CPT 21335Surgery

Open tx nose & septal fx

CPT 21335 covers the surgical repair of a broken nose and nasal septum through an open procedure, where the surgeon makes incisions to directly access and realign the fractured bones.

Showing rates for

National Average

Base Medicare rate

$699.01

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

9.02

PE RVU (NF)

11.23

MP RVU

1.36

Total RVU

21.61

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

NCCI bundling edits

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Billing tips

Clearly document 'open' approach with specific description of incisions (intercartilaginous, transfixion, or external) to justify 21335 versus closed reduction code 21325
Impact: Prevents $274.31 loss from downcoding to 21325 which reimburses at only $424.70
Report separately billable services like septoplasty (30520) only if performed beyond what's necessary for fracture reduction and documented as distinct procedure
Impact: Can add $527.29 when medically necessary septoplasty is properly documented as separate from traumatic septal reduction
Verify fracture timing documentation shows treatment within 7-14 days post-injury; late repairs may require different coding approach
Impact: Prevents denials and ensures appropriate classification as acute fracture care versus secondary rhinoplasty
Document any internal fixation devices, splints, or packing materials used, as these support medical necessity for open approach
Impact: Strengthens claim against audit and may justify modifier 22 for complex cases requiring hardware
Capture anesthesia separately when performed in facility; general anesthesia is typical and should be billed by anesthesia provider
Impact: Ensures facility receives appropriate anesthesia reimbursement beyond the surgical fee
Use correct ICD-10 codes specifying nasal bone fracture (S02.2XXA for initial encounter) with appropriate seventh character for encounter type
Impact: Proper diagnosis coding prevents delays and denials; mismatched encounter indicators can trigger automatic rejections

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Frequently asked questions

What is the Medicare reimbursement rate for CPT 21335 in 2025?

The 2025 Medicare national average reimbursement for CPT 21335 is $699.01 for both facility and non-facility settings. This rate is based on 21.61 total RVUs multiplied by the 2025 conversion factor of 32.3465. Actual payment may vary by geographic locality.

What is the difference between CPT 21335 and 21325?

CPT 21335 is for open treatment of nasal/septal fractures requiring surgical incisions and direct visualization, while 21325 is for closed reduction performed through external manipulation without incisions. The open approach (21335) reimburses at $699.01 versus $424.70 for closed reduction (21325), making proper documentation of technique critical.

How many RVUs is CPT code 21335 worth?

CPT 21335 has 21.61 total RVUs for 2025, consisting of 9.02 work RVUs, 11.23 practice expense RVUs, and 1.36 malpractice RVUs. These values are the same for both facility and non-facility settings.

Can CPT 21335 be billed with septoplasty code 30520?

CPT 21335 and 30520 can be billed together only when septoplasty addresses pathology distinctly separate from the traumatic fracture reduction. Documentation must clearly demonstrate that septoplasty corrected pre-existing or additional septal issues beyond what was necessary for fracture treatment. Use modifier 59 or XU to indicate distinct procedural service.

What diagnosis codes support medical necessity for CPT 21335?

Primary diagnosis codes include S02.2XXA (fracture of nasal bones, initial encounter), S02.91XA (unspecified fracture of facial bones), and potentially S01.20XA if open wound is present. The seventh character 'A' for initial encounter is critical for acute fracture treatment. Chronic nasal deformity codes (M95.0) are not appropriate for fracture coding.

What is the global period for CPT 21335?

CPT 21335 has a 90-day global surgical period. All routine postoperative care within 90 days of surgery is included in the $699.01 reimbursement. Complications requiring return to OR need modifier 78, while unrelated procedures need modifier 79 for separate payment.

Does CPT 21335 require prior authorization from Medicare or commercial payers?

Medicare typically does not require prior authorization for CPT 21335 as it's an urgent/emergent trauma procedure. However, many commercial payers do require authorization, especially when performed non-emergently. Always verify specific payer requirements before scheduling, as authorization policies vary significantly by plan.