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The CPT® Code 21080 refers to the process of creating a definitive obturator prosthesis, which is a permanent dental device designed to address specific anatomical defects resulting from surgical procedures or trauma affecting the maxilla. An obturator prosthesis serves multiple functions, including the separation of the oral and nasal cavities, which is crucial for proper oral function. It aids in chewing and swallowing, provides occlusion with the mandible, supports the mandible, and plays a significant role in reestablishing speech. Additionally, it is designed to offer a cosmetically acceptable appearance, enhancing the patient's quality of life post-surgery. The creation of this prosthesis follows a thorough healing period after surgery, ensuring that the anatomical structures are stable and accurately represented. The process begins with obtaining an impression of the healed defect and surrounding oral structures, which is essential for the precise fabrication of the prosthesis. This definitive obturator is a critical component in the rehabilitation of patients who have undergone significant maxillary resections, allowing them to regain functionality and aesthetics.
© Copyright 2025 Coding Ahead. All rights reserved.
The definitive obturator prosthesis (CPT® Code 21080) is indicated for patients who have undergone surgical resection of a portion or all of one or both maxillae. This procedure is typically performed in cases where there is a need to restore the integrity of the oral cavity following trauma or surgical intervention. The obturator is essential for patients who require support in chewing, swallowing, and speaking, as well as for those who seek to improve their cosmetic appearance after significant maxillary defects.
The procedure for creating a definitive obturator prosthesis involves several critical steps that ensure the prosthesis is tailored to the patient's specific anatomical needs. Initially, the prosthetist will obtain an impression of the defect and surrounding oral structures after the surgical wound has completely healed. This step is crucial as it captures the precise contours and dimensions necessary for the prosthesis. Following the impression, the prosthetist may utilize radiological studies, such as a CT scan, to further evaluate the anatomy and ensure an accurate fit. Once the necessary information is gathered, a mold is prepared based on the impressions taken. This mold serves as the foundation for constructing the custom prosthesis. The definitive obturator is then fabricated, taking into account the functional requirements of the patient, such as occlusion with the mandible and the need for separation between the oral and nasal cavities. The final product is designed to be a permanent solution that restores both function and aesthetics for the patient.
After the definitive obturator prosthesis has been fabricated and fitted, patients may require follow-up appointments to ensure proper fit and function. It is essential to monitor the prosthesis for any adjustments needed as the patient's oral structures may continue to change over time. Patients are typically advised on care and maintenance of the prosthesis to ensure longevity and optimal function. Additionally, they may receive guidance on how to adapt to the new prosthesis, including techniques for speech and eating. Regular dental check-ups are recommended to assess the condition of the prosthesis and the health of the surrounding oral tissues.
| Short Descr | IMPRES&PREP DEF OBT PROSTH | Medium Descr | IMPRESSION & PREPJ DEFINITIVE OBTURATOR PROSTH | Long Descr | Impression and custom preparation; definitive obturator prosthesis | Status Code | Active Code | Global Days | 090 - Major Surgery | PC/TC Indicator (26, TC) | 0 - Physician Service Code | Multiple Procedures (51) | 2 - Standard payment adjustment rules for multiple procedures apply. | Bilateral Surgery (50) | 0 - 150% payment adjustment for bilateral procedures does NOT apply. | Physician Supervisions | 09 - Concept does not apply. | Assistant Surgeon (80, 82) | 1 - Statutory payment restriction for assistants at surgery applies to this procedure... | Co-Surgeons (62) | 0 - Co-surgeons not permitted for this procedure. | Team Surgery (66) | 0 - Team surgeons not permitted for this procedure. | Diagnostic Imaging Family | 99 - Concept Does Not Apply | APC Status Indicator | Hospital Part B services paid through a comprehensive APC | ASC Payment Indicator | Office-based surgical procedure added to ASC list in CY 2008 or later with MPFS nonfacility PE RVUs; payment based on MPFS nonfacility PE RVUs. | Type of Service (TOS) | 2 - Surgery | Berenson-Eggers TOS (BETOS) | P6B - Minor procedures - musculoskeletal | MUE | 1 | CCS Clinical Classification | 32 - Other non-OR therapeutic procedures on nose, mouth and pharynx |
| 58 | Staged or related procedure or service by the same physician or other qualified health care professional during the postoperative period: it may be necessary to indicate that the performance of a procedure or service during the postoperative period was: (a) planned or anticipated (staged); (b) more extensive than the original procedure; or (c) for therapy following a surgical procedure. this circumstance may be reported by adding modifier 58 to the staged or related procedure. note: for treatment of a problem that requires a return to the operating/procedure room (eg, unanticipated clinical condition), see modifier 78. | 51 | Multiple procedures: when multiple procedures, other than e/m services, physical medicine and rehabilitation services or provision of supplies (eg, vaccines), are performed at the same session by the same individual, the primary procedure or service may be reported as listed. the additional procedure(s) or service(s) may be identified by appending modifier 51 to the additional procedure or service code(s). note: this modifier should not be appended to designated "add-on" codes (see appendix d). | 52 | Reduced services: under certain circumstances a service or procedure is partially reduced or eliminated at the discretion of the physician or other qualified health care professional. under these circumstances the service provided can be identified by its usual procedure number and the addition of modifier 52, signifying that the service is reduced. this provides a means of reporting reduced services without disturbing the identification of the basic service. note: for hospital outpatient reporting of a previously scheduled procedure/service that is partially reduced or cancelled as a result of extenuating circumstances or those that threaten the well-being of the patient prior to or after administration of anesthesia, see modifiers 73 and 74 (see modifiers approved for asc hospital outpatient use). | 59 | Distinct procedural service: under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-e/m services performed on the same day. modifier 59 is used to identify procedures/services, other than e/m services, that are not normally reported together, but are appropriate under the circumstances. documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. however, when another already established modifier is appropriate it should be used rather than modifier 59. only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. note: modifier 59 should not be appended to an e/m service. to report a separate and distinct e/m service with a non-e/m service performed on the same date, see modifier 25. | 76 | Repeat procedure or service by same physician or other qualified health care professional: it may be necessary to indicate that a procedure or service was repeated by the same physician or other qualified health care professional subsequent to the original procedure or service. this circumstance may be reported by adding modifier 76 to the repeated procedure or service. note: this modifier should not be appended to an e/m service. | 79 | Unrelated procedure or service by the same physician or other qualified health care professional during the postoperative period: the individual may need to indicate that the performance of a procedure or service during the postoperative period was unrelated to the original procedure. this circumstance may be reported by using modifier 79. (for repeat procedures on the same day, see modifier 76.) | AQ | Physician providing a service in an unlisted health professional shortage area (hpsa) | GC | This service has been performed in part by a resident under the direction of a teaching physician | GW | Service not related to the hospice patient's terminal condition | GZ | Item or service expected to be denied as not reasonable and necessary | LT | Left side (used to identify procedures performed on the left side of the body) | Q1 | Routine clinical service provided in a clinical research study that is in an approved clinical research study | RT | Right side (used to identify procedures performed on the right side of the body) |
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| 2025-01-01 | Changed | Short and Medium Descriptions changed. |
| 2013-01-01 | Changed | Medium Descriptor changed. |
| 1991-01-01 | Added | First appearance in code book in 1991. |
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