CPT 21338Surgery

Open nasoethmoid fx w/o fixj

CPT code 21338 covers the surgical repair of a broken nasoethmoid bone (the bone structure around the nose and inner eye area) using an open approach without placing hardware or fixation devices. The surgeon accesses the fracture through an incision and repositions the bone fragments without using plates, screws, or wires.

Showing rates for

National Average

Base Medicare rate

$656.63

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

6.87

PE RVU (NF)

12.43

MP RVU

Total RVU

20.3

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

NCCI bundling edits

Loading bundling edits…

Billing tips

Clearly document why fixation was not used - bone stability, patient age, medical contraindications, or fracture pattern - to prevent auditor assumptions that fixation was performed but not coded
Impact: Prevents upcoding allegations and potential recoupment of $200-400 in overpayment if auditor assumes 21339 should have been billed
Separately document and bill for any concurrent septoplasty (30520) or turbinate reduction if performed for functional reasons unrelated to fracture stabilization, using modifier 59
Impact: Can add $200-500 in legitimate additional reimbursement when appropriately documented as distinct procedures
Use time-based and complexity-based language in operative reports to support modifier 22 when comminution, scarring, or anatomical complexity increases operative time beyond typical 60-90 minutes
Impact: Successfully appealed modifier 22 claims can increase reimbursement by $130-260 (20-40% increase)
Bill only once per encounter even if multiple nasoethmoid fracture fragments are addressed; code describes treatment of the nasoethmoid complex as a unit, not per fragment
Impact: Prevents unbundling denials and potential fraud flags that trigger comprehensive audits
For pediatric patients, document growth plate considerations and rationale for avoiding permanent fixation to support medical necessity
Impact: Reduces denial rate by approximately 15-25% for pediatric cases where reviewers may question adequacy of non-fixation approach
Verify facility vs non-facility setting designation before billing, though both reimburse identically at $656.63 for this code; confirm site of service aligns with claim form

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 21338?

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 21338 in 2025?

The 2025 Medicare national average reimbursement for CPT 21338 is $656.63 for both facility and non-facility settings. This rate is based on 20.3 total RVUs multiplied by the 2025 conversion factor of 32.3465. Actual reimbursement may vary by geographic locality based on the GPCI adjustment.

What is the difference between CPT 21338 and 21339?

CPT 21338 describes open treatment of nasoethmoid fracture without fixation, while 21339 includes internal or external fixation. Code selection depends entirely on whether hardware (plates, screws, wires) or rigid external fixation was applied. The presence of any rigid fixation requires billing 21339 instead of 21338.

Can CPT 21338 be billed with other facial fracture repair codes?

Yes, CPT 21338 can be billed with other facial fracture codes when distinct fracture sites are treated during the same operative session. Use modifier 51 for multiple procedures, and ensure operative documentation clearly delineates separate work for each fracture site. The nasoethmoid component must be documented as requiring separate surgical attention beyond incidental visualization.

How many RVUs is CPT code 21338 worth?

CPT 21338 has 20.3 total RVUs for 2025, consisting of 6.87 work RVUs, 12.43 practice expense RVUs, and 1.0 malpractice RVUs. The facility and non-facility PE RVUs are identical at 12.43 for this code.

What documentation is needed to bill CPT 21338 and avoid denials?

Essential documentation includes a detailed operative report describing the incision approach, direct visualization of the fracture, reduction technique performed, explicit statement that no internal fixation was placed, and clinical rationale for the non-fixation approach. Pre-operative imaging interpretation and post-operative stability assessment are also critical to demonstrate medical necessity.

Is CPT 21338 subject to the global surgical package?

Yes, CPT 21338 is a major surgical procedure subject to a 90-day global surgical package. This includes all routine postoperative care for 90 days following surgery. Any related complications or additional procedures during this period require modifier 78, while unrelated procedures require modifier 79 for separate reimbursement.

When should modifier 22 be used with CPT 21338?

Modifier 22 should be appended to CPT 21338 when the nasoethmoid fracture repair involves significantly greater complexity than typical cases, such as severe comminution, extensive scarring from previous surgery, unusual anatomical variations, or substantially increased operative time beyond 60-90 minutes. Documentation must clearly detail the additional work and complexity to justify the 20-40% increase in reimbursement.