them against the CMS fee schedule lookup before you submit, since an addendum can revise a value mid-year.

CMS lists no non-facility practice expense RVU for 21348 and marks that field NA in the relative value file. CMS treats the code as facility-only, so the payment does not move when the setting changes. At 28.38 total RVUs it sits among the higher-weighted codes in facial fracture surgery.

CMS also publishes two conversion factors for 2026. CMS pays practices that qualify as participants in an advanced alternative payment model at $33.5675 per RVU. By contrast, it pays everyone else at $33.4009, the figure the table above uses.

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2026 Medicare fee schedule for CPT 21348

The calculated payment above is a national average before Geographic Practice Cost Indices (GPCI) adjustments. Because those adjustments vary by area, the practice’s location changes the final Medicare payment for 21348.

Geographic payment adjustments

CMS applies separate GPCI multipliers to the work, practice expense, and malpractice RVU components for each Medicare locality. Urban areas with high overhead costs (e.g. Manhattan, San Francisco) typically receive upward adjustments, while rural localities receive lower multipliers. The formula is:

Adjusted payment = [(wRVU x work GPCI) + (PE RVU x PE GPCI) + (MP RVU x MP GPCI)] x conversion factor

Medicare pays a practice billing 21348 in a high-cost urban locality above the national average. In fact, the practice expense GPCI drives most of that difference. Run a locality-specific lookup through the CMS tool before you quote a patient or negotiate against a Medicare benchmark.

Private payer rates for this procedure vary by contract. For example, many commercial plans set reimbursement as a percentage of Medicare, usually well above 100% for surgical work. Alternatively, others negotiate a flat rate that ignores the fee schedule entirely.

Practice management software like Pabau tracks claims and reimbursements by payer, so underpayments against a contracted rate surface without a spreadsheet.

ICD-10 codes that pair with 21348

Payers establish medical necessity from the ICD-10-CM diagnosis on the claim. In particular, the diagnosis for CPT code 21348 should name the LeFort II fracture itself, which is S02.412. In addition, the seventh character records the encounter and whether the fracture is open or closed.

Use the seventh character that matches the encounter, which is normally A or B on the operative claim. For further verification, the AAPC CPT-to-ICD-10 crosswalk lists additional paired diagnosis codes.

Not every payer accepts every pairing. Some commercial plans require pre-authorization that links a named diagnosis to this procedure, so confirm the pairing with each payer first.

Modifiers that apply to 21348

Modifier selection for CPT code 21348 depends on the surgical team composition, whether the surgeon performed multiple procedures, and the clinical complexity involved. As a result, applying the wrong modifier, or omitting a required one, is a leading cause of claim denial for this code.

Check the MPFS co-surgery indicator before you bill modifier -62 on 21348. Not all payers follow the CMS defaults, so confirm modifier acceptance with each commercial payer.

Global period for CPT 21348

CPT code 21348 carries a 90-day global surgery period under the Medicare Physician Fee Schedule. In fact, this is standard for major surgical procedures. The global period begins the day after surgery and runs for 90 calendar days.

What is bundled during the global period

Specifically, Medicare and most commercial payers that follow CMS global surgery rules will not pay separately for services the 90-day global package includes:

• All post-operative E/M visits related to the procedure, through day 90
• Wound checks and suture removal at the operative site
• Routine follow-up imaging ordered as part of standard post-operative monitoring
• Treatment of complications not requiring a return to the operating room

What can be billed separately

• Treatment of a new, unrelated condition that arises during the global period (append modifier -24 to the E/M code)
• A significant, separately identifiable E/M service on the day of surgery for an unrelated problem (append modifier -25)
• Return to the operating room for a complication that requires a new procedure (append modifier -78 to the return procedure)
• Staged procedures planned at the time of original surgery (append modifier -58)

Document the clinical reason in the medical record any time you bill outside the global bundle. In particular, global period audits look for E/M claims filed inside the 90-day window without a supporting modifier.

Structured digital forms and records keep that audit trail together, so the note behind a modifier is easy to produce.

Related CPT codes for LeFort II and adjacent facial fractures

The four nasomaxillary complex codes share one CPT parent, each distinguished by one feature: only 21348 involves a bone graft, and only 21347 requires multiple open approaches. In other words, reading the pair as graft versus no graft misses 21346.

When both descriptors fit, report only 21348, since it captures the graft. For neighboring fracture patterns.

Bundling rules and NCCI edits

The bone graft is part of CPT 21348, so harvesting it is not separately payable. The descriptor says as much in its own parenthetical, which includes obtaining the graft. As a result, billing a standalone graft code alongside 21348 runs straight into National Correct Coding Initiative edits.

• Report only one code from 21345 through 21348 for the same LeFort II fracture. They describe alternative treatments of one injury.
• Do not bill 20900, 20902 or 21210 for the graft harvest that supplied the 21348 graft.
• The code includes fixation hardware placed to hold the reduction. Plates, screws and wires are not separately reportable.
• Modifier 50 does not apply, because a LeFort II fracture is bilateral by definition.

You can still bill genuinely distinct procedures alongside 21348. For example, repair of a concurrent orbital floor fracture through its own approach qualifies. Check the payer bundling policy first, and make sure the operative note describes each procedure separately.

Documentation requirements for CPT 21348

In fact, most denials and downcodes on this code start in the operative note. Getting the code right at billing means nothing if the note cannot support it under audit. The graft is the one entry that separates 21348 from the other three codes in the family, so it needs its own explicit description.

What the operative note must include

• Explicit open approach: The note must describe the incision, the tissue dissection, and exposure of the fracture site. Closed reduction language anywhere in the note points to 21345 rather than an open code.
• Fracture site identification: Document the LeFort II pattern and confirm involvement of the nasomaxillary complex, meaning the nasal bones plus the maxillary articulation. However, a nasal septal fracture alone belongs to a different code family.
• Number of open approaches: Record each open approach the surgeon used and why the case needed it. This is what separates 21347 from 21346, so record it explicitly rather than leaving it implied.
• Reduction technique: Describe how the surgeon mobilized and reduced the fragments. However, noting only that the surgeon reduced the fracture is not enough for some payers.
• Bone graft harvest and placement: This is the entry that supports 21348 over 21345, 21346 and 21347. Name the graft source and donor site, the amount the surgeon harvested, and where the surgeon placed the graft. For an allograft, record the product name and lot number.
• Indication for the graft: State the bone loss, comminution or defect that made grafting necessary. In short, auditors want the clinical reason recorded alongside the act.
• Fixation method: Document the plates, screws, wires or other fixation devices used.

Pre-authorization considerations

Medicare generally does not require prior authorization for 21348 in a hospital setting. However, commercial payers vary. For example, Aetna, Cigna and UnitedHealthcare typically require authorization for major facial surgery.

Obtain authorization before the procedure, using the ICD-10 diagnosis codes that will appear on the claim. A mismatch between the authorized diagnosis and the billed diagnosis triggers a denial. Meanwhile.

Common billing errors and claim denial reasons

These are the denial patterns that billers in oral and maxillofacial surgery practices meet most often on this code. Most of them come from selecting a code by comparison instead of by descriptor.

• Billing 21348 when the surgeon placed no graft: If the note describes an open reduction the surgeon held with wiring or local fixation, the code is 21346. If it describes multiple open approaches, the code is 21347. Neither of those supports 21348.
• Treating 21347 as 21348 without the graft: The descriptor defines 21347 by requiring multiple open approaches. In practice, choosing between the two codes on the graft alone misreads what 21347 actually describes, and it hides 21346 entirely.
• Incorrect ICD-10 pairing: Submitting 21348 with a nasal bone or septal fracture diagnosis signals a mismatch. Instead, the diagnosis should be S02.412 with the seventh character that matches the encounter.
• Global period E/M billing without modifiers: Filing a post-operative office visit within 90 days without modifier -24, -25 or -78 draws an automatic denial. As a result, the claim reads as a duplicate or bundled service.
• Co-surgery billing errors: Where two surgeons each bill 21348-62, both operative notes have to document distinct surgical roles. Without that, payers deny the co-surgery modifier.
• Appending a laterality or bilateral modifier: A LeFort II fracture is bilateral by definition. Adding -50, -RT or -LT to 21348 invites a denial rather than preventing one.

It also keeps the billed CPT code matched to the procedure in the note, so the coder never has to interpret an ambiguous entry.

Related CPT codes

• CPT code 22840 — Posterior Non-Segmental Instrumentation
• CPT code 21422 — Open treatment of palatal or maxillary fracture
• CPT code 21433 — Open treatment of panfacial fracture
• CPT code 21685 — Hyoid myotomy and suspension

How Pabau supports LeFort II fracture billing

In most oral and maxillofacial surgery practices the operative note lives in one system and the biller builds the claim in another. A biller reads the note, decides between 21346, 21347 and 21348, then retypes the code into a billing screen. As a result, every hop is a chance for the billed code to drift from the documentation behind it.

Pabau keeps both in one record. First the surgeon writes the note, then your team attaches the CPT code to that treatment, and the claim goes out referencing the same entry. When a payer asks what supported 21348, the graft description sits one click from the claim.

Pabau tracks reimbursement by payer in the same place. A shortfall against a contracted rate shows up on a report, rather than in an audit months later. As a result, your billers spend their time on the denials that need a person, not on re-keying codes between systems.

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Conclusion

The habit that protects this family is coding from the operative note rather than from the code you billed last time. If the note names the graft, the donor site and the reason the case needed grafting, 21348 holds up under audit. If it does not, 21346 or 21347 is the honest answer.

In short, that habit costs a line or two of dictation and saves an appeal. The 90-day global window is the other place these claims leak, so check that every post-operative visit you bill carries the modifier that justifies it.

Pabau’s medical practice management platform keeps CPT code assignment connected to clinical documentation, so billers work from the same record the surgeon created. Book a demo to see how that removes a re-keying step from your billing.

Continue your research

Coding a bone graft harvest on its own claim? CPT code 20902 covers when a major graft harvest is separately reportable and when it is bundled.

Documenting a structural allograft instead of autograft? CPT code 20931 sets out the product and lot detail payers expect in the operative note.

Repairing facial lacerations alongside the fracture? CPT code 12032 explains how intermediate wound repair is measured and billed with other work.

Coding an adjacent facial fracture? ICD-10 code S02.600D walks through mandible fracture follow-up and the seventh character it needs.

Choosing a seventh character for delayed healing? ICD-10 code S02.81XG shows how a facial fracture that heals slowly is reported after the first encounter.

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