CPT 21235Surgery

Ear cartilage graft

CPT code 21235 covers the surgical harvest and preparation of cartilage tissue from the ear to be used as graft material in reconstructive procedures elsewhere in the body, most commonly for nasal or facial reconstruction.

Showing rates for

National Average

Base Medicare rate

$718.42

This calculator gives a typical-case estimate using standard Medicare modifier rules. Actual payment depends on payer policies, documentation, code-specific CMS status indicators, and locality. Verify before billing.

RVU breakdown

Work RVU

7.5

PE RVU (NF)

13.68

MP RVU

1.03

Total RVU

22.21

Conversion factor: 32.3465 · Source: CMS MPFS RVU25A · Confidence: High

NCCI bundling edits

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Billing tips

Always document the ear cartilage harvest as a separate distinct procedure with its own incision, dissection, and closure in the operative report
Impact: Prevents bundling denials worth $718.42; Medicare and commercial payers frequently deny when harvest is not clearly documented as separate from primary procedure
Bill in the non-facility setting when performed in an office-based surgical suite to capture the higher rate of $718.42 versus $560.24 facility rate
Impact: Increases reimbursement by $158.18 per procedure (28% higher payment) when appropriate setting requirements are met
Use modifier 59 when billing 21235 with rhinoplasty codes (30400-30420) or other nasal reconstruction codes to prevent CCI edits
Impact: Avoids automatic bundling denials; without modifier 59, many payers will deny the $718.42 as included in the primary procedure
Document the specific anatomical location of harvest (conchal bowl, cymba concha, etc.) and dimensions of cartilage obtained
Impact: Reduces audit risk and strengthens appeals; specific documentation supports medical necessity and can prevent recoupment of payments averaging $718.42 per case
Consider billing modifier 22 when harvesting from previously operated ears or when requiring bilateral harvest for large graft needs
Impact: Can increase reimbursement by $143-359 (20-50% above base rate) when proper comparative documentation is submitted with the claim
Verify that the primary procedure code does not include graft harvest in its descriptor before billing 21235 separately
Prevents unbundling violations and compliance issues; some comprehensive codes already include harvest, and separate billing could result in overpayment recoupment

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Frequently asked questions

What is the Medicare reimbursement rate for CPT code 21235 in 2025?

The 2025 Medicare national average reimbursement for CPT 21235 is $718.42 in the non-facility setting and $560.24 in the facility setting. These rates are based on a total RVU of 22.21 and a conversion factor of 32.3465. Actual payment may vary by geographic location based on local wage indices and other adjustments.

Can CPT 21235 be billed with rhinoplasty codes?

Yes, CPT 21235 can be billed with rhinoplasty codes (30400-30420), but modifier 59 is typically required to bypass National Correct Coding Initiative (NCCI) edits. The operative report must clearly document that the ear cartilage harvest was a separate, distinct procedure involving a different anatomical site with its own incision and closure, not inherent to the rhinoplasty itself.

What are the RVU values for CPT code 21235?

CPT 21235 has a work RVU of 7.5, non-facility practice expense (PE) RVU of 13.68, facility PE RVU of 8.79, and malpractice (MP) RVU of 1.03, for a total non-facility RVU of 22.21. These values reflect the significant physician work and resources required for surgical cartilage harvest.

Is CPT 21235 bundled with other facial reconstruction procedures?

CPT 21235 is subject to NCCI edits with many facial reconstruction codes, meaning it may be bundled unless properly documented and billed with appropriate modifiers like 59. The key is documenting that the ear cartilage harvest is truly a separate procedure with distinct work, not an inherent component of the primary reconstruction that already includes graft procurement.

What documentation is needed to bill CPT 21235 separately?

Documentation must include: the medical necessity for autologous ear cartilage, the specific ear location harvested (with laterality), a description of the separate ear incision and dissection, cartilage dimensions obtained, closure technique for the ear wound, and how the graft was used. The operative report should clearly distinguish the harvest procedure from the primary reconstruction to justify separate billing.

Can CPT 21235 be billed bilaterally?

Yes, when cartilage is harvested from both ears during the same operative session, CPT 21235 can be billed with modifier 50 (bilateral procedure). This typically increases reimbursement to 150% of the single-procedure rate, or approximately $1,077.63 for non-facility Medicare cases, though payer policies may vary.

What specialties typically bill CPT code 21235?

CPT 21235 is most commonly billed by plastic and reconstructive surgeons, otolaryngologists (ENT), facial plastic surgeons, oral and maxillofacial surgeons, and oculoplastic surgeons. The procedure requires surgical training in cartilage harvest techniques and is performed in hospital outpatient departments, ambulatory surgery centers, and office-based surgical suites.