CPT 21346Surgery

Opn tx nasomax fx w/fixj

CPT 21346 covers open surgical treatment of a broken nose and upper jaw (nasal-maxillary fracture) with fixation using hardware like plates or screws to hold the bones in proper position during healing.

Showing rates for

National Average

Base Medicare rate

$981.72

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

11.45

PE RVU (NF)

17.25

MP RVU

1.65

Total RVU

30.35

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

NCCI bundling edits

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Billing tips

Document specific fixation hardware used (plate type, screw sizes, number of fixation points) and anatomic approach in operative report
Impact: Prevents downcoding to closed reduction 21345 which pays approximately $450 less; hardware documentation justifies open approach and 21346 assignment
Separately report bone graft harvest (20900-20902) when autogenous bone used for defect reconstruction beyond simple fracture reduction
Impact: Additional $200-$400 reimbursement depending on harvest site; use modifier 51 and ensure documentation shows separate procedure
When treating multiple facial fractures, sequence 21346 first if it has highest RVU among procedures performed to minimize multiple procedure reduction
Impact: With 30.35 total RVUs, 21346 often carries highest value; billing as primary procedure preserves full $981.72 while secondary codes reduced 50%
Bill facility fee separately using ASC code or hospital outpatient code when performed in those settings; implants typically pass-through costs
Impact: Facility can bill C1713 for anchor/screw devices and C1716 for absorbable fixation adding $500-$2000 to total facility reimbursement
Verify global period (90 days) and avoid billing E/M services during postop window unless modifier 24 or 25 applies for unrelated issues
Impact: Inappropriate postop E/M billing triggers automatic denials and potential recoupment of $100-$200 per visit plus audit risk
For pediatric patients under 5 years, consider whether 21421 (closed treatment nasal fracture) or other age-appropriate code better represents service since internal fixation approach differs

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Frequently asked questions

What is the Medicare reimbursement rate for CPT code 21346 in 2025?

The 2025 Medicare national average reimbursement for CPT 21346 is $981.72 for both facility and non-facility settings. This rate is based on 30.35 total RVUs (11.45 work RVU, 17.25 practice expense RVU, 1.65 malpractice RVU) multiplied by the 2025 conversion factor of 32.3465. Actual payment may vary by geographic location based on locality adjustments.

What is the difference between CPT 21346 and 21345?

CPT 21346 is for open treatment of nasal-maxillary fractures with internal fixation (using plates, screws, or wires), while 21345 is for open treatment without internal fixation. Code 21346 requires documentation of hardware placement and typically reimburses significantly more due to the complexity and materials involved. The choice depends on whether rigid fixation was necessary for fracture stability.

Can CPT 21346 be billed with septoplasty on the same day?

Billing 21346 with septoplasty (30520) on the same day is appropriate only when both procedures address distinct issues with separate documentation and medical necessity. Use modifier 59 to indicate separate procedures. However, expect scrutiny as payers often view septal work as included in fracture repair. Documentation must clearly distinguish traumatic fracture stabilization from functional nasal airway correction to avoid bundling denials.

What documentation is required to justify CPT 21346 for insurance reimbursement?

Required documentation includes pre-operative imaging (CT scan showing fracture), detailed operative report describing open surgical approach, specific fracture reduction technique, type and placement of internal fixation hardware, post-reduction stability assessment, and medical necessity justification. The operative note must clearly demonstrate this was open surgery with direct visualization and hardware fixation, not closed or percutaneous treatment.

How many RVUs is CPT code 21346 worth in 2025?

CPT 21346 has 30.35 total RVUs in 2025, consisting of 11.45 work RVUs, 17.25 practice expense RVUs (both facility and non-facility), and 1.65 malpractice RVUs. This relatively high RVU value reflects the surgical complexity, time, and skill required for open reduction and internal fixation of nasal-maxillary fractures.

What ICD-10 codes are typically used with CPT 21346?

Common ICD-10 codes include S02.2 (fracture of nasal bones) with appropriate seventh character for encounter type (A for initial, D for subsequent), S02.4 series for maxillary fractures (S02.401-S02.42 depending on specific location), and potentially S02.8 for other facial bone fractures if multiple sites involved. Specificity regarding laterality (right, left, unspecified) and encounter type is essential for claim acceptance.

Who can bill CPT code 21346 and what credentials are required?

CPT 21346 can be billed by board-certified or board-eligible surgeons in oral and maxillofacial surgery, plastic surgery, otolaryngology, or trauma surgery with hospital privileges for open facial fracture repair. Billing requires completion of accredited residency training in the specialty and demonstrated competency in craniofacial trauma management. Mid-level providers may assist but typically cannot independently bill this complex surgical procedure.