CPT 21620Surgery

Partial removal of sternum

CPT 21620 covers the surgical procedure to partially remove the sternum (breastbone), typically performed to treat infections, tumors, or severe chest wall deformities. This is a complex surgical procedure requiring extensive reconstruction of the chest wall.

Showing rates for

National Average

Base Medicare rate

$492.96

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

7.28

PE RVU (NF)

6.26

MP RVU

1.7

Total RVU

15.24

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

NCCI bundling edits

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Billing tips

Document precise extent of sternal resection including specific anatomic portions (manubrium, body segments, xiphoid) and measurements in centimeters
Impact: Prevents downcoding to debridement codes (11044-11047) which reimburse $50-150 versus $492.96 for 21620
Separately bill any concurrent chest wall reconstruction (21740-21750) with modifier 59 if distinct from the sternectomy itself
Impact: Can add $800-2000 in additional reimbursement when properly documented as separate anatomic site or extensive reconstruction
Use modifier 22 with detailed operative note when resection requires management of mediastinal structures, extensive vascular dissection, or removal exceeding one-third of sternum
Impact: Increases base $492.96 payment by $100-250 with appropriate documentation of increased complexity
Ensure documentation clearly differentiates from total sternectomy (21630) and simple sternal debridement to support code selection
Impact: Prevents denial for incorrect code selection; 21630 reimburses similarly but has different medical necessity criteria
Report any bone biopsy or cultures as included in 21620; do not separately bill 20220 or 20245 from same surgical site
Impact: Avoids bundling denials and potential fraud flags; these services are considered integral to the primary procedure
For post-cardiac surgery sternal osteomyelitis, ensure linkage to appropriate infection diagnosis codes (M86.38, T81.4XXA) with history codes for previous surgery (Z98.89)
Impact: Proper diagnosis coding supports medical necessity and reduces denial rate by 30-40% for this common indication

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Frequently asked questions

What is the Medicare reimbursement rate for CPT 21620 in 2025?

The 2025 Medicare national average reimbursement for CPT 21620 is $492.96 for both facility and non-facility settings, based on 15.24 total RVUs and the conversion factor of 32.3465.

What is the difference between CPT 21620 and 21630?

CPT 21620 is for partial sternum removal where a portion of the sternal bone is resected while preserving some sternal structure. CPT 21630 covers radical resection with complete removal of the entire sternum, typically requiring more extensive reconstruction.

Can CPT 21620 be billed with chest wall reconstruction codes?

Yes, chest wall reconstruction codes (21740-21750) can be billed separately with modifier 59 when the reconstruction involves distinct anatomic sites such as rib resection, muscle flap creation, or prosthetic mesh placement beyond the sternal resection itself. Documentation must clearly show separate, distinct procedures.

What diagnosis codes support medical necessity for CPT 21620?

Common supporting diagnoses include chronic sternal osteomyelitis (M86.38), postprocedural infection (T81.4XXA), primary bone neoplasms (C41.3), metastatic disease to sternum (C79.51), and radiation osteonecrosis (M87.88). History of cardiac surgery (Z98.89) should be included when applicable.

How many RVUs is CPT code 21620 worth in 2025?

CPT 21620 has 15.24 total RVUs in 2025, consisting of 7.28 work RVUs, 6.26 practice expense RVUs, and 1.7 malpractice RVUs. Both facility and non-facility PE RVU values are identical at 6.26.

When should modifier 22 be used with CPT 21620?

Modifier 22 is appropriate when partial sternectomy involves significantly increased complexity such as extensive prior radiation, multiple previous sternotomies, tumor involvement of mediastinal structures, or resection exceeding one-third of the sternum requiring complex reconstruction. Documentation must detail the additional time and difficulty with specific measurements and anatomic challenges.

Is CPT 21620 typically performed inpatient or outpatient?

CPT 21620 is almost exclusively performed as an inpatient procedure due to the complexity, need for intensive postoperative monitoring, and typical patient comorbidities. The identical facility and non-facility rates ($492.96) reflect that this is a hospital-based procedure with significant associated facility costs beyond the professional fee.