CPT 21348Surgery

Opn tx nasomax fx w/graft

CPT 21348 covers open surgical treatment of a broken nose and cheekbone (nasomaxillary fracture) with bone grafting. This involves making incisions to access the fracture, realigning the bones, and placing graft material to support healing.

Showing rates for

National Average

Base Medicare rate

$1,066.79

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

17.52

PE RVU (NF)

12.95

MP RVU

2.51

Total RVU

32.98

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

NCCI bundling edits

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Billing tips

Document graft source, type, and volume precisely in operative report (autogenous vs. allograft, bone vs. cartilage, harvesting site if autograft)
Impact: Prevents denials for insufficient documentation; graft documentation is audited in 40% of claims and missing details result in downcoding to 21347 (without graft), losing $200+ in reimbursement
Bill separately for bone graft harvesting using CPT 20900-20902 with modifier 59 when autograft is obtained from separate incision site
Impact: Additional $150-$400 reimbursement for graft harvest; must document separate site and distinct procedure to avoid bundling denials
Use modifier 22 with detailed narrative when operative time exceeds 2.5 hours or involves panfacial trauma requiring extensive reconstruction
Impact: Can increase reimbursement by 20-50% ($213-$533 additional) but requires submission of operative note with claim and comparative time documentation
Verify fracture classification (Le Fort I, II, III, NOE) is documented with imaging correlation before coding to ensure 21348 is most appropriate code
Impact: Prevents upcoding/downcoding issues; Le Fort III and NOE with grafting may warrant 21348 while simple nasal fractures should use 21335-21336, avoiding $600+ payment discrepancies
Submit claims within 7-10 days post-surgery with complete operative report attached for complex trauma cases
Impact: Reduces initial denial rate by 30%; complex facial fracture claims have 45% higher approval rate on first submission when supporting documentation included
Code imaging guidance (70486-70488 for CT, 76375 for 3D rendering) separately when used for intraoperative navigation or planning

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Frequently asked questions

What is the Medicare reimbursement rate for CPT 21348 in 2025?

The 2025 Medicare national average reimbursement for CPT 21348 is $1066.79 for both facility and non-facility settings. This rate is based on 32.98 total RVUs (17.52 work RVU, 12.95 PE RVU, 2.51 MP RVU) multiplied by the 2025 conversion factor of 32.3465. Actual reimbursement varies by geographic location based on local cost adjustments.

What is the difference between CPT 21348 and 21347?

CPT 21348 includes bone or cartilage grafting as part of the nasomaxillary fracture repair, while 21347 is open treatment without graft placement. The graft component adds approximately $200-250 to reimbursement. Documentation must clearly specify graft type, source, and placement to justify billing 21348 instead of 21347.

Can CPT 21348 be billed bilaterally with modifier 50?

Yes, modifier 50 can be used when bilateral nasomaxillary fractures are treated with grafting on both sides during the same operative session. This increases total reimbursement to 150% of the base rate ($1600.19 for Medicare). Documentation must clearly show separate fractures and grafting procedures on both left and right sides with medical necessity for bilateral treatment.

What modifiers are commonly used with CPT 21348?

Common modifiers include: modifier 50 for bilateral procedures, modifier 51 for multiple procedures, modifier 22 for increased complexity with extensive trauma, modifier 62 for co-surgery involving multiple specialists, modifier 78 for related return to OR, and modifier 79 for unrelated procedures during global period. Each modifier has specific documentation requirements and reimbursement impacts.

Can I bill bone graft harvesting separately with CPT 21348?

Yes, when autogenous bone graft is harvested from a separate incision site (such as iliac crest or rib), you can bill CPT 20900-20902 separately with modifier 59. The harvest site must be documented as distinct from the facial fracture repair site. However, graft harvesting from the same surgical field (local bone) is considered included in 21348 and cannot be billed separately.

How long is the global period for CPT 21348?

CPT 21348 has a 90-day global surgical period. This means all routine follow-up care related to the fracture repair within 90 days post-surgery is included in the initial payment. Complications requiring return to OR use modifier 78, while unrelated procedures use modifier 79 to bill separately during this period.

What documentation prevents denials for CPT 21348?

Essential documentation includes: pre-operative CT imaging showing fracture pattern and displacement, detailed operative report specifying graft type/source/volume, description of reduction technique and fixation method, medical necessity for open approach vs. closed reduction, and clear anatomic documentation of all fractured bones treated. Graft placement must be explicitly documented with preparation method and specific placement location to avoid downcoding to 21347.