CPT 21315Surgery

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CPT 21315 covers the treatment of a broken nose without the need for splints, packing, or other stabilization devices. The physician manipulates the nasal bones back into position using a closed (non-surgical) technique.

Showing rates for

National Average

Base Medicare rate

$149.76

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

0.96

PE RVU (NF)

3.51

MP RVU

0.16

Total RVU

4.63

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

NCCI bundling edits

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Billing tips

Verify the setting (facility vs. non-facility) is correctly coded, as this creates a $91.21 payment difference
Impact: Incorrect place of service coding can result in automatic downcoding and 61% reduction in reimbursement
Document explicitly that NO stabilization was used (no splints, packing, or external devices), as presence of any stabilization requires coding 21320 instead
Impact: Miscoding between 21315 and 21320 can result in $50-150 payment variance depending on payer
Ensure manipulation is documented with specific description of technique, force applied, and anatomical landmarks addressed
Impact: Lack of manipulation documentation leads to denial with requirement to downcode to E/M visit only, losing $120+ in revenue
Bill within the optimal timing window (3-14 days post-injury) and document why this timing was chosen
Impact: Procedures performed outside this window face higher scrutiny and 30-40% higher denial rates
Never bundle with same-day E/M unless modifier 25 is appended with distinct documentation showing separately identifiable evaluation
Impact: Unbundled E/M without proper modifier 25 documentation results in automatic denial of E/M service ($75-200 loss)
For Medicare patients, verify the 10-day global period and do not separately bill for routine follow-up visits during this time
Impact: Billing follow-up visits during global period results in denials and potential audit flags; estimated $80-150 per inappropriate claim

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Frequently asked questions

What is the difference between CPT 21315 and 21320?

CPT 21315 is for closed nasal fracture treatment WITHOUT stabilization, while 21320 includes stabilization (splints, packing, or external devices). The presence of any stabilization method requires coding 21320. Documentation must explicitly state whether stabilization was or was not used.

How much does Medicare pay for CPT 21315 in 2025?

Medicare pays $149.76 for non-facility settings (office, clinic) and $58.55 for facility settings (hospital, ASC) based on the 2025 national average rates. Actual payment varies by geographic locality and MAC jurisdiction.

Can I bill an E/M visit and CPT 21315 on the same day?

Yes, but only if the E/M service is separately identifiable and documented as distinct from the decision to perform the manipulation. Append modifier 25 to the E/M code and ensure documentation clearly shows the evaluation component separate from the procedure.

What is the global period for CPT 21315?

CPT 21315 has a 10-day global period for Medicare. This means routine follow-up care within 10 days post-procedure is included in the payment and should not be billed separately. Only complications or unrelated services can be billed during this period.

Do I need imaging to bill CPT 21315?

Imaging is not absolutely required by CPT definition, but clinical documentation must support the presence of a fracture requiring manipulation. Most payers expect radiographic confirmation (nasal bone X-rays or CT scan) to establish medical necessity, and absence of imaging increases denial risk.

Can CPT 21315 be billed bilaterally?

No, CPT 21315 is not a bilateral procedure code. Nasal fracture treatment is considered a midline structure procedure and is reported once per encounter regardless of whether one or both nasal bones are involved. Do not append modifiers 50, LT, or RT.

What RVU value does CPT 21315 have?

CPT 21315 has a total RVU of 4.63 (Work RVU: 0.96, Non-Facility PE RVU: 3.51, Facility PE RVU: 0.69, MP RVU: 0.16) for 2025. When multiplied by the conversion factor of 32.3465, this yields the Medicare payment rates.