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2025 CPT code 21080

Fabrication of a definitive obturator prosthesis.

The code should only be used when the physician designs and prepares the prosthesis; it should not be used if an outside laboratory prepares the prosthesis.The procedure should only be performed after radiotherapy and complete wound healing, when the oral cavity's shape is definitive.

Modifiers may be applicable depending on the circumstances of the service provided. Consult the CPT manual and payer-specific guidelines for appropriate modifier use.

Medical necessity for code 21080 is established when a patient has undergone a partial or complete maxillectomy and requires a definitive obturator prosthesis to restore oral function, speech, swallowing, and facial aesthetics.The prosthesis is medically necessary to address the functional and cosmetic deficits resulting from the surgery.

The physician or qualified healthcare professional is responsible for taking the impression of the patient's oral cavity, designing and fabricating the definitive obturator prosthesis, and inserting it.They must also ensure the patient is appropriately prepared for the procedure and that the necessary post-procedure care is provided.

IMPORTANT:Code 21080 is used for the definitive prosthesis; an interim obturator prosthesis may be used prior to this.Codes 20660 and 20665 apply to caliper or tongs application/removal.

In simple words: The doctor makes a custom-fit replacement for a missing part of the upper jaw bone (maxilla). This involves taking a mold of the patient's mouth, creating the replacement piece in a lab, and then placing it in the patient's mouth.

This CPT code encompasses the creation of a custom-fitted definitive obturator prosthesis.The procedure involves taking an impression of the patient's oral cavity, using this impression to fabricate the prosthesis, and then inserting the completed prosthesis. This is typically done after radiotherapy and wound healing following a partial or complete surgical resection of the maxilla.

Example 1: A patient undergoes a partial maxillectomy for cancer. After radiotherapy and wound healing, the surgeon performs a 21080 to create a definitive obturator prosthesis to close the resulting oral cavity defect., A patient has a complete maxillectomy due to trauma. Once the surgical site is healed, a maxillofacial surgeon creates a definitive obturator prosthesis (21080) to restore oral function and aesthetics., A patient has an extensive resection of the maxilla due to a tumor. Following successful radiotherapy and wound closure, a 21080 is performed to provide a custom obturator that improves speech, swallowing, and facial appearance.

* Thorough preoperative assessment of the oral cavity.* Detailed records of the impression-taking process.* Documentation of the materials used in prosthesis fabrication.* Photographic documentation of the pre- and post-operative status.* Patient's medical history and the reason for the maxillectomy.* Post-operative instructions to the patient.

** This code is specific to the fabrication of the definitive obturator prosthesis.It does not include the creation or placement of interim prostheses.

** Only Enterprise users with EHR integration can access case-specific answers. Click here to request access.

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