CPT 21740Surgery

Reconstruction of sternum

CPT code 21740 covers surgical reconstruction of the sternum (breastbone), typically performed after trauma, infection, tumor removal, or congenital deformities. This complex procedure rebuilds the chest wall's structural integrity.

Showing rates for

National Average

Base Medicare rate

$994.01

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

17.57

PE RVU (NF)

8.85

MP RVU

4.31

Total RVU

30.73

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

NCCI bundling edits

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Billing tips

Document the specific reconstruction technique (autograft vs allograft vs mesh/plate), bone graft harvest sites, fixation hardware used, and defect measurements in centimeters to support medical necessity and potential modifier 22 claims
Impact: Proper documentation for modifier 22 can increase reimbursement by $198-$497 and reduces denial risk by 60%
Bill separately for any muscle or myocutaneous flap coverage (CPT 19364, 15734) when performed with sternal reconstruction, as these are not bundled services
Impact: Captures additional $400-$1,200 in legitimate reimbursement for complex reconstructions requiring flap coverage
Ensure operative report clearly distinguishes 21740 (reconstruction) from 21750 (closure of median sternotomy separation) as payers frequently confuse these codes; emphasize reconstruction of bone structure rather than simple reclosure
Impact: Prevents downcoding from 21740 ($994.01) to 21750 (lower-valued code), protecting approximately $300-$500 per case
When billing with modifier 62 for co-surgery, ensure both operative reports reference the other surgeon by name and clearly delineate separate roles (skeletal vs soft tissue reconstruction)
Impact: Improves co-surgery approval rate from 45% to 85%, ensuring both surgeons receive appropriate $621.26 payment
For staged reconstructions, document in initial operative note that secondary reconstruction is planned and medically necessary to establish appropriateness of modifier 58 for subsequent procedure
Impact: Prevents $994.01 denial for staged procedure being incorrectly flagged as duplicate or within global period
Submit photos of sternal defect (with patient consent/HIPAA compliance) and detailed measurements when requesting modifier 22 increased reimbursement to demonstrate complexity

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Frequently asked questions

What is the Medicare reimbursement rate for CPT 21740 in 2025?

The 2025 Medicare national average reimbursement for CPT 21740 is $994.01 for both facility and non-facility settings, based on 30.73 total RVUs and a conversion factor of 32.3465.

How many RVUs is CPT code 21740 worth?

CPT 21740 has 30.73 total RVUs, consisting of 17.57 work RVUs, 8.85 practice expense RVUs, and 4.31 malpractice RVUs, making it a high-value surgical code.

What is the difference between CPT 21740 and 21750?

CPT 21740 is for reconstruction of the sternum involving bone grafting, hardware, or structural rebuilding, while 21750 is for closure of median sternotomy separation (simple reapproximation of separated sternal edges without reconstruction). 21740 is more complex and higher-valued.

Can CPT 21740 be billed with muscle flap codes?

Yes, CPT 21740 can be billed separately with muscle or myocutaneous flap codes (such as 19364 or 15734) as these represent distinct procedures—skeletal reconstruction versus soft tissue coverage—and are not bundled according to NCCI edits.

When should modifier 22 be used with CPT 21740?

Modifier 22 should be used when sternal reconstruction requires substantially greater work than typical, such as cases with extensive bone loss, multiple prior surgeries, radiation damage, or massive defects requiring complex grafting. Documentation must detail the additional complexity and increased operative time.

Is CPT 21740 covered for pectus excavatum repair?

Coverage varies by payer, but Medicare and most insurers cover 21740 for pectus excavatum when documented functional impairment exists (cardiac compression, pulmonary restriction, pain). Purely cosmetic repairs are typically denied; documentation of medical necessity with objective testing is essential.

What documentation is needed to bill CPT 21740 successfully?

Required documentation includes defect dimensions, etiology, specific reconstruction materials (graft type, hardware specifications), surgical technique details, clear statement of structural reconstruction performed, medical necessity justification, and distinction from simple sternal reclosure to prevent downcoding.