CPT Code 21248

CPT code 21248 is for the reconstruction of the jaw, detailing the specific medical procedure for accurate billing and insurance purposes.

Accelerate your revenue cycle

Boost patient experience and your bottom line by automating patient cost estimates, payer underpayment detection, and contract optimization in one place.

Get a Demo

What is CPT Code 21248

CPT code 21248 is for the reconstruction of the jaw. This procedure involves rebuilding or repairing the jawbone, often using grafts or implants, to restore its structure and function.

Does CPT 21248 Need a Modifier?

For CPT code 21248 (Reconstruction of jaw), the following modifiers may be applicable:

1. Modifier 22 - Increased Procedural Services: Used when the work required to provide a service is substantially greater than typically required. This could apply if the reconstruction is more complex than usual.

2. Modifier 52 - Reduced Services: Used when a service or procedure is partially reduced or eliminated at the physician's discretion. This might be relevant if only part of the jaw reconstruction is performed.

3. Modifier 53 - Discontinued Procedure: Used when a procedure is started but discontinued due to extenuating circumstances or those that threaten the well-being of the patient.

4. Modifier 59 - Distinct Procedural Service: Used to indicate that a procedure or service was distinct or independent from other services performed on the same day. This could apply if multiple procedures are performed on the jaw but are separate and distinct from the reconstruction.

5. Modifier 62 - Two Surgeons: Used when two surgeons work together as primary surgeons performing distinct parts of a procedure. This might be relevant if the jaw reconstruction requires the expertise of two surgeons.

6. Modifier 66 - Surgical Team: Used when a highly complex procedure requires the services of several physicians, often of different specialties, working together as a team.

7. Modifier 76 - Repeat Procedure by Same Physician: Used when the same physician performs a procedure or service more than once on the same day.

8. Modifier 77 - Repeat Procedure by Another Physician: Used when a procedure or service is repeated by another physician on the same day.

9. Modifier 78 - Unplanned Return to the Operating/Procedure Room by the Same Physician Following Initial Procedure for a Related Procedure During the Postoperative Period: Used if the patient needs to return to the operating room for a related procedure during the postoperative period.

10. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: Used if an unrelated procedure is performed by the same physician during the postoperative period of the initial procedure.

11. Modifier 80 - Assistant Surgeon: Used when an assistant surgeon is required during the procedure.

12. Modifier 81 - Minimum Assistant Surgeon: Used when an assistant surgeon is required for a minimal portion of the procedure.

13. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available): Used when an assistant surgeon is necessary because a qualified resident surgeon is not available.

14. Modifier AS - Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist services for assistant at surgery: Used when these non-physician practitioners assist in the surgery.

These modifiers help provide additional information about the circumstances under which the jaw reconstruction procedure was performed, ensuring accurate billing and reimbursement.

CPT Code 21248 Medicare Reimbursement

Medicare reimbursement for CPT code 21248, which pertains to the reconstruction of the jaw, depends on several factors including the specific circumstances of the procedure, the patient's medical necessity, and the setting in which the service is provided. Generally, Medicare Part B may cover medically necessary reconstructive surgeries, including jaw reconstruction, if they are deemed essential for the patient's health and well-being.

To determine if CPT code 21248 is reimbursed by Medicare and the specific reimbursement amount, healthcare providers should refer to the Medicare Physician Fee Schedule (MPFS) or the local Medicare Administrative Contractor (MAC) guidelines. These resources provide detailed information on covered services and the corresponding reimbursement rates.

As reimbursement rates can vary based on geographic location and other factors, it is crucial to consult the latest MPFS or contact your local MAC for the most accurate and up-to-date information. Additionally, verifying the patient's eligibility and obtaining prior authorization, if required, can help ensure that the procedure is covered and reimbursed appropriately.

Are You Being Underpaid for 21248 CPT Code?

Discover how MD Clarity's RevFind software can enhance your revenue cycle management by accurately reading your contracts and detecting underpayments down to the CPT code level and by individual payer. For instance, if you perform a jaw reconstruction (CPT code 21248), RevFind will ensure you receive the full reimbursement you're entitled to. Schedule a demo today to see how RevFind can optimize your revenue and streamline your billing processes.

Get paid in full by bringing clarity to your revenue cycle

Full Page Background