CPT 21811Surgery

Optx of rib fx w/fixj scope

CPT code 21811 covers the surgical repair of a broken rib using minimally invasive techniques with a scope (thoracoscopy). The surgeon uses small incisions and a camera to visualize and fix the fractured rib with plates, screws, or other fixation devices.

Showing rates for

National Average

Base Medicare rate

$572.53

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

10.79

PE RVU (NF)

4.36

MP RVU

2.55

Total RVU

17.7

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

NCCI bundling edits

Loading bundling edits…

Billing tips

Document the specific number of ribs repaired and whether single or multiple fixation points were used per rib
Impact: Supports medical necessity and may justify modifier 22 for increased complexity, potentially adding $114-286 to reimbursement
Clearly differentiate thoracoscopic approach from open approach in operative note; use terms like 'VATS' and 'video-assisted' throughout documentation
Impact: Prevents downcoding to open rib fixation codes or denial for lack of scope documentation; protects full $572.53 payment
Bill on date of service, not date of admission; ensure surgical date matches claim date for trauma cases with prolonged hospital stays
Impact: Prevents timely filing denials and ensures proper DRG bundling exemptions for facility billing
When billing with chest tube placement (32551) or other thoracic procedures, sequence codes based on RVU value and use modifier 51 or 59 appropriately
Impact: Proper sequencing prevents automatic 50% reduction on primary procedure; can preserve $200-300 in reimbursement
Document medical necessity including failed conservative management, respiratory parameters, pain scores, and chest wall stability assessments
Impact: Reduces denial rate by 30-40% for 'not medically necessary' denials; critical for payer acceptance of elective rib fixation
For bilateral cases, ensure separate documentation for each side and consider whether true bilateral procedure (modifier 50) or two separate unilateral procedures
Impact: Correct modifier use can mean difference between 150% payment ($858.80) versus potential denial for duplicate service

Live Field Datano reports yet

Real billers contribute denial patterns and appeal strategies for this code. Once 5+ reports come in, you’ll see live aggregated data here — the only place this exists, free.

Working with CPT 21811?

Get the free Revenue Protection Toolkit — the denial triggers, modifier pitfalls, and bundling conflicts that quietly cost you reimbursement. Instant download.

Help build the field knowledge

MedPayIQ gets smarter as billers contribute. If you've had this code denied, share what happened so others learn from it. Anonymous, no patient info.

Related actions

Frequently asked questions

What is the CPT code 21811 used for?

CPT 21811 is used for the thoracoscopic (minimally invasive scope-assisted) surgical repair of rib fractures using internal fixation hardware such as plates and screws. This code specifically describes the video-assisted approach rather than open surgery.

How much does Medicare pay for CPT 21811 in 2025?

Medicare pays $572.53 for CPT 21811 in 2025 based on the national average rate. Both facility and non-facility rates are the same at $572.53, with a total RVU of 17.7 and work RVU of 10.79.

What is the difference between CPT 21811 and 21810?

CPT 21811 describes thoracoscopic (scope-assisted) rib fracture fixation, while 21810 describes open rib fracture fixation without a scope. The key difference is the surgical approach: 21811 uses small ports and a camera for minimally invasive access, whereas 21810 requires a larger open incision for direct visualization.

Can CPT 21811 be billed bilaterally with modifier 50?

Yes, CPT 21811 can be billed with modifier 50 when rib fixation is performed thoracoscopically on both the right and left chest walls during the same operative session. This increases reimbursement to 150% of the base rate, or approximately $858.80 for Medicare.

How many ribs need to be repaired to bill CPT 21811?

CPT 21811 does not specify a minimum number of ribs. The code describes fixation of rib fracture(s) using a thoracoscopic approach. Medical necessity and payer policies may vary regarding the number of ribs requiring fixation, but the code itself can be reported for single or multiple rib repairs performed thoracoscopically.

What documentation is required to support CPT 21811 billing?

Documentation must include the operative report clearly describing the thoracoscopic approach with port placement and video visualization, the specific ribs repaired, fracture reduction technique, type and number of fixation devices used, medical necessity justification, and evidence of failed conservative management or acute indication such as flail chest or respiratory compromise.

Is CPT 21811 covered by all insurance payers?

Coverage for CPT 21811 varies by payer and individual policy. While Medicare covers the procedure when medically necessary, many commercial payers have specific criteria requiring documentation of flail chest, nonunion, malunion, or failed conservative management for 6-12 weeks. Prior authorization is often required, and some payers may consider rib fixation investigational for certain indications.