CPT 21610Surgery

Partial removal of rib

CPT code 21610 covers the surgical partial removal of a rib, typically performed to treat rib deformities, tumors, chronic infection, or thoracic outlet syndrome. This is a major surgical procedure requiring general anesthesia and significant postoperative care.

Showing rates for

National Average

Base Medicare rate

$1,199.73

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

15.91

PE RVU (NF)

14.64

MP RVU

6.54

Total RVU

37.09

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

NCCI bundling edits

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Billing tips

Document the specific rib(s) resected and the extent of resection with measurements (e.g., '8 cm segment of right 5th rib removed') to support medical necessity and differentiate from complete rib removal
Impact: Prevents denials for insufficient documentation; improves first-pass claim acceptance rate by 35-40%
Verify whether the procedure is performed for neoplastic versus non-neoplastic indications and ensure appropriate ICD-10 coding, as payers may have different coverage policies
Impact: Incorrect diagnosis linkage causes 25-30% of initial denials; proper coding ensures $1199.73 reimbursement versus denial
When performed with thoracotomy or other chest wall procedures, review NCCI edits carefully and apply modifier 59 only when procedures are truly distinct and separate
Impact: Inappropriate modifier 59 use triggers audits; appropriate use recovers $600-900 in otherwise bundled payments
Confirm facility versus non-facility setting coding, though both have identical 2025 Medicare rates ($1199.73); ASC rates may differ and should be verified separately
Impact: ASC payment rates are typically 55-65% of physician fee schedule; ensures accurate facility revenue capture
Document medical necessity including failed conservative management for non-oncologic cases (physical therapy, medications, injections) as most payers require this for coverage
Impact: Missing conservative treatment documentation results in 40-50% denial rate for non-emergent cases
If performed for thoracic outlet syndrome, ensure vascular studies and neurological documentation are in the medical record as many payers have specific coverage criteria

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Frequently asked questions

What is the Medicare reimbursement rate for CPT 21610 in 2025?

The 2025 Medicare national average reimbursement for CPT 21610 is $1199.73 for both facility and non-facility settings. This is based on a total RVU of 37.09 (work RVU 15.91, PE RVU 14.64, MP RVU 6.54) multiplied by the 2025 conversion factor of 32.3465.

What is the difference between CPT 21610 and complete rib removal?

CPT 21610 specifically covers partial removal of a rib where segments of the rib remain intact anteriorly or posteriorly. Complete rib removal (entire rib from costochondral junction to vertebral attachment) would be coded differently. The operative report must clearly document that only a portion of the rib was excised to support 21610.

Can CPT 21610 be billed bilaterally with modifier 50?

Yes, modifier 50 can be appended to CPT 21610 when partial rib removal is performed on both sides during the same operative session, such as bilateral first rib resection for thoracic outlet syndrome. This typically increases reimbursement to 150% of the unilateral rate when properly documented.

What documentation is required to support medical necessity for CPT 21610?

Required documentation includes pre-operative imaging confirming pathology, specific diagnosis (tumor, infection, fracture, vascular compression), for non-oncologic cases evidence of failed conservative treatment, operative report detailing specific rib and extent of resection, and pathology report when tissue is sent for analysis. Documentation must justify why partial resection was medically necessary.

Does CPT 21610 have a global period?

Yes, CPT 21610 is a major surgical procedure with a 90-day global period. This means routine postoperative care for 90 days after surgery is included in the $1199.73 reimbursement and should not be billed separately. Complications requiring return to OR may be billed with modifier 78 or 79 depending on relatedness.

What are common reasons for denial of CPT 21610 claims?

Common denials include insufficient medical necessity documentation (especially lack of conservative treatment failure for non-oncologic cases), incomplete operative reports missing specific rib identification or extent of resection, bundling issues when billed with chest wall procedures without appropriate modifiers, and lack of supporting diagnostic imaging or pathology reports.

Can CPT 21610 be performed in an ASC or only in hospital?

CPT 21610 can be performed in an Ambulatory Surgery Center (ASC), hospital outpatient, or hospital inpatient setting depending on patient comorbidities and surgical complexity. However, ASC payment rates may differ from the physician fee schedule rate of $1199.73, and some payers may have site-of-service restrictions requiring hospital settings for this procedure.