CPT 21343Surgery

Open tx dprsd front sinus fx

CPT 21343 covers the surgical repair of a broken frontal sinus (the air-filled space in the forehead bone above the eyes) when the bone fragment is pushed inward and requires an open surgical approach to restore normal position.

Showing rates for

National Average

Base Medicare rate

$1,061.29

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

14.32

PE RVU (NF)

16.42

MP RVU

2.07

Total RVU

32.81

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

NCCI bundling edits

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Billing tips

Document depression depth and posterior table involvement in operative note
Impact: Prevents downcoding to closed treatment (21340) which reimburses significantly less; proper documentation supports full $1061.29 payment versus potential denial
Separately report cranialization or obliteration with appropriate add-on codes if performed
Impact: Sinus obliteration procedures can add $300-800 in additional reimbursement when medically necessary and documented as distinct from basic fracture reduction
Bill globally on date of surgery, not date of injury or initial evaluation
Impact: Ensures proper global period tracking and prevents confusion with E/M services; 90-day global period starts on surgical date affecting follow-up billing
Verify medical necessity documentation includes CT imaging showing depression and surgical indication
Impact: Lack of radiographic evidence is primary denial reason; pre-operative CT documentation prevents up to 100% claim denial ($1061.29 loss)
Use modifier 22 with detailed dictation when bone grafting or extensive sinus repair significantly exceeds typical work
Impact: Well-documented complexity can justify 20-30% additional payment ($212-318) for cases with extensive comminution or dural involvement
Coordinate billing with neurosurgery when dural repair is required to determine co-surgery versus sequential procedures
Impact: Proper modifier 62 usage allows both surgeons payment ($663.31 each) versus single surgeon payment with assistant-at-surgery reduced rate

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Frequently asked questions

What is the Medicare reimbursement rate for CPT 21343 in 2025?

The 2025 Medicare national average reimbursement for CPT 21343 is $1061.29 for both facility and non-facility settings, based on 32.81 total RVUs and the conversion factor of 32.3465.

What is the difference between CPT 21343 and 21340?

CPT 21343 describes open treatment of depressed frontal sinus fracture requiring surgical incision and direct visualization, while 21340 covers closed treatment without surgical incision. The open approach (21343) reimburses at $1061.29 compared to significantly lower payment for closed treatment.

How many RVUs is CPT code 21343 worth?

CPT 21343 has 32.81 total RVUs in 2025, consisting of 14.32 work RVUs, 16.42 practice expense RVUs, and 2.07 malpractice RVUs, making it a high-value surgical procedure code.

Can CPT 21343 be billed with other facial fracture repair codes?

Yes, CPT 21343 can be billed with other facial fracture codes when treating anatomically distinct fracture sites during the same surgical session, but requires proper documentation of separate sites and consideration of NCCI bundling edits. Modifier 59 or anatomic modifiers may be required.

What documentation is required to bill CPT 21343?

Required documentation includes pre-operative CT imaging showing frontal sinus fracture with depression, operative report detailing open surgical approach with incision location, fracture visualization and reduction technique, fixation method if used, and assessment of sinus integrity and drainage.

Does CPT 21343 have a global period?

Yes, CPT 21343 has a 90-day global surgical period, meaning routine postoperative visits within 90 days of surgery are included in the $1061.29 reimbursement and cannot be billed separately unless using appropriate modifiers for unrelated or complication-related services.

Which medical specialties typically bill CPT code 21343?

CPT 21343 is primarily billed by oral and maxillofacial surgeons, plastic surgeons, otolaryngologists (ENT), and craniofacial surgeons who treat facial trauma in hospital and trauma center settings with appropriate surgical privileges for complex facial fracture repair.