Claims for oral surgical procedures may be processed under either the patient's dental coverage or medical coverage. An operative report or pathology notes (as appropriate) are required for HMSA to determine the appropriate application of dental or medical plan benefits for the following procedures.
| CPT Code | Description |
|---|---|
| 21015 | Radical resection of tumor (e.g., malignant neoplasm), soft tissue of face or scalp |
| 21025 | Excision of bone (e.g., for osteomyelitis or bone abscess); mandible |
| 21026 | facial bone(s) |
| 21029 | Removal by contouring of benign tumor of facial bone (e.g., fibrous dysplasia) |
| 21030 | Excision of benign tumor or cyst or maxilla or zygoma by enucleation and curettage |
| 21032 | Excision of maxillary torus palatinus |
| 21034 | Excision of malignant tumor or maxilla or zygoma |
| 21040 | Excision of benign tumor or cyst of mandible, by enucleation and/or curettage |
| 21044 | Excision of malignant tumor or mandible |
| 21045 | radical resection |
| 21046 | Excision of benign tumor or cyst of mandible; requiring intra-oral osteotomy (e.g., locally aggressive or destructive lesion(s)) |
| 21047 | requiring extra-oral osteotomy and partial mandibulectomy (e.g., locally aggressive or destructive lesion(s)) |
| 21048 | Excision of benign tumor or cyst of maxilla; requiring intra-oral osteotomy (e.g., locally aggressive or destructive lesion(s)) |
| 21049 | requiring extra-oral osteotomy and partial maxillectomy (e.g., locally aggressive or destructive lesion(s)) |
| 21050 | Condylectomy, temporomandibular joint (separate procedure) |
| 21060 | Meniscectomy, partial or complete, temporomandibular joint (separate procedure) |
| 21070 | Coronoidectomy (separate procedure) |
| 21073 |
Manipulation of temporomandibular joint(s) (TMJ), therapeutic, requiring an anesthesia service (i.e., general or monitored anesthesia care) If this service is performed in the emergency room, medical records will be evaluated for possible coverage based on the emergent nature of the patient's presenting problem. However, in other settings, this service will not be covered because treatment of TMJ is a specific exclusion of HMSA plans. See Exclusions for more information. |
| 21110 | Application of interdental fixation device for conditions other than fracture or dislocation, includes removal |
| 41820 | Gingivectomy, excision gingiva, each quadrant |
| 41821 | Operculectomy, excision pericoronal tissues |
| 41850 | Destruction of lesion (except excision), dentoalveolar structures |
| 41870 | Periodontal mucosal grafting |
Revision History
| Date | Nature of Revision |
|---|---|
| 08/03/2026 | Migrated to new platform. |