CPT Coding for LeFort I Procedures

The LeFort I osteotomy procedure is a type of maxillofacial surgery that is performed to correct congenital malformations or acquired deformities of the midface and jaw such as maxillary atrophy, misaligned teeth (overbite or underbite), and facial asymmetry. The basic procedure consists of making a horizontal cut through the maxillary sinuses and nasal septum through an intraoral incision. The maxilla is down-fractured and separated from the skull base, which allows the maxilla to be moved in any direction to correct the deformity. In some cases, vertical or segmental osteotomies are also performed to divide the maxilla into 2 or more pieces to also allow for expansion or reduction of the maxilla in the transverse plane.

Example of a Single-Piece LeFort I Cut

Image courtesy of Health Direct

Example of the 2-Piece LeFort I Segmentation

Image courtesy of Plastic Surgery Key

Example of the 3-Piece LeFort I Segmentation

Image courtesy of MDPI

The following CPT Codes are utilized for the LeFort I procedures depending on how many separate pieces are created and moved and if bone graft is utilized.

• 21141: Reconstruction midface, LeFort I; single piece, segment movement in any direction without bone graft
• 21142: 2 pieces, segment movement in any direction, without bone graft
• 21143: 3 or more pieces, segment movement in any direction, without bone graft
• 21145: single piece, segment movement in any direction, requiring bone grafts (includes obtaining autografts)
• 21146: 2 pieces, segment movement in any direction, requiring bone grafts (includes obtaining autografts) (eg, ungrafted unilateral alveolar cleft)
• 21147: 3 or more pieces, segment movement in any direction, requiring bone grafts (includes obtaining autografts) (eg, ungrafted bilateral alveolar cleft or multiple osteotomies)

The LeFort I osteotomy is one of the most common procedures used to correct midface deformities. With the segmentation of the maxilla, you can make corrections by advancement, retrusion, elongation, and shortening. The key to reporting the correct CPT code is looking for horizontal and vertical/segmental cuts to determine how many pieces are created, and if the procedure is done with or without a graft.

References

• CPT Codebook 2025

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The information contained in this coding advice is valid at the time of posting. Viewers are encouraged to research subsequent official guidance in the areas associated with the topic as they can change rapidly.