CPT 21750Surgery

Repair of sternum separation

CPT code 21750 covers the surgical repair of a separated sternum (breastbone), typically occurring after trauma, surgery, or infection. This procedure involves realigning and stabilizing the sternum using surgical techniques such as wiring or plating.

Showing rates for

National Average

Base Medicare rate

$656.63

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

11.4

PE RVU (NF)

6.22

MP RVU

2.68

Total RVU

20.3

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

NCCI bundling edits

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Billing tips

Document whether this is primary repair or revision of previous repair attempt, as revision procedures may require modifier 22 and detailed operative note justification
Impact: Modifier 22 with strong documentation can increase reimbursement by $130-$330 beyond base $656.63 rate
Clearly distinguish 21750 from debridement codes (11042-11047) when both are performed; sternal repair includes limited debridement but extensive tissue removal should be separately coded with modifier 59
Impact: Can add $100-$400 in legitimate additional reimbursement when extensive debridement is medically necessary and documented
For post-operative sternal dehiscence during global period of original sternotomy, always use modifier 78 and link to original procedure date to avoid claim rejection
Impact: Prevents automatic denial; ensures payment of approximately $459.64 (70% of base rate) rather than $0
Verify insurance policy on bilateral procedures; while sternum is midline, some payers have specific edits requiring modifier 50 documentation
Impact: Prevents unexpected denials and need for time-consuming appeals
Include detailed measurement documentation of sternal separation (in centimeters), description of fixation method used (wire gauge/number, plate type/size), and any hardware removed
Impact: Reduces audit risk and supports medical necessity; lack of specifics is leading cause of post-payment recoupment
When performed with concurrent procedures like pectoralis flap advancement (15734), ensure clear documentation that sternal repair and soft tissue reconstruction are distinct and both medically necessary

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Frequently asked questions

What is the Medicare reimbursement for CPT 21750 in 2025?

The 2025 Medicare national average reimbursement for CPT 21750 is $656.63 for both facility and non-facility settings. This rate is based on 20.3 total RVUs multiplied by the 2025 conversion factor of 32.3465. Actual payment may vary by geographic locality and individual payer contracts.

Can CPT 21750 be billed with debridement codes on the same day?

Yes, but documentation must clearly justify separate procedures. Limited debridement is included in 21750, but extensive debridement of infected or necrotic tissue beyond what is typical for sternal repair can be separately coded using 11042-11047 with modifier 59. The operative note must quantify the extent of debridement and demonstrate it was a distinct, separately identifiable service.

How do I bill 21750 if performed during the global period of the original sternotomy?

Use modifier 78 when sternal repair is performed during the 90-day global period of the original sternotomy procedure. This indicates an unplanned return to the operating room for a complication. Reimbursement will be reduced to approximately 70% of the full fee, and you must link the claim to the original procedure with appropriate diagnosis codes for sternal dehiscence or disruption.

What RVU value does CPT 21750 have?

CPT 21750 has a total RVU value of 20.3 for 2025, consisting of 11.4 work RVUs, 6.22 practice expense RVUs (both facility and non-facility), and 2.68 malpractice RVUs. This relatively high RVU reflects the complexity and risk associated with sternal repair procedures.

Which medical specialties typically bill CPT 21750?

CPT 21750 is most commonly billed by cardiothoracic surgeons managing sternal dehiscence after cardiac surgery, trauma surgeons treating sternal fractures, and general surgeons addressing sternal infections or separations. Plastic and reconstructive surgeons may also bill this code when performing complex sternal reconstruction, often in conjunction with soft tissue flaps.

What documentation is required to support medical necessity for CPT 21750?

Required documentation includes imaging or clinical measurements demonstrating significant sternal separation, evidence of failed conservative management when appropriate, description of symptoms (pain, instability, respiratory compromise), assessment of infection risk, and clear explanation of why surgical repair is necessary. Operative notes must detail the degree of separation, fixation method used, and any complications addressed.

When should modifier 22 be used with CPT 21750?

Modifier 22 should be appended to 21750 when the sternal repair is significantly more complex than typical cases due to factors such as extensive infection requiring radical debridement, multiple previous failed repair attempts, severe osteoporosis requiring specialized fixation techniques, or unusual anatomical challenges. The operative report must clearly document why the procedure required substantially greater physician work and time than typical, and a cover letter should request additional reimbursement with specific justification.