CPT 21630Surgery

Radical resection sternum

CPT code 21630 covers the radical surgical removal of the sternum (breastbone), typically performed to treat tumors, severe infections, or extensive traumatic injuries affecting this bone.

Showing rates for

National Average

Base Medicare rate

$1,286.74

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

19.18

PE RVU (NF)

17.1

MP RVU

3.5

Total RVU

39.78

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

NCCI bundling edits

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Billing tips

Document complete tumor margins and pathology necessity in operative report
Impact: Prevents medical necessity denials; oncologic cases have 85% higher approval rate with detailed margin documentation and tumor board references
Code reconstruction separately with appropriate codes (15734-15738 for muscle flaps, 19357 for tissue expander)
Impact: Additional $800-$3500 in reimbursement for documented reconstructive components not included in base 21630 code
Bill modifier 22 with detailed time and complexity addendum when operative time exceeds 6 hours or prior radiation present
Impact: Potential additional $257-$643 payment increase with proper documentation of extensive complexity factors
Verify prior authorization obtained before surgery with specific diagnosis codes supporting radical approach
Impact: Pre-authorization reduces denial rate from 32% to under 5% for this high-cost procedure
Submit operative photos and imaging studies with initial claim for tumor cases
Impact: Reduces request for additional documentation delays by 60% and accelerates payment by average 18 days
Code separately for harvest site when muscle flap used from distant site (latissimus, rectus)
Impact: Additional $400-$900 reimbursement for documented flap harvest from separate anatomical site

Common denials

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Frequently asked questions

What is the Medicare reimbursement rate for CPT 21630 in 2025?

The 2025 Medicare national average reimbursement for CPT 21630 is $1286.74 for both facility and non-facility settings, based on 39.78 total RVUs and the conversion factor of 32.3465.

Can CPT 21630 be billed with chest wall reconstruction codes?

Yes, chest wall reconstruction codes (15734-15738 for muscle flaps, 19357 for tissue expander, or prosthetic mesh placement) can be billed separately with 21630 when reconstruction is performed and clearly documented as distinct from the resection component. Use modifier 59 if necessary to indicate separate procedure.

What diagnosis codes support medical necessity for CPT 21630?

Primary supporting diagnoses include malignant neoplasm of sternum (C41.3), secondary malignant neoplasm of bone (C79.51), chronic osteomyelitis of sternum (M86.38), and traumatic destruction requiring radical resection. Documentation must show why less extensive resection is inadequate.

How many RVUs is CPT code 21630 worth in 2025?

CPT 21630 has 39.78 total RVUs in 2025, consisting of 19.18 work RVUs, 17.1 practice expense RVUs (both facility and non-facility), and 3.5 malpractice RVUs, reflecting the high complexity and risk of radical sternal resection.

What is the global period for CPT 21630?

CPT 21630 carries a 90-day global surgical period, during which routine postoperative care is included in the base reimbursement. Complications requiring return to OR may be billed with modifier 78, and planned staged procedures use modifier 58.

When should modifier 22 be used with CPT 21630?

Modifier 22 should be appended to 21630 when surgical complexity significantly exceeds typical cases due to extensive tumor involvement, prior radiation therapy, multiple reconstructive components, revision surgery with scarring, or unusual anatomical challenges. Submit detailed operative note with time documentation and complexity explanation for 20-50% increased reimbursement consideration.

What is the difference between CPT 21630 and partial sternal resection codes?

CPT 21630 specifically describes radical (complete or near-complete) resection of the sternum, typically for oncologic indications requiring wide margins. Partial sternal resection for limited disease or infection would be coded with 21627 (sternal debridement) or unlisted code 21899, depending on extent. Documentation must clearly support the radical nature of the resection.