CPT 21820Surgery

Treat sternum fracture

CPT code 21820 covers the treatment of a broken breastbone (sternum) without surgery. This typically involves stabilization, pain management, and monitoring to ensure proper healing of this central chest bone.

Showing rates for

National Average

Base Medicare rate

$153.65

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

1.36

PE RVU (NF)

3.11

MP RVU

0.28

Total RVU

4.75

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

NCCI bundling edits

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Billing tips

Verify facility vs non-facility status carefully - the $1.30 difference between facility ($152.35) and non-facility ($153.65) rates may seem small but impacts revenue projections and contract negotiations
Impact: Ensures accurate reimbursement and prevents need for claim corrections or appeals
Document the decision-making process for closed treatment versus surgical intervention, including assessment of fracture stability, displacement measurement, and respiratory function evaluation
Impact: Reduces denial risk by 40-60% when medical necessity is clearly established in initial encounter documentation
Bill same-day E/M services with modifier 25 only when separate, significant, and identifiable evaluation beyond the fracture treatment is documented (e.g., assessment of other injuries or comorbidities)
Impact: Can add $75-150 to encounter reimbursement when appropriately documented and coded
For trauma cases, ensure ICD-10 code includes 7th character for episode of care (A for initial encounter) and laterality when applicable - use S22.20XA for unspecified sternal fracture, initial encounter
Impact: Prevents automatic denials from incomplete or incorrect diagnosis coding; estimates show 15-20% of claims denied for diagnosis coding errors
Global period is 90 days - do not separately bill routine follow-up visits during this period unless modifier 24 (unrelated E/M) or 25 (significant, separately identifiable E/M) applies with appropriate documentation
Impact: Prevents $500-1000+ in recoupments per case when global period rules are violated
When performed in ED setting, coordinate billing with facility fees to ensure no duplication and verify whether split/shared E/M rules apply if both ED physician and orthopedist evaluate patient

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Frequently asked questions

What is the Medicare reimbursement rate for CPT 21820 in 2025?

The 2025 Medicare national average reimbursement for CPT 21820 is $153.65 for non-facility settings and $152.35 for facility settings. These rates are based on 4.75 total RVUs (1.36 work RVU, 3.11 non-facility PE RVU, 0.28 MP RVU) multiplied by the 2025 conversion factor of 32.3465.

Can I bill an E/M code with CPT 21820 on the same day?

Yes, you can bill a separate E/M service with CPT 21820 using modifier 25, but only when the E/M represents a significant, separately identifiable service beyond the evaluation included in the fracture treatment. Documentation must clearly show the distinct nature of the E/M service, such as evaluation of other injuries or medical conditions requiring separate assessment and management decisions.

What is the global period for CPT code 21820?

CPT 21820 has a 90-day global period. This means all routine follow-up care related to the sternum fracture treatment is included in the initial payment, and you cannot separately bill for postoperative visits during this period unless using appropriate modifiers (24, 25, 78, or 79) for unrelated or complicated care.

What ICD-10 codes should I use with CPT 21820?

The most common ICD-10 code is S22.20XA (unspecified fracture of sternum, initial encounter for closed fracture). More specific codes include S22.21XA (fracture of manubrium, initial encounter) or S22.22XA (fracture of body of sternum, initial encounter). Always use the 7th character 'A' for initial encounter, 'D' for subsequent encounter during healing, or 'S' for sequela.

Does CPT 21820 require surgical manipulation of the fracture?

No, CPT 21820 specifically describes closed treatment of a sternal fracture WITHOUT manipulation. If manipulation is performed to reduce the fracture, a different CPT code would apply. This code is for conservative management including stabilization, pain control, and monitoring without active reduction maneuvers.

What specialties typically bill CPT code 21820?

CPT 21820 is most commonly billed by orthopedic surgeons, trauma surgeons, emergency medicine physicians, thoracic surgeons, and general surgeons. The code may be used in emergency departments, trauma centers, hospital inpatient settings, and orthopedic clinics where patients with chest trauma are evaluated and treated.

What documentation is needed to support billing CPT 21820?

Required documentation includes mechanism of injury, physical examination findings (point tenderness, respiratory assessment), imaging confirmation of sternal fracture with interpretation, clinical rationale for closed treatment, treatment plan with immobilization and pain management details, patient counseling about complications, follow-up plan, and complete ICD-10 diagnosis coding with 7th character for episode of care.