How To Use CPT Code 21295

CPT code 21295 describes the reduction of the masseter muscle and bone, primarily for the treatment of benign masseteric hypertrophy, using an extraoral approach. This article will cover the description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information and billing examples.

1. What is CPT Code 21295?

CPT 21295 is used to describe the reduction of the masseter muscle and bone, primarily for the treatment of benign masseteric hypertrophy. This procedure is performed to soften the appearance of a square jaw and is often considered a cosmetic procedure.

2. Official Description

The official description of CPT code 21295 is: ‘Reduction of masseter muscle and bone (eg, for treatment of benign masseteric hypertrophy) extraoral approach.’

3. Procedure

During the procedure for CPT 21295, the patient is appropriately prepped and anesthetized. The provider makes an incision along the mandible, or lower jaw, and continues through the tissue until reaching the masseter muscle and the mandibular bone. Surgical tools are then used to contour the mandible to achieve an aesthetic appearance. The hypertrophic portion of the masseter muscle is excised, and the wound is irrigated and closed in layers.

4. Qualifying circumstances

CPT 21295 is typically performed for cosmetic purposes to reduce the size of the masseter muscle and bone. It is important to note that many insurers consider this procedure to be cosmetic, so preauthorization and confirmation of medical necessity may be required.

5. When to use CPT code 21295

CPT code 21295 should be used when a provider performs the reduction of the masseter muscle and bone using an extraoral approach for the treatment of benign masseteric hypertrophy. It is important to verify with the insurance company if this procedure is covered and if it is considered medically necessary.

6. Documentation requirements

To support a claim for CPT 21295, the provider must document the following information:

• Patient’s diagnosis of benign masseteric hypertrophy
• Preauthorization and confirmation of medical necessity, if required
• Date of the procedure
• Details of the procedure, including the incision, contouring of the mandible, excision of the hypertrophic portion of the masseter muscle, and closure of the incision
• Any complications or additional procedures performed
• Signature of the provider

7. Billing guidelines

When billing for CPT 21295, it is important to verify with the insurance company if the procedure is covered and if it is considered medically necessary. As this procedure is often considered cosmetic, preauthorization may be required. It is also important to follow any specific billing guidelines provided by the insurance company.

8. Historical information

CPT code 21295 was added to the Current Procedural Terminology system on January 1, 1990. There have been no updates to the code since its addition.

9. Similar codes to CPT 21295

There are several similar codes to CPT 21295 that may be used for related procedures. These include:

• CPT 21120: Reduction of zygomatic arch
• CPT 21121: Reconstruction of zygomatic arch
• CPT 21122: Reconstruction of zygomatic arch and orbital floor
• CPT 21210: Reconstruction of mandibular ramus and/or body
• CPT 21215: Reconstruction of mandibular symphysis

9. Examples

1. A patient undergoes CPT 21295 to reduce the size of their masseter muscle and bone for cosmetic purposes, achieving a softer appearance of their square jaw.
2. A provider performs CPT 21295 on a patient with benign masseteric hypertrophy, reducing the size of their masseter muscle and bone to improve their facial aesthetics.
3. A cosmetic surgeon uses CPT 21295 to contour the mandible and excise the hypertrophic portion of the masseter muscle, achieving a more balanced and aesthetically pleasing jawline for the patient.
4. A patient undergoes CPT 21295 to address their square jaw caused by benign masseteric hypertrophy, resulting in a more harmonious facial profile.
5. A provider performs CPT 21295 on a patient who desires a reduction in the size of their masseter muscle and bone to achieve a more feminine or masculine facial appearance.
6. A cosmetic surgeon uses CPT 21295 to contour the mandible and reduce the size of the masseter muscle and bone, enhancing the patient’s overall facial aesthetics.
7. A patient undergoes CPT 21295 to address their square jaw, achieving a more balanced and proportionate facial structure.
8. A provider performs CPT 21295 on a patient with benign masseteric hypertrophy, improving their facial aesthetics and enhancing their self-confidence.
9. A cosmetic surgeon uses CPT 21295 to reduce the size of the masseter muscle and bone, creating a more aesthetically pleasing jawline for the patient.
10. A patient undergoes CPT 21295 to soften the appearance of their square jaw, achieving a more youthful and balanced facial profile.