2025 CPT code 21208
(Active) Effective Date: N/A Revision Date: N/A Surgery - Osteoplasty Surgical Procedures on the Musculoskeletal System Feed
Osteoplasty of facial bones involving augmentation using autograft, allograft, or prosthetic implant.
Modifiers may apply based on the circumstances of the procedure.For example, modifier 76 may be appended if a repeat procedure is performed by the same physician, and modifier 54 should be used if the initial treatment provider is not performing subsequent treatment.
Reimbursement is typically contingent upon medical necessity. Cosmetic procedures are generally not covered.Medical necessity may be established for reconstructive procedures addressing trauma, congenital anomalies, or other medically necessary conditions requiring facial bone augmentation for functional or structural reasons.
The surgeon is responsible for pre-operative planning including determining the source of the bone graft or implant, performing the surgical procedure which includes precise bone dissection, implant placement and wound closure, and providing postoperative care.
- Surgical Procedures on the Musculoskeletal System
- Repair, Revision, and/or Reconstruction Procedures on the Head
In simple words: This code covers surgery to rebuild or reshape facial bones. The surgeon might use a bone graft from the patient's own body, a bone graft from a donor, or an artificial implant to fix a bone defect or improve the bone's shape. This is often done to correct problems caused by injury or birth defects.
This CPT code encompasses osteoplasty procedures on facial bones where augmentation is achieved through the use of autogenous bone grafts harvested from the patient, allografts from donors, or prosthetic implants.The procedure aims to correct defects or deformities resulting from trauma or congenital conditions.It includes the necessary steps for implant placement, meticulous tissue dissection, and wound closure.Separate codes apply for procedures such as significant vessel exploration or complex repair of resulting defects.
Example 1: A patient sustains a severe facial fracture in a car accident requiring reconstruction of the zygomatic arch using a titanium plate and screws. This augmentation of the facial bone would be coded as 21208., A patient is born with a significant congenital maxillary hypoplasia.The surgeon performs an osteoplasty with an autograft from the iliac crest to improve midface projection. This would be coded as 21208., A patient experiences significant facial bone resorption after radiation therapy for a prior cancer. The surgeon uses an allograft to restore volume and contour to the affected area, using code 21208.
Detailed operative report including type of implant used (autograft, allograft, or prosthetic), precise location of the augmentation, and size of the implant.Preoperative and postoperative photos are recommended.Detailed description of the surgical technique employed should be included. Justification for medical necessity should be documented if the procedure is not purely reconstructive.
** This code is frequently denied by third-party payers if prior authorization is not obtained and medical necessity is not clearly established.Careful documentation and adherence to payer guidelines is crucial for successful reimbursement.
- Revenue Code: P3D (MAJOR PROCEDURE, ORTHOPEDIC - OTHER)
- RVU: This information is not available in the provided text.Consult the most recent CMS relative value units and conversion factors for accurate reimbursement information.
- Global Days : The global period for this procedure is not specified in the provided text.Refer to CMS guidelines and payer-specific policies for global surgical day information.
- Payment Status: Active, but reimbursement is dependent on medical necessity and may require pre-authorization.
- Modifier TC rule: A Technical Component (TC) modifier does not typically apply to this code as it represents the entire surgical procedure.
- Fee Schedule : Historical fee schedule information is not provided. Consult fee schedules from relevant payers and historical data sources for this information.
- Specialties:Plastic Surgery, Oral and Maxillofacial Surgery
- Place of Service:Office, Ambulatory Surgical Center, Hospital (Inpatient or Outpatient)