CPT 21320Surgery

Clsd tx nsl fx w/mnpj&stablj

CPT code 21320 covers the non-surgical treatment of a broken nose where the doctor manipulates the bones back into position and stabilizes them without making any incisions. This is the closed reduction method for nasal fractures with manipulation and stabilization.

Showing rates for

National Average

Base Medicare rate

$209.93

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

1.59

PE RVU (NF)

4.67

MP RVU

0.23

Total RVU

6.49

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

NCCI bundling edits

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Billing tips

Bill in non-facility setting when performed in office to capture full $209.93 vs $92.51 facility rate
Impact: $117.42 additional revenue per procedure (127% higher reimbursement in office setting)
Document time of injury and medical necessity for timing of reduction (optimal 3-10 days post-injury before significant callus formation)
Impact: Prevents denials for procedures performed outside optimal treatment window; delays beyond 14 days may require different coding or be considered elective
Separately document and bill for anesthesia administration if performed by different provider; do not include local anesthesia in procedure note as it is bundled
Impact: Avoid unbundling violations; local/topical anesthesia is included in the 21320 payment
Use imaging confirmation (X-ray, CT) prior to procedure and document in medical record; bill imaging separately with appropriate CPT codes
Impact: Supports medical necessity and proper procedure selection; imaging codes (70160, 70486-70488) add $25-$150 in separate reimbursement
Document both manipulation AND stabilization methods (nasal packing, external splint, tape) to support code selection over lower-level codes
Impact: Prevents downcoding to 21315 (closed treatment without manipulation, pays $68.49 non-facility - $141.44 less)
For ED encounters, ensure distinct documentation if billing both E/M service with modifier 25 and procedure code 21320
Impact: Can add $93-$184 for ED E/M (99282-99284 with modifier 25) if separately identifiable service documented

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Frequently asked questions

What is the difference between CPT 21320 and 21315 for nasal fracture treatment?

CPT 21320 includes manipulation (active repositioning of displaced nasal bones) and stabilization (packing, splinting), paying $209.93 non-facility, while 21315 is for closed treatment without manipulation, paying only $68.49. The key distinction is whether the provider actively manipulates displaced fracture fragments back into anatomic position.

How much does Medicare pay for CPT 21320 in 2025?

Medicare pays $209.93 for CPT 21320 in non-facility settings and $92.51 in facility settings based on the 2025 national average. Actual payment varies by geographic location based on GPCI adjustments, and the facility rate is significantly lower because overhead costs are covered separately.

Can I bill an E/M code with CPT 21320 on the same day?

Yes, you can bill an E/M code with CPT 21320 using modifier 25 on the E/M service, but only if there is a separately identifiable evaluation and management service beyond the typical pre-procedure assessment. Documentation must clearly show the E/M addressed issues distinct from the decision to perform the nasal reduction.

What RVU value does CPT code 21320 have?

CPT 21320 has a total RVU of 6.49 for 2025, consisting of 1.59 work RVU, 4.67 practice expense RVU (non-facility), 1.04 PE RVU (facility), and 0.23 malpractice RVU. These values are multiplied by the conversion factor of 32.3465 to determine Medicare payment.

How long is the global period for CPT 21320?

CPT 21320 has a 10-day global period, meaning routine postoperative care for 10 days after the procedure is included in the payment and should not be billed separately. Any visits after the 10-day global period or for unrelated issues can be billed with appropriate E/M codes.

What documentation is required to bill CPT 21320 without denials?

Required documentation includes: injury date and mechanism, pre-procedure nasal deformity assessment, imaging confirmation (or clinical justification), detailed description of manipulation technique performed, post-reduction alignment assessment, and specific stabilization method used (type of packing and/or external splint applied).

When should I use modifier 50 with CPT 21320 for nasal fractures?

Modifier 50 is generally not appropriate for CPT 21320 as nasal fracture reduction is considered a midline structure procedure. The nasal bones are treated as a single anatomic unit even when both sides are fractured. Review payer-specific guidelines as some may have different policies, but most do not recognize bilateral billing for this code.