CPT 21339Surgery

Open nasoethmoid fx w/ fixj

CPT code 21339 covers the surgical repair of a broken nasoethmoid bone (the area where the nose meets the eye sockets) using an open approach with hardware fixation. This is a complex facial fracture repair requiring direct access to the bone and placement of plates or screws to hold the fragments in proper position.

Showing rates for

National Average

Base Medicare rate

$742.03

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

8.5

PE RVU (NF)

13.2

MP RVU

1.24

Total RVU

22.94

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

NCCI bundling edits

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Billing tips

Document the specific approach (coronal, transconjunctival, sublabial, external) and exact location and type of internal fixation hardware used (number of plates, screws, size)
Impact: Prevents downcoding to 21338 (percutaneous treatment) or 21335 (closed reduction without fixation), protecting $742.03 vs lower reimbursement
When multiple facial fractures are repaired, code each separately and append modifier 51 to secondary procedures in descending RVU order with 21339 typically as primary code
Impact: Maximizes reimbursement for complex facial trauma; failing to code separately could result in 30-50% revenue loss on total case
For bilateral fractures requiring separate fixation on each side, append modifier 50 and ensure documentation clearly describes work performed on both sides
Impact: Increases reimbursement from $742.03 to $1,113.05 (150% payment) for Medicare
Submit operative report with clear dictation of 'open reduction' and 'internal fixation' terminology; avoid vague language about 'repair' or 'treatment'
Impact: Medical review denials can delay payment 30-60 days; specific terminology reduces review rate by approximately 40%
For cases with unusual complexity (severe comminution, prior surgery, pathologic fracture), append modifier 22 with comparison statement showing additional time/difficulty beyond typical case
Impact: Successful modifier 22 appeals can increase payment 20-50% ($148-$371 additional) but requires strong documentation
Verify fracture classification with CT imaging documentation in chart; NOE fractures are classified as Type I, II, or III with different fixation requirements

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Frequently asked questions

What is the Medicare reimbursement rate for CPT code 21339 in 2025?

The 2025 Medicare national average reimbursement for CPT 21339 is $742.03 for both facility and non-facility settings. This rate is based on a total RVU of 22.94 multiplied by the 2025 conversion factor of $32.3465. Actual payment may vary by geographic locality using the GPCI adjustments.

What is the difference between CPT 21339 and 21335 for nasoethmoid fractures?

CPT 21335 covers closed treatment of nasoethmoid fractures without manipulation or fixation, while 21339 represents open treatment with internal fixation. Code 21339 requires surgical incision, direct visualization of the fracture, and placement of hardware (plates, screws, wires), whereas 21335 is non-surgical observation or external splinting only. The reimbursement difference is substantial, with 21339 at $742.03 versus significantly lower rates for closed treatment.

Can CPT 21339 be billed with other facial fracture codes?

Yes, CPT 21339 can be billed with other facial fracture repair codes when distinct fractures are treated at separate anatomical sites with separate fixation. Common pairings include orbital floor fractures (21385-21387), zygomatic fractures (21365-21366), and maxillary fractures (21421-21422). Use modifier 51 on secondary procedures and ensure documentation clearly describes each separate fracture and fixation.

What RVU value does CPT 21339 have for 2025?

CPT 21339 has a total RVU of 22.94 for 2025, consisting of work RVU of 8.5, practice expense RVU of 13.2 (both facility and non-facility), and malpractice RVU of 1.24. This high RVU value reflects the complexity and surgical skill required for open nasoethmoid fracture fixation.

What documentation is required to bill CPT 21339 successfully?

Required documentation includes pre-operative CT imaging confirming the nasoethmoid fracture, a detailed operative report describing the open surgical approach with specific incision location, description of fracture reduction technique, itemized list of internal fixation hardware used (type, size, number of plates and screws), and post-operative imaging confirming hardware placement. The operative note must explicitly state 'open reduction' and 'internal fixation' to avoid downcoding.

Is CPT 21339 a bilateral procedure code?

No, CPT 21339 is inherently unilateral. When bilateral nasoethmoid fractures require open fixation on both sides, append modifier 50 to indicate bilateral procedure. Medicare will reimburse at 150% of the base rate ($1,113.05 total) for bilateral procedures. Documentation must clearly describe the work performed on each side separately.

What specialties typically perform and bill CPT 21339?

CPT 21339 is most commonly billed by oral and maxillofacial surgeons, plastic surgeons specializing in craniofacial surgery, otolaryngologists (ENT surgeons), and trauma surgeons with facial fracture expertise. The procedure is typically performed in hospital settings (inpatient or outpatient surgical departments) or ambulatory surgical centers, requiring appropriate surgical privileges and board certification in a relevant surgical specialty.