CPT 21345Surgery

Closed tx nose/jaw fx

CPT 21345 covers the closed treatment (without surgery) of a broken nose or jaw bone, where the doctor repositions the bone fragments without making an incision. This is a non-surgical manipulation procedure typically performed in an emergency department or office setting.

Showing rates for

National Average

Base Medicare rate

$785.05

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

9.06

PE RVU (NF)

13.91

MP RVU

1.3

Total RVU

24.27

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

NCCI bundling edits

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Billing tips

Always verify place of service code (POS 22 for outpatient hospital vs POS 11 for office) as this determines facility vs non-facility rate application
Impact: $155.59 difference in Medicare reimbursement between settings - incorrect POS coding can result in automatic underpayment or claim rejection
Document timing of procedure relative to injury - Medicare and commercial payers expect closed reduction within 7-14 days of initial trauma for optimal reimbursement
Impact: Procedures performed beyond 2 weeks may face increased scrutiny and potential denial; delayed reductions may require 21346 or open procedure codes
Clearly distinguish between simple nasal fracture reduction (21315) and maxillary/complex nasal fractures requiring 21345 through documentation of fracture complexity and manipulation difficulty
Impact: 21315 pays $433.05 vs $785.05 for 21345 - undercoding costs $352 per case while overcoding risks audit penalties
When performed in ED settings, ensure modifier 54 is appended if transfer of postoperative care to specialist is documented, and coordinate with accepting physician to bill modifier 55
Impact: Proper care transfer coding prevents duplicate global fee billing and allows both providers appropriate payment splits
Use modifier 25 appropriately when E/M service precedes the decision for closed reduction - documentation must support separate identifiable service beyond routine pre-procedure assessment
Impact: Adds $150-$350 in legitimate additional reimbursement but triggers higher audit risk if not properly documented with distinct diagnoses or medical necessity
Bill anesthesia services separately when conscious sedation (99152-99153) or nerve blocks (64400-64450) are required and documented with separate provider or monitoring

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Frequently asked questions

What is the Medicare reimbursement rate for CPT 21345 in 2025?

The 2025 Medicare national average reimbursement for CPT 21345 is $785.05 for non-facility settings and $629.46 for facility settings. The total RVU is 24.27 (9.06 work RVU, 13.91 non-facility PE RVU, 9.1 facility PE RVU, and 1.3 MP RVU) multiplied by the 2025 conversion factor of 32.3465.

What is the difference between CPT 21345 and 21315?

CPT 21315 covers closed treatment of simple nasal bone fractures without manipulation or with basic manipulation, while 21345 is used for more complex closed treatment involving maxillary fractures or complicated nasal fractures requiring significant manipulation. The key differentiator is fracture complexity and extent of reduction required, with 21345 paying substantially more ($785.05 vs $433.05).

Can CPT 21345 be billed with an E/M code on the same day?

Yes, CPT 21345 can be billed with an E/M service on the same day using modifier 25 on the E/M code, but only when the evaluation represents a separately identifiable service beyond the routine pre-procedure assessment. Documentation must clearly support distinct medical decision-making, such as evaluation of multiple injuries or medical conditions requiring separate assessment.

How long after injury can closed reduction CPT 21345 be performed?

Closed reduction is typically most effective when performed within 7-14 days of initial injury, before significant callus formation begins. Procedures performed beyond this window face increased scrutiny from payers and may require additional documentation justifying the delay. After 2-3 weeks, open reduction (21346-21348) may be more appropriate depending on healing status.

What modifiers are commonly used with CPT 21345?

Common modifiers include: 54 (surgical care only when transferring postop care), 25 (separate E/M service), 78 (repeat procedure during postop period), LT/RT (laterality for maxillary fractures), and 50 (bilateral procedure). Modifier 54 is particularly common in emergency department settings where specialists assume postoperative care.

Does CPT 21345 include nasal packing and splinting?

Yes, CPT 21345 includes application of nasal packing, external splints, or other stabilization materials as part of the procedure. These supplies and services should not be billed separately as they are considered integral to the closed reduction. Only separately identifiable procedures beyond standard stabilization may be reported with appropriate modifiers.

What documentation is required to support medical necessity for CPT 21345?

Required documentation includes imaging reports confirming fracture type and displacement, pre-procedure assessment noting deformity or functional impairment, detailed description of manipulation technique, post-reduction assessment confirming alignment, timing relative to injury, and medical justification for the procedure. Lack of imaging documentation or failure to describe fracture complexity are common denial triggers.