Oral Surgery Coding & Reimbursement Alert

Question: When I checked on codes that I need to report placement of implants, I saw that there are two codes, 21248 and 21249. I am not able to understand when I have to report 21248 and when to use 21249. Also, let me know if I have to report these codes for each implant that is placed by our surgeon?

Minnesota Subscriber

Answer:  As you have pointed out, there are two CPT® codes that you can use when your surgeon places an implant either into the maxilla or the mandibular jaw bone. The two codes that you will use for placing an implant are:

• 21248 (Reconstruction of mandible or maxilla, endosteal implant [e.g., blade, cylinder] partial)

• 21249 (…complete).

The descriptors to both 21248 and 21249 are similar except for the terms “partial” and “complete.” You will have to recognize which of these CPT® codes you will choose to report for the placement of implants using these term differences in the descriptor.

You will use 21248 when your surgeon performs a partial restoration using implants that covers less than half of the arch that is being restored. For instance, if the patient is receiving implants to restore teeth in the mandibular arch, you will report 21248 when your surgeon is placing implants only in one half of the mandible. On the other hand, if more than half of the arch is being restored by the placement of implants, you will have to choose 21249 to report the procedure.

You will not have to report these CPT® codes for each of the implants that your clinician places to restore the arch. Most payers prefer you to only report one unit of the code and report the exact number of implants placed in the “units” column in the form. For example, if your surgeon placed three implants, you will report “3” in the “units” column in the form to enable the payer to know that your clinician placed three implants for the restoration of the arch.