Adopted Regulation February 18, 2010



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21127

1,348.10

Augmentation, mandibular body or angle; with bone graft, onlay or interpositional (includes obtaining autograft)

21137

899.28

Reduction forehead; contouring only

21138

1,521.12

Reduction forehead; contouring and application of prosthetic material or bone graft (includes obtaining autograft)

21139

1,521.12

Reduction forehead; contouring and setback of anterior frontal sinus wall

21150

1,521.12

Reconstruction midface, LeFort II; anterior intrusion (e.g., Treacher-Collins Syndrome)

21181

886.24

Reconstruction by contouring of benign tumor of cranial bones (e.g., fibrous dysplasia), extracranial

21198

1,521.12

Osteotomy, mandible, segmental;

21199

1,521.12

Osteotomy, mandible, segmental; with genioglossus advancement

21206

1,075.18

Osteotomy, maxilla, segmental (e.g., Wassmund or Schuchard)

21208

1,197.16

Osteoplasty, facial bones; augmentation (autograft, allograft, or prosthetic implant)

21209

1,075.18

Osteoplasty, facial bones; reduction

21210

1,197.16

Graft, bone; nasal, maxillary or malar areas (includes obtaining graft)

21215

1,197.16

Graft, bone; mandible (includes obtaining graft)

21230

1,197.16

Graft; rib cartilage, autogenous, to face, chin, nose or ear (includes obtaining graft)

21235

886.24

Graft; ear cartilage, autogenous, to nose or ear (includes obtaining graft)

21240

1,037.00

Arthroplasty, temporomandibular joint, with or without autograft (includes obtaining graft)

21242

1,075.18

Arthroplasty, temporomandibular joint, with allograft

21243

1,075.18

Arthroplasty, temporomandibular joint, with prosthetic joint replacement

21244

1,197.16

Reconstruction of mandible, extraoral, with transosteal bone plate (e.g., mandibular staple bone plate)

21245

1,197.16

Reconstruction of mandible or maxilla, subperiosteal implant; partial

21246

1,197.16

Reconstruction of mandible or maxilla, subperiosteal implant; complete

21248

1,197.16

Reconstruction of mandible or maxilla, endosteal implant (e.g., blade, cylinder); partial

21249

1,197.16

Reconstruction of mandible or maxilla, endosteal implant (e.g., blade, cylinder); complete

21260

1,521.12

Periorbital osteotomies for orbital hypertelorism, with bone grafts; extracranial approach

21267

1,197.16

Orbital repositioning, periorbital osteotomies, unilateral, with bone grafts; extracranial approach

21270

1,075.18

Malar augmentation, prosthetic material

21275

1,197.16

Secondary revision of orbitocraniofacial reconstruction

21280

1,075.18

Medial canthopexy (separate procedure)

21282

627.75

Lateral canthopexy

21295

282.94

Reduction of masseter muscle and bone (e.g., for treatment of benign masseteric hypertrophy); extraoral approach

21296

595.76

Reduction of masseter muscle and bone (e.g., for treatment of benign masseteric hypertrophy); intraoral approach

21310

86.31

Closed treatment of nasal bone fracture without manipulation

21315

379.27

Closed treatment of nasal bone fracture; without stabilization

21320

508.83

Closed treatment of nasal bone fracture; with stabilization

21325

726.08

Open treatment of nasal fracture; uncomplicated

21330

764.25

Open treatment of nasal fracture; complicated, with internal and/or external skeletal fixation

21335

886.24

Open treatment of nasal fracture; with concomitant open treatment of fractured septum

21336

738.59

Open treatment of nasal septal fracture, with or without stabilization

21337

508.83

Closed treatment of nasal septal fracture, with or without stabilization

21338

726.08

Open treatment of nasoethmoid fracture; without external fixation

21339

764.25

Open treatment of nasoethmoid fracture; with external fixation

21340

1,037.00

Percutaneous treatment of nasoethmoid complex fracture, with splint, wire or headcap fixation, including repair of canthal ligaments and/or the nasolacrimal apparatus

21345

886.24

Closed treatment of nasomaxillary complex fracture (LeFort II type), with interdental wire fixation or fixation of denture or splint

21355

984.35

Percutaneous treatment of fracture of malar area, including zygomatic arch and malar tripod, with manipulation

21356

673.43

Open treatment of depressed zygomatic arch fracture (e.g., Gillies approach)

21360

899.28

Open treatment of depressed malar fracture, including zygomatic arch and malar tripod

21390

1,521.12

Open treatment of orbital floor blowout fracture; periorbital approach, with alloplastic or other implant

21400

332.52

Closed treatment of fracture of orbit, except blowout; without manipulation

21401

536.92

Closed treatment of fracture of orbit, except blowout; with manipulation

21406

1,521.12

Open treatment of fracture of orbit, except blowout; without implant

21407

1,521.12

Open treatment of fracture of orbit, except blowout; with implant

21421

726.08

Closed treatment of palatal or maxillary fracture (LeFort I type), with interdental wire fixation or fixation of denture or splint

21440

305.78

Closed treatment of mandibular or maxillary alveolar ridge fracture (separate procedure)

21445

726.08

Open treatment of mandibular or maxillary alveolar ridge fracture (separate procedure)

21450

126.20

Closed treatment of mandibular fracture; without manipulation

21451

340.49

Closed treatment of mandibular fracture; with manipulation

21452

508.83

Percutaneous treatment of mandibular fracture, with external fixation

21453

984.35

Closed treatment of mandibular fracture with interdental fixation

21454

764.25

Open treatment of mandibular fracture with external fixation

21461

1,037.00

Open treatment of mandibular fracture; without interdental fixation

21462

1,075.18

Open treatment of mandibular fracture; with interdental fixation

21465

1,037.00

Open treatment of mandibular condylar fracture

21480

86.31

Closed treatment of temporomandibular dislocation; initial or subsequent

21485

508.83

Closed treatment of temporomandibular dislocation; complicated (e.g., recurrent requiring intermaxillary fixation or splinting), initial or subsequent

21490

984.35

Open treatment of temporomandibular dislocation

21495

626.27

Open treatment of hyoid fracture

21497

508.83

Interdental wiring, for condition other than fracture

21501

547.84

Incision and drainage, deep abscess or hematoma, soft tissues of neck or thorax;

21502

591.31

Incision and drainage, deep abscess or hematoma, soft tissues of neck or thorax; with partial rib ostectomy

21550

577.49

Biopsy, soft tissue of neck or thorax

21555

592.43

Excision tumor, soft tissue of neck or thorax; subcutaneous

21556

592.43

Excision tumor, soft tissue of neck or thorax; deep, subfascial, intramuscular

21557

793.47

Radical resection of tumor (e.g., malignant neoplasm), soft tissue of neck or thorax

21600

738.44

Excision of rib, partial

21610

738.44

Costotransversectomy (separate procedure)

21685

273.65

Hyoid myotomy and suspension

21700

591.31

Division of scalenus anticus; without resection of cervical rib

21720

619.40

Division of sternocleidomastoid for torticollis, open operation; without cast application

21725

64.48

Division of sternocleidomastoid for torticollis, open operation; with cast application

21800

74.48

Closed treatment of rib fracture, uncomplicated, each

21805

657.85

Open treatment of rib fracture without fixation, each

21820

74.48

Closed treatment of sternum fracture

21920

132.44

Biopsy, soft tissue of back or flank; superficial

21925

592.43

Biopsy, soft tissue of back or flank; deep

21930

592.43

Excision, tumor, soft tissue of back or flank

21935

620.52

Radical resection of tumor (e.g., malignant neoplasm), soft tissue of back or flank

22102

1,765.70

Partial excision of posterior vertebral component (e.g., spinous process, lamina or facet) for intrinsic bony lesion, single vertebral segment; lumbar

22103

1,765.70

Partial excision of posterior vertebral component (e.g., spinous process, lamina or facet) for intrinsic bony lesion, single vertebral segment; each additional segment (List separately in addition to code for primary procedure)

22305

74.48

Closed treatment of vertebral process fracture(s)

22310

157.13

Closed treatment of vertebral body fracture(s), without manipulation, requiring and including casting or bracing

22315

406.41

Closed treatment of vertebral fracture(s) and/or dislocation(s) requiring casting or bracing, with and including casting and/or bracing, with or without anesthesia, by manipulation or traction

22505

478.45

Manipulation of spine requiring anesthesia, any region

22520

1,130.28

Percutaneous vertebroplasty, one vertebral body, unilateral or bilateral injection; thoracic

22521

1,130.28

Percutaneous vertebroplasty, one vertebral body, unilateral or bilateral injection; lumbar

22522

1,130.28

Percutaneous vertebroplasty, one vertebral body, unilateral or bilateral injection; each additional thoracic or lumbar vertebral body (List separately in addition to code for primary procedure)

22523

3,145.69

Percutaneous vertebral augmentation, including cavity creation (fracture reduction and bone biopsy included when performed) using mechanical device, one vertebral body, unilateral or bilateral cannulation (e.g., kyphoplasty); thoracic

22524

3,145.69

Percutaneous vertebral augmentation, including cavity creation (fracture reduction and bone biopsy included when performed) using mechanical device, one vertebral body, unilateral or bilateral cannulation (e.g., kyphoplasty); lumbar

22525

3,145.69

Percutaneous vertebral augmentation, including cavity creation (fracture reduction and bone biopsy included when performed) using mechanical device, one vertebral body, unilateral or bilateral cannulation (e.g., kyphoplasty); each additional thoracic or lumbar vertebral body (List separately in addition to code for primary procedure)

22900

673.17

Excision, abdominal wall tumor, subfascial (e.g., desmoid)

23000

484.44

Removal of subdeltoid calcareous deposits, open

23020

1,019.46

Capsular contracture release (e.g., Sever type procedure)

23030

498.25

Incision and drainage, shoulder area; deep abscess or hematoma

23031

575.92

Incision and drainage, shoulder area; infected bursa

23035

619.40

Incision, bone cortex (e.g., osteomyelitis or bone abscess), shoulder area

23040

766.53

Arthrotomy, glenohumeral joint, including exploration, drainage, or removal of foreign body

23044

819.18

Arthrotomy, acromioclavicular, sternoclavicular joint, including exploration, drainage, or removal of foreign body



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