CPT 21325Surgery

Open tx nose fx uncomplicatd

CPT code 21325 covers the surgical repair of a broken nose (nasal fracture) without complications, performed through an open technique requiring incisions. This is used when the fracture can be fixed without extensive reconstruction or internal hardware.

Showing rates for

National Average

Base Medicare rate

$434.09

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

4.18

PE RVU (NF)

8.64

MP RVU

0.6

Total RVU

13.42

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

NCCI bundling edits

Loading bundling edits…

Billing tips

Verify timing from injury date - Medicare and most payers require open treatment within 7-14 days of initial fracture for optimal reimbursement under 21325 versus delayed reconstruction codes
Impact: Billing beyond optimal timing window may trigger downcoding to evaluation codes or denials, losing the full $434.09 reimbursement
Document complexity clearly to distinguish from 21320 (closed treatment) or 21330 (complicated open treatment) - specify that open approach was necessary but extensive reconstruction was not required
Impact: Proper documentation prevents $150-200 underpayment from downcoding to 21320 or unnecessary denials when 21330 characteristics are absent
Bill facility versus non-facility setting correctly - 21325 has identical rates ($434.09) for both settings, but verify place of service code matches actual location
Impact: Incorrect POS codes trigger audits even though payment is identical; ensures clean claims processing and avoids 15-30 day payment delays
Do not bundle septal repair (30520) if performed concurrently unless medically distinct and separately documented with modifier 59
Impact: Appropriate use of modifier 59 for documented separate septal work can add $300-400 in additional reimbursement when clinically supported
Report anesthesia separately - 21325 is not an anesthesia-included code; ensure anesthesia provider bills 00160 (anesthesia for nasal procedures) separately
Impact: Anesthesia represents additional $150-300 in facility revenue; failure to bill separately leaves significant money on table
For global period tracking, note that 21325 carries a 90-day global period - all routine postoperative care is included in the $434.09 payment

Live Field Datano reports yet

Real billers contribute denial patterns and appeal strategies for this code. Once 5+ reports come in, you’ll see live aggregated data here — the only place this exists, free.

Working with CPT 21325?

Get the free Revenue Protection Toolkit — the denial triggers, modifier pitfalls, and bundling conflicts that quietly cost you reimbursement. Instant download.

Help build the field knowledge

MedPayIQ gets smarter as billers contribute. If you've had this code denied, share what happened so others learn from it. Anonymous, no patient info.

Related actions

Frequently asked questions

What is the Medicare reimbursement rate for CPT 21325 in 2025?

The 2025 Medicare national average reimbursement for CPT 21325 is $434.09 for both facility and non-facility settings. This rate is calculated using the total RVU of 13.42 multiplied by the 2025 conversion factor of 32.3465. Actual payment may vary by geographic locality based on the GPCI adjustments applied to each RVU component.

What is the difference between CPT 21325 and 21320 for nasal fracture treatment?

CPT 21320 covers closed treatment of nasal fractures using external manipulation without incisions, while 21325 requires open surgical technique with incisions to directly visualize and reduce the fracture. The open approach (21325) is necessary when closed reduction is inadequate or when direct visualization is required for proper alignment. Medicare reimburses 21325 at $434.09 compared to approximately $280 for 21320, reflecting the increased complexity and surgical resources required.

How many RVUs is CPT code 21325 worth in 2025?

CPT 21325 has a total RVU value of 13.42 in 2025, comprised of 4.18 work RVUs, 8.64 practice expense RVUs (both facility and non-facility), and 0.6 malpractice RVUs. This RVU allocation reflects moderate surgical complexity with significant practice expense requirements for open facial fracture procedures.

Can CPT 21325 be billed with septoplasty on the same day?

Yes, but with caution. CPT 21325 can be billed with septoplasty (30520) when both procedures are medically necessary and distinct, typically requiring modifier 59 to indicate separate procedures. Documentation must clearly show that the nasal bone fracture treatment and septal repair addressed different injuries or anatomical problems. Many payers scrutinize this combination for bundling issues, so comprehensive operative notes distinguishing each procedure's medical necessity are essential.

What is the global period for CPT code 21325?

CPT 21325 has a 90-day global surgical period. This means the $434.09 Medicare payment includes all routine preoperative visits (typically 1 day before), the procedure itself, and all routine postoperative care for 90 days following surgery. Any E/M services during this period require modifier 24 (unrelated) or 25 (significant, separately identifiable) to receive separate payment.

What documentation is required to bill CPT 21325 to Medicare?

Medicare requires comprehensive documentation including: clear description of the nasal fracture with diagnostic imaging, clinical justification for open versus closed treatment, detailed operative report describing incisions and direct fracture visualization, reduction technique under direct vision, stabilization method, and time from injury to treatment. The operative note must clearly demonstrate that incisions were made and the fracture was directly visualized, distinguishing it from closed reduction (21320).

Which medical specialties typically bill CPT code 21325?

CPT 21325 is primarily billed by otolaryngologists (ENT surgeons), facial plastic surgeons, oral and maxillofacial surgeons, and plastic surgeons with facial trauma expertise. These specialists must have appropriate hospital privileges and credentialing for open facial bone procedures. The procedure is typically performed in hospital outpatient departments, ambulatory surgical centers, or inpatient settings for trauma cases, requiring facility resources and anesthesia support.