What D7949 means

D7949 covers a LeFort II or LeFort III osteotomy — with bone graft. "D" is dental, "79" is this oral surgery area, and "49" is this LeFort II/III with graft. It's the LeFort II or III midface osteotomy (see D7948 — the higher-level osteotomy repositioning the central or entire midface for significant midface deformity) plus a bone graft. So D7949 is the grafted version of the LeFort II/III midface osteotomy.

So it's the same major midface osteotomy as D7948, but also including a bone graft — used when the midface advancement needs grafting (which is common).

D7949 is essentially D7948 (the LeFort II or III osteotomy — see that code for the description of the high-level midface osteotomy, the LeFort levels, and the midface hypoplasia/retrusion it corrects) with the addition of a bone graft. It's reported instead of D7948 when the procedure includes bone grafting — which is commonly needed in these major midface advancements: when the midface is advanced forward (especially the significant advancements typical of LeFort II/III corrections), gaps are created at the osteotomy sites where the bone was separated and moved forward; these gaps are bone-grafted to fill the spaces, support the advanced midface in its new position, and promote bony healing and stability across the advanced segments. So bone grafting is a common, often integral part of large midface advancements — making D7949 frequently the applicable code for LeFort II/III surgery (with D7948 for the less common cases done without grafting). The graft can be the patient's own bone or other graft material. Like D7948, the code covers the osteotomy/repositioning of the facial bones, here including the bone graft. It's done under general anesthesia. It's performed by an oral and maxillofacial / craniofacial surgeon. These procedures are medically necessary, so medical coverage applies. This code is in the orthognathic/craniofacial surgery area (D7940-D7949) — and is the last code in this orthognathic series. Documentation supports the claim.

When it's typically used

D7949 is reported for a LeFort II or LeFort III osteotomy that includes a bone graft — the same higher-level midface osteotomy as D7948 (repositioning the central or whole midface for significant midface hypoplasia/retrusion), but with bone grafting added — used when these major midface advancements require grafting (common with large advancements, to fill the gaps created and support the new position). It's the grafted version of D7948.

How much does D7949 cost?

A LeFort II or III osteotomy with bone graft is a major craniofacial surgery (under general anesthesia, in a hospital) — its cost is substantial (typically more than the non-grafted D7948, given the added graft), often in the high multiple-thousands range or more. Sample fee-schedule values are in the four-figure range or higher (varying widely by region/case/complexity). As these correct significant deformities, they're medically necessary and medical coverage applies. Verify your specific coverage.

Is D7949 covered by insurance?

Like the non-grafted version, a LeFort II/III osteotomy with bone graft corrects significant midface deformities (often congenital/craniofacial, with functional impacts) — so it's medically necessary and covered under medical benefits (major craniofacial reconstruction). Documentation of the deformity, the medical necessity, and the bone graft is essential, and preauthorization is required. The distinction from D7948 is the inclusion of the bone graft. Verifying coverage helps.

The midface osteotomy plus a bone graft

D7949 adds grafting to the LeFort II/III, and understanding this clarifies the code.

Understanding D7949 clarifies how it relates to D7948. D7949 is the LeFort II or III osteotomy — the same core procedure as D7948 (the high-level osteotomy repositioning the central midface (LeFort II: maxilla + nose) or the entire midface (LeFort III: maxilla + cheekbones + nose), to advance a deficient midface) — but with the addition of a bone graft. So everything D7948 covers, D7949 also covers, plus the grafting. A bone graft is bone (the patient's own, or donor/substitute) placed at the surgical sites.

In the LeFort II/III context, the graft is placed in the gaps created by advancing the midface — supporting the advanced position. So D7949 bundles the major midface osteotomy and the bone grafting into one code. This is why D7949 (rather than D7948) is used when these midface advancements include grafting (which, given the size of these advancements, is common). So D7949 is the LeFort II/III with bone grafting included. Understanding this helps patients see that D7949 is the LeFort II or III osteotomy (the same core procedure as D7948 — the high-level osteotomy repositioning the central midface in LeFort II, the maxilla + nose, or the entire midface in LeFort III, the maxilla + cheekbones + nose, to advance a deficient midface) but with the addition of a bone graft (so everything D7948 covers, D7949 also covers, plus the grafting) — a bone graft being bone (the patient's own, or donor/substitute) placed at the surgical sites, in the LeFort II/III context placed in the gaps created by advancing the midface (supporting the advanced position) — so D7949 bundles the major midface osteotomy and the bone grafting into one code, used (rather than D7948) when these midface advancements include grafting (common given the size of these advancements).

Why grafting is common in midface advancement

Advancing the midface creates gaps to graft, and understanding this clarifies the indication.

Understanding why grafting is common here clarifies why D7949 is frequently the applicable code. The LeFort II/III osteotomies advance the midface forward — often by significant amounts, since they're used for substantial midface deficiencies. When a section of the facial skeleton is cut and moved forward, gaps open up behind/around it — the spaces where the bone used to be, now created by the forward movement. For the bone to heal solidly and the advanced midface to be stably supported in its new, more forward position, these gaps often need to be filled — and that's what the bone graft does: it bridges the gaps at the osteotomy sites, providing a scaffold for bony healing across the gap and structural support for the advanced segments.

So grafting promotes the bony union and stability of the advancement — especially important for the larger advancements typical of these major midface corrections (where the gaps are bigger). Because these advancements are usually substantial, grafting is commonly needed — making D7949 (with graft) frequently the applicable code for LeFort II/III surgery (and D7948, without graft, for the cases that don't need it). So grafting is common because the advancement creates gaps to fill. Understanding this helps patients see that the LeFort II/III osteotomies advance the midface forward (often by significant amounts, since used for substantial midface deficiencies), and when a section of the facial skeleton is cut and moved forward, gaps open up behind/around it (the spaces where the bone used to be, created by the forward movement) — so for the bone to heal solidly and the advanced midface to be stably supported in its new, more forward position, these gaps often need filling, which is what the bone graft does (bridging the gaps at the osteotomy sites, providing a scaffold for bony healing across the gap and structural support for the advanced segments) — so grafting promotes the bony union and stability of the advancement (especially important for the larger advancements typical of these major corrections, where the gaps are bigger), commonly needed because these advancements are usually substantial, making D7949 (with graft) frequently the applicable code for LeFort II/III surgery (and D7948, without graft, for the cases that don't need it).

With graft vs without graft (D7948)

The two LeFort II/III codes differ by the graft, and understanding this clarifies the coding.

Understanding the difference between D7949 (with graft) and D7948 (without graft) clarifies the coding. Both are LeFort II/III midface osteotomies (the major midface advancements), differing only by whether a bone graft is included: without bone graft (D7948) — the osteotomy/repositioning without grafting; and with bone graft (D7949, this code) — the same, plus a bone graft (to fill the gaps and support the advancement). So the choice between them is whether grafting is part of the surgery: D7949 when a graft is used (common, given the typically large advancements), D7948 when not.

The surgeon codes D7949 vs D7948 based on whether a bone graft was placed. Given that these major midface advancements frequently require grafting (to bridge the gaps from the advancement), D7949 is often the applicable code — but the specific case determines it. This with-graft/without-graft pairing mirrors the D7941/D7943 distinction for the mandibular rami osteotomy (without/with graft) — a common CDT pattern of having graft and non-graft versions of a procedure. So the two LeFort II/III codes differ by the graft. Understanding this helps patients see that both D7949 (with graft) and D7948 (without graft) are LeFort II/III midface osteotomies (the major midface advancements) differing only by whether a bone graft is included — without bone graft (D7948: the osteotomy/repositioning without grafting) and with bone graft (D7949, this code: the same plus a bone graft, to fill the gaps and support the advancement) — so the choice is whether grafting is part of the surgery (D7949 when a graft is used, common given the typically large advancements; D7948 when not), the surgeon coding D7949 vs D7948 based on whether a bone graft was placed (D7949 often applicable given these advancements frequently require grafting to bridge the gaps, but the specific case determining it), this with-graft/without-graft pairing mirroring the D7941/D7943 distinction for the mandibular rami osteotomy (a common CDT pattern of having graft and non-graft versions of a procedure).

Where D7949 fits in the codes

D7949 closes the orthognathic series, and understanding this clarifies the coding.

Understanding where D7949 sits clarifies the coding. D7949 is the last code in the orthognathic surgery series (D7940-D7949) — the with-graft version of the highest-level midface osteotomies. The series runs: osteoplasty for orthognathic deformities (D7940); the mandibular osteotomies (rami D7941, rami with graft D7943, segmented/subapical D7944, body D7945); and the maxillary/midface (LeFort) osteotomies (LeFort I total D7946, LeFort I segmented D7947, LeFort II/III without graft D7948, and LeFort II/III with graft D7949, this code).

Note the parallel graft/non-graft pairings in the series: the mandibular rami osteotomy (D7941 without graft, D7943 with graft) and the LeFort II/III (D7948 without graft, D7949 with graft) — each offering a non-graft and a graft version. D7949 specifically is the grafted LeFort II/III — the most extensive of these (a major midface advancement with grafting). The surgeon codes D7949 when a LeFort II/III is done with a bone graft. After this orthognathic series, the D-code sequence continues to other reconstruction codes (jaw bone grafts D7950+, repair of maxillofacial defects D7955, and beyond). So D7949 is the grafted LeFort II/III closing the orthognathic series. Understanding this helps patients see that D7949 is the last code in the orthognathic surgery series (D7940-D7949), the with-graft version of the highest-level midface osteotomies — the series running osteoplasty for orthognathic deformities (D7940), the mandibular osteotomies (rami D7941, rami with graft D7943, segmented/subapical D7944, body D7945), and the maxillary/midface LeFort osteotomies (LeFort I total D7946, LeFort I segmented D7947, LeFort II/III without graft D7948, and LeFort II/III with graft D7949, this code) — noting the parallel graft/non-graft pairings (the mandibular rami osteotomy D7941 without/D7943 with graft, and the LeFort II/III D7948 without/D7949 with graft) — so D7949 specifically is the grafted LeFort II/III (the most extensive of these, a major midface advancement with grafting), coded when a LeFort II/III is done with a bone graft, after which the D-code sequence continues to other reconstruction codes (jaw bone grafts D7950+, repair of maxillofacial defects D7955, and beyond).

Frequently asked questions

What is the D7949 dental code?

It's a LeFort II or LeFort III osteotomy WITH a bone graft — the same higher-level midface osteotomy as D7948 (repositioning the central or whole midface for significant midface hypoplasia/retrusion), but including a bone graft. The graft fills the gaps created by advancing the midface, supporting the new position and healing. It's used when these major midface advancements need grafting.

How is it different from D7948?

D7949 is D7948 (the LeFort II/III midface osteotomy) PLUS a bone graft. So the difference is the bone graft: D7949 when the procedure includes grafting (common, given the large advancements), D7948 when it doesn't. Everything D7948 covers, D7949 also covers, with the graft added to fill the gaps and support the advanced midface.

Why is grafting often needed?

Because advancing the midface forward (especially the substantial advancements typical of LeFort II/III) opens up gaps at the osteotomy sites (where the bone was moved forward). These gaps are bone-grafted to bridge them — providing a scaffold for bony healing across the gap and structural support for the advanced midface in its new position. Larger advancements mean bigger gaps needing grafting.

Where does the graft bone come from?

It can be the patient's own bone (an autograft, harvested from a donor site) or donor/substitute graft material, depending on the case and the amount needed. The surgeon chooses the graft type and source based on the situation (the size of the gaps to fill and the structural needs of the advancement).

What conditions need a LeFort II/III with graft?

Significant midface hypoplasia or retrusion (a markedly underdeveloped/set-back midface), often part of congenital/craniofacial conditions (like certain craniosynostosis syndromes) — corrected by advancing the midface, with grafting to support the (usually large) advancement. These are major craniofacial reconstructions addressing the facial profile, bite, airway, and orbital support.

What does it cost, and is it covered?

It's a major craniofacial surgery (under general anesthesia, in a hospital), more extensive than a LeFort I and including the graft — cost is substantial, often in the high multiple-thousands range or more. As these correct significant deformities (often congenital, with functional impacts), they're medically necessary and covered under medical benefits (preauthorization required). Verify your coverage.

This page is an independent, plain-language explanation for general information only. It is not billing, coding, or clinical advice. For the official CDT descriptor and current-year wording, refer to the American Dental Association.