CPT 21330Surgery

Open tx nose fx w/skele fixj

CPT code 21330 covers the surgical repair of a broken nose through an open approach with skeletal fixation, meaning the surgeon makes incisions to access the nasal bones and uses hardware or internal supports to stabilize the fracture.

Showing rates for

National Average

Base Medicare rate

$521.75

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

5.79

PE RVU (NF)

9.51

MP RVU

0.83

Total RVU

16.13

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

NCCI bundling edits

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Billing tips

Document the specific type of skeletal fixation used (K-wires, mini-plates, external fixation device) with catalog numbers when applicable
Impact: Reduces denial risk by 65% compared to vague operative notes; skeletal fixation documentation is required to justify 21330 vs lower-paying 21325
Separately report any septoplasty (30520) or turbinate reduction performed during the same session if medically necessary and documented as distinct procedures
Impact: Can add $200-400 in additional reimbursement when properly documented with modifier 59, but requires clear medical necessity documentation
Bill on the date of service when procedure is performed, not the injury date, and ensure global period tracking begins correctly
Impact: 21330 carries a 90-day global period; incorrect dating can trigger automatic denials for related E/M services worth $75-200 each
For procedures requiring general anesthesia, verify anesthesia team bills separately using base units plus time rather than care team model
Impact: Prevents coordination of benefits issues that delay payment by 30-45 days on average
Appeal denials that downcode to 21325 (closed treatment) by submitting operative report highlighting incision locations and fixation hardware placement
Impact: Successful appeals recover $180-240 difference between 21325 and 21330 reimbursement rates
For Medicare patients, verify that skeletal fixation supplies are included in facility payment rather than billed separately under HCPCS codes
Impact: Prevents compliance risk from duplicate billing; facility supply charges are bundled into the $521.75 facility rate

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Frequently asked questions

What is the Medicare reimbursement rate for CPT 21330 in 2025?

The 2025 Medicare national average reimbursement for CPT 21330 is $521.75 for both facility and non-facility settings. This is based on 16.13 total RVUs (5.79 work RVU, 9.51 practice expense RVU, 0.83 malpractice RVU) multiplied by the 2025 conversion factor of 32.3465.

What is the difference between CPT 21330 and 21325 for nasal fracture repair?

CPT 21330 requires open treatment with skeletal fixation (incisions with hardware placement like wires or plates), while 21325 is for closed treatment with stabilization using splints or packing without skeletal fixation. The open approach with fixation (21330) reimburses at $521.75 compared to approximately $300-350 for closed treatment, reflecting the increased complexity and surgical risk.

Can CPT 21330 be billed with septoplasty on the same date of service?

Yes, but requires modifier 59 on the secondary procedure and clear documentation that the septoplasty (30520) was performed for independent medical necessity beyond the fracture reduction. The operative report must demonstrate distinct work, separate incisions if applicable, and medical justification for both procedures to avoid bundling denials.

What RVU value does CPT 21330 carry in 2025?

CPT 21330 has a total RVU value of 16.13 in 2025, consisting of 5.79 work RVUs, 9.51 practice expense RVUs (both facility and non-facility), and 0.83 malpractice RVUs according to the CMS Physician Fee Schedule.

What type of skeletal fixation qualifies for billing CPT 21330?

Qualifying skeletal fixation includes K-wires, interosseous wiring, mini-plates and screws, external fixation devices, or bone pins that provide rigid stabilization of nasal bone fragments. Simple splinting, external taping, or packing alone does not qualify; the fixation must involve hardware attachment to or through the bone structure.

What is the global period for CPT 21330?

CPT 21330 has a 90-day global surgical period, meaning all routine post-operative care within 90 days of the procedure is included in the $521.75 reimbursement. Separate E/M services during this period require modifier 24 (unrelated) or 25 (significant, separately identifiable service on same day as procedure) to receive additional payment.

Who can bill CPT 21330 and what credentials are required?

CPT 21330 can be billed by otolaryngologists, facial plastic surgeons, oral and maxillofacial surgeons, and plastic surgeons with appropriate training and hospital privileges for facial trauma surgery. The surgeon must be credentialed to perform open facial fracture repairs, and the procedure typically requires facility privileges for operating room access and anesthesia support.