CPT 21615Surgery

Removal of rib

CPT code 21615 covers the surgical removal of a rib, typically performed to treat conditions like thoracic outlet syndrome, rib fractures that won't heal, or to access internal structures during surgery.

Showing rates for

National Average

Base Medicare rate

$607.79

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

10.45

PE RVU (NF)

5.81

MP RVU

2.53

Total RVU

18.79

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

NCCI bundling edits

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Billing tips

Document the specific rib number removed (first rib, cervical rib, etc.) and medical necessity with clear diagnosis linking to symptoms
Impact: Reduces denial rate by 40-60% for medical necessity challenges; essential for thoracic outlet syndrome cases
Code approach separately if combined with thoracotomy or other major access procedures; review NCCI edits before bundling
Impact: Can preserve additional $800-$2,500 in reimbursement depending on approach complexity and payer policies
For first rib resection, verify payer policy on transaxillary vs supraclavicular approach coding differences
Impact: Some payers differentiate approach methods; incorrect coding may result in 15-20% payment variance
Bill facility vs non-facility based on actual place of service; this code shows identical rates ($607.79) but verify individual payer contracts
Impact: Practice setting verification prevents place-of-service denials; some commercial payers may have different fee schedules
Obtain prior authorization for elective rib resection cases, especially for thoracic outlet syndrome; many payers require conservative therapy failure documentation
Impact: Prevents post-service denials averaging $600-$1,200 when authorization is missing; some payers mandate 3-6 months conservative treatment
When performed with tumor excision, document whether rib removal is integral to tumor excision or separately reportable based on extent
Impact: Proper differentiation can justify additional reimbursement of $400-$800 when services are distinct and modifier 59 applies

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Frequently asked questions

What is the Medicare reimbursement rate for CPT 21615 in 2025?

The 2025 Medicare national average reimbursement for CPT 21615 is $607.79 for both facility and non-facility settings, based on 18.79 total RVUs and the 2025 conversion factor of 32.3465.

How many RVUs is CPT code 21615 worth?

CPT 21615 has 18.79 total RVUs, consisting of 10.45 work RVUs, 5.81 practice expense RVUs, and 2.53 malpractice RVUs for 2025.

Does CPT 21615 require prior authorization?

Prior authorization requirements vary by payer, but most commercial insurers and Medicare Advantage plans require pre-authorization for elective rib removal, especially for thoracic outlet syndrome. Documentation of failed conservative treatment (typically 3-6 months) is usually mandatory for approval.

Can CPT 21615 be billed bilaterally with modifier 50?

Yes, modifier 50 can be appended when bilateral rib removal is performed during the same operative session. Reimbursement is typically 150% of the unilateral rate, though Medicare may reimburse 100% for the first side and 50% for the second side depending on payer policy.

What diagnosis codes justify medical necessity for CPT 21615?

Common supporting diagnosis codes include G54.0 (brachial plexus disorders/thoracic outlet syndrome), M89.88 (disorder of bone, other sites including ribs), C79.51 (secondary malignant neoplasm of bone), M86.88 (osteomyelitis of other sites), and S22.3XXA-S22.4XXA (rib fracture codes with appropriate 7th character for encounter type).

What is the global period for CPT 21615?

CPT 21615 has a 90-day global period, meaning all routine post-operative care for 90 days following surgery is included in the base reimbursement and should not be billed separately. Complications requiring return to the OR would be billed with modifier 78 or 79 as appropriate.

Is CPT 21615 facility-only or can it be performed in an office setting?

CPT 21615 is typically performed in hospital inpatient, hospital outpatient, or ambulatory surgical center settings due to the surgical complexity and anesthesia requirements. The 2025 Medicare facility and non-facility rates are identical at $607.79, though the procedure is rarely appropriate for office-based settings due to clinical considerations.