CPT 21344Surgery

Open tx compl front sinus fx

CPT 21344 covers the surgical repair of a complicated fracture to the frontal sinus (the air-filled cavity in the forehead bone above the eyes) using an open surgical approach. This involves making an incision to directly access and repair the broken bone fragments.

Showing rates for

National Average

Base Medicare rate

$1,356.29

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

21.57

PE RVU (NF)

17.25

MP RVU

3.11

Total RVU

41.93

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

NCCI bundling edits

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Billing tips

Document fracture complexity explicitly including number of fragments, anterior vs posterior table involvement, and nasofrontal duct status
Impact: Prevents downcoding to simpler fracture codes (21343) which reimburse $400-500 less; clear complexity documentation supports the $1356.29 rate
When neurosurgical co-surgery is required for posterior table/dural repair, coordinate modifier 62 usage in advance and ensure operative reports clearly delineate each surgeon's distinct role
Impact: Proper co-surgery billing yields $847.68 per surgeon vs incorrect primary/assistant billing at $1356.29 + $203.44, avoiding overpayment recoupment
Bill for image guidance separately (70486-70488) when intraoperative CT or navigation is used, as these are not bundled with 21344
Impact: Additional $200-400 in legitimate reimbursement for technology-assisted repair; verify payer-specific policies on same-day imaging
For cases requiring both frontal sinus repair and orbital floor reconstruction, bill both codes (21344 and 21386/21387) with modifier 59 on the secondary procedure
Impact: Captures full work value of combined procedures; without modifier 59, secondary procedure may be bundled resulting in $800-1200 loss
Submit pre-authorization with CT imaging for complex cases before surgery, particularly when cranialization or obliteration is planned
Impact: Reduces denial rate from 15-20% to under 5% for this high-dollar code; saves average 45-60 days in payment delays
Use ICD-10 codes that specify open fracture (S02.19xB) vs closed (S02.19xA) and document any associated intracranial injury (S06.x codes) to support medical necessity

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Frequently asked questions

What is the difference between CPT 21343 and 21344 for frontal sinus fractures?

CPT 21343 covers open treatment of simple frontal sinus fractures with minimal displacement and single-table involvement, while 21344 is for complicated fractures involving multiple fragments, both anterior and posterior tables, or requiring sinus obliteration/cranialization. The complicated nature in 21344 justifies the higher reimbursement of $1356.29 compared to simpler repairs.

How much does Medicare pay for CPT 21344 in 2025?

Medicare pays $1356.29 for CPT 21344 in 2025 based on the national average non-facility rate. This rate applies to both facility and non-facility settings as they are identical for this procedure code. The payment reflects 41.93 total RVUs multiplied by the 2025 conversion factor of 32.3465.

Can CPT 21344 be billed with orbital fracture repair codes?

Yes, CPT 21344 can be billed with orbital fracture repair codes (21385-21387) when both procedures are performed and documented separately. Append modifier 59 or XS to the secondary procedure to indicate distinct anatomical sites. Ensure operative notes clearly document separate incisions or approaches for each fracture repair to avoid bundling denials.

When is modifier 62 appropriate for CPT 21344?

Modifier 62 (co-surgery) is appropriate for CPT 21344 when two surgeons of different specialties perform distinct portions of the procedure simultaneously, such as a neurosurgeon repairing dural tears/posterior table while an oral-maxillofacial surgeon repairs the anterior table and facial structures. Each surgeon must document their specific role and both receive 62.5% of the allowable fee ($847.68 each).

What RVU value does CPT 21344 have in 2025?

CPT 21344 has a total RVU value of 41.93 in 2025, consisting of 21.57 work RVUs, 17.25 practice expense RVUs, and 3.11 malpractice RVUs. Both facility and non-facility PE RVUs are identical at 17.25, which is uncommon and reflects the hospital-based nature of this complex trauma procedure.

What diagnosis codes support medical necessity for CPT 21344?

Primary diagnosis codes supporting CPT 21344 include S02.19xA (closed frontal bone fracture) or S02.19xB (open frontal bone fracture) with 7th character indicating encounter type. Associated codes like S06.x (intracranial injury) or S01.x (open wound of head) strengthen medical necessity. Document fracture displacement, comminution, and posterior table involvement to justify the complicated repair approach.

How should I bill CPT 21344 if cranialization was performed?

Bill CPT 21344 as written when cranialization (removal of posterior table and incorporation of frontal sinus into anterior cranial fossa) is performed as part of complicated frontal sinus fracture repair. Consider modifier 22 for increased complexity if extensive dural repair or frontal lobe protection was required, with documentation supporting 20-50% additional work. Cranialization is included in the complicated fracture repair and not separately billable.