21465 Mandibular fracture repair Medicare reimbursement rates in Massachusetts

This service involves surgically exposing and realigning a fractured mandibular condyle, with fixation used when needed to stabilize the fragments. It is typically performed in an operating room by an oral and maxillofacial surgeon, or another surgeon qualified to treat facial fractures. The operative record should identify the condylar fracture and describe the open approach and treatment performed. A fracture managed without surgical exposure is not reported with this code.

Select 21465 for the open treatment of a condylar fracture, rather than a general mandibular fracture code or a code for closed management. Documentation should establish the fracture site and the surgical work; note fixation and any additional fracture procedures performed during the session. Medicare assigns a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. For multiple procedures in one session, the highest-valued procedure is paid in full and other procedures at 50%. Bilateral reporting with modifier 50 is paid at 150%. Assistant-at-surgery payment may be available; co-surgeons are paid only with supporting documentation, and team surgery is not permitted.