2025 CPT code 21179

Reconstruction of the entire or majority of the forehead and/or supraorbital rims using allografts or prosthetic materials.

Refer to the official CPT coding guidelines for detailed information on appropriate code selection, modifier application, and documentation requirements.

Modifiers may apply based on specific circumstances, such as multiple procedures (modifier 51), reduced services (modifier 52), or repeat procedures (modifier 76).The need for modifiers is determined by the clinical scenario.

Medical necessity for this procedure is established when a significant forehead and/or supraorbital rim defect exists due to trauma, congenital anomaly, or cancer resection, and the reconstruction is deemed medically necessary to restore function, prevent further complications, or improve the patient's quality of life.Documentation supporting the medical necessity should be robust and align with payer guidelines.

The clinical responsibility lies with the surgeon who performs the reconstruction. This includes pre-operative planning, surgical execution, and post-operative care.

IMPORTANT 21180 (autograft used instead of allograft or prosthetic material)

In simple words: This code covers surgery to rebuild most or all of the forehead and the bony area around the eyes.The surgeon uses either donor bone or artificial material to repair damage from birth defects, cancer removal, or injuries.

This code encompasses the surgical reconstruction of the entire or majority of the forehead and/or supraorbital rims.The reconstruction involves the use of grafts, specifically allografts (tissue from a donor) or prosthetic materials. The procedure addresses defects resulting from congenital malformations, cancer surgery, or trauma.It includes the necessary dissection, reshaping, placement of the graft or prosthesis, securing it in place, hemostasis (control of bleeding), and closure of the incision.Appreciable vessel exploration and/or neuroplasty should be reported separately.

Example 1: A patient presents with a large forehead defect due to trauma from a motor vehicle accident. The surgeon performs a reconstruction using an allograft to restore the bony structure and contour of the forehead., A patient with a congenital craniofacial anomaly undergoes a surgical procedure to reconstruct their forehead and supraorbital rims. An allograft is used to fill the bony defects, improving both aesthetics and functional aspects., A patient undergoes resection of a malignant tumor in the forehead area. Following the tumor removal, a substantial defect remains. The surgeon reconstructs the affected area using a prosthetic material to recreate the normal anatomy.

Detailed operative notes describing the extent of the reconstruction, type of graft or prosthetic material used, and any additional procedures performed.Preoperative and postoperative images are also necessary, along with any relevant pathology reports.

** Always cross-reference with the most current CPT manual and payer-specific guidelines for accurate coding and reimbursement.

  • Revenue Code: P3D (Major Procedure, Orthopedic - Other)
  • RVU: This information requires access to specific payer fee schedules and may vary based on geographic location and other factors.RVUs are not included in this dataset.
  • Global Days : The global period for this procedure will vary depending on payer and other factors.This information is not contained within the source data.
  • Payment Status: Active
  • Modifier TC rule: Not applicable for this procedure.
  • Fee Schedule : Historical fee schedule data is not available in this dataset. It can be found through various payer-specific resources.
  • Specialties:Plastic Surgery, Neurosurgery, Oral and Maxillofacial Surgery
  • Place of Service:Inpatient Hospital, Ambulatory Surgical Center, Outpatient Hospital
** Only Enterprise users with EHR integration can access case-specific answers. Click here to request access.