CPT 21347Surgery

Opn tx nasomax fx multple

CPT code 21347 covers open surgical repair of multiple nasal and upper jaw (maxillary) fractures. This involves making incisions to directly access and fix broken facial bones using plates, screws, or wires.

Showing rates for

National Average

Base Medicare rate

$1,014.39

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

13.53

PE RVU (NF)

15.87

MP RVU

1.96

Total RVU

31.36

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

NCCI bundling edits

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Billing tips

Clearly document all fracture sites involved in operative report, specifying nasal bones, maxilla, and any extension to orbital floor or zygoma to justify code selection over simpler fracture codes
Impact: Prevents downcoding to 21346 (single fracture) which reimburses approximately $200-300 less
Detail the type and extent of internal fixation used (number of plates, screws, wire fixation) as this supports medical necessity for open approach versus closed treatment
Impact: Reduces denial risk by 40-50% when hardware details are documented; closed treatment codes reimburse $600-700 less
Do not unbundle bone grafting when performed as integral part of fracture stabilization; use 21346 add-on codes only for significant grafting beyond fracture site stabilization
Impact: Improper unbundling triggers automatic denials and potential audit flags that can delay payment 30-60 days
For bilateral procedures or modifier 50 considerations, note that 21347 typically describes bilateral involvement inherently; avoid modifier 50 unless payer specifically requires it
Impact: Incorrect modifier 50 usage may trigger denial or reduce payment to 150% rather than full bilateral reimbursement
When performed with other facial fracture repairs (orbital, zygomatic), ensure proper sequencing with most extensive procedure first and verify no CCI edits exist
Impact: Proper sequencing can maximize reimbursement by $150-400 depending on additional procedures performed
Verify global period (90 days) and ensure any related E/M services within this window use appropriate modifiers (24, 25) only when truly unrelated to fracture care

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Frequently asked questions

What is the Medicare reimbursement rate for CPT 21347 in 2025?

The 2025 Medicare national average reimbursement for CPT 21347 is $1014.39 for both facility and non-facility settings. This is based on 31.36 total RVUs (13.53 work RVU, 15.87 PE RVU, 1.96 MP RVU) multiplied by the 2025 conversion factor of 32.3465.

What is the difference between CPT 21347 and 21346?

CPT 21347 is for open treatment of nasomaxillary complex fractures involving multiple fracture sites, while 21346 covers open treatment of nasomaxillary complex fractures with a single fracture site. The key differentiator is the number of distinct fracture sites requiring surgical repair, which must be clearly documented in the operative report.

Can CPT 21347 be billed with modifier 50 for bilateral procedures?

Generally no, CPT 21347 typically describes bilateral involvement of the nasomaxillary complex inherently, as these fractures commonly affect both sides. Modifier 50 should not be used unless payer-specific guidelines explicitly require it, as this may trigger denials or inappropriate payment adjustments.

What documentation is required to bill CPT 21347?

Required documentation includes preoperative imaging showing multiple fracture sites, detailed operative report describing surgical approach and reduction technique, specific description of internal fixation hardware used (type, number, location of plates/screws), and clear documentation of multiple distinct fracture sites in both the diagnosis and operative findings.

How many RVUs is CPT code 21347 worth in 2025?

CPT 21347 has 31.36 total RVUs in 2025, consisting of 13.53 work RVUs, 15.87 practice expense RVUs, and 1.96 malpractice RVUs. This makes it a high-value surgical code reflecting the complexity of open nasomaxillary fracture repair.

Can CPT 21347 be billed with septoplasty or rhinoplasty codes?

This is challenging and often denied due to bundling rules. If septoplasty (30520) addresses pre-existing functional obstruction clearly unrelated to the acute fracture, it may be separately billable with modifier 59 and extensive documentation. Cosmetic rhinoplasty is never separately billable with fracture repair performed on the same date.

What is the global period for CPT 21347?

CPT 21347 has a 90-day global surgical period. All routine postoperative care related to the fracture repair is included in the reimbursement. E/M services during this period require modifier 24 (unrelated) or 25 (significant, separately identifiable) and must be clearly documented as distinct from routine postoperative care.