2025 CPT code 21076
Effective Date: N/A Surgery - Surgical Procedures on the Musculoskeletal System Feed
Impression and custom preparation of a surgical obturator prosthesis.
Modifiers may be applicable to indicate specific circumstances, such as increased procedural services (22), multiple procedures (51), or a staged procedure (58). Refer to current CPT guidelines for appropriate modifier usage.
Medical necessity is established by the presence of an anatomical defect in the oral or facial region that requires a prosthesis for functional restoration, such as speech, swallowing, or preventing leakage into the nasal cavity.
The physician takes an impression of the patient's intraoral structures, creates a mold from the impression, and then fabricates the obturator prosthesis from a biocompatible material like acrylic resin.
In simple words: A surgical obturator is a custom-made device used to cover a hole in the mouth, often after surgery. This code covers the steps of making a mold of the area and creating the device to fit perfectly.
This code represents the process of creating a custom-made surgical obturator prosthesis, typically used after maxillofacial surgery to close an opening, often in the palate. It includes taking an impression of the surgical area and fabricating a prosthesis to restore function and facilitate healing.
Example 1: A patient undergoes a maxillectomy for cancer removal, requiring a surgical obturator to close the resulting palatal defect. The physician performs 21076 to create and fit the prosthesis., Following trauma to the face, a patient has a significant portion of their hard palate missing. Code 21076 is used for the impression, fabrication, and fitting of a custom obturator., A patient with a congenital cleft palate requires an obturator prosthesis. The surgeon uses 21076 to create a prosthesis to improve speech and swallowing.
Documentation should include the medical necessity for the prosthesis (e.g., surgical defect, trauma, congenital condition), the type of material used, the impression technique, and the fitting process.
** Code 21076 is reported only when the physician designs and prepares the prosthesis. If the prosthesis is fabricated by an outside laboratory, a different code may be applicable. The creation of interim obturators (21079) or definitive obturators (21080) are reported separately.
- Revenue Code: P1G
- Specialties:Oral and Maxillofacial Surgery, Prosthodontics, Plastic Surgery
- Place of Service:Office, Outpatient Hospital, Ambulatory Surgical Center