Autogenous auricular cartilage harvest and grafting to reconstruct or repair a defect of the nose or ear — graft harvest is included in this single code.

Verified May 8, 2026 · 5 sources ↓

Medicare: $737.16
Work RVU: 7.31
Global, days: 90
Region: Other

Drawn from AAPCCoaccessMdclarityPayerpriceCMS

Documentation requirements

What must appear in the operative or office note to support the claim.

Source · Editorial brief grounded in 5 cited references ↓

Identify the anatomic defect and its etiology (congenital, traumatic, post-resection, or prior graft failure) — cosmetic-only indication disqualifies coverage
Confirm autogenous auricular cartilage was used; allograft or alloplastic implant use invalidates 21235
Describe the harvest site and whether a separate incision was required to obtain the graft
Document objective evidence of functional impairment when the indication is nasal obstruction (e.g., valve collapse on exam, nasal endoscopy findings, or failed conservative measures such as nasal dilators or steroid trials)
Operative note must name the recipient site (nose or ear), describe graft shaping and placement technique, and explain why cartilage support was required over soft-tissue repair alone
Record conservative or non-surgical management attempted prior to surgery when clinically appropriate, unless an acute or congenital indication bypasses that requirement

Applicable modifiers

Modifiers commonly billed with this code.

Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual

22 Increased complexity 50 Bilateral procedure 51 Multiple procedures 52 Reduced services 59 Distinct service 76 Repeat, same physician 78 Unplanned return — related 79 Unrelated during global LT Left side RT Right side

What this code covers

Source · Editorial summary grounded in 5 cited references ↓

CPT 21235 covers the complete procedure of harvesting cartilage from the patient's own ear (auricle) and placing it to repair or reconstruct a structural defect of the nose or ear. Because the code descriptor explicitly includes obtaining the graft, you do not bill a separate harvest code — the harvest is bundled. Indications include congenital deformities (microtia, anotia, constricted ear), nasal valve collapse causing functional obstruction, post-traumatic structural deficit, tumor resection defects, and revision cases where a prior graft has failed.

The 90-day global period means all routine post-operative visits through day 90 are included. Unrelated problems seen in that window require modifier 24; a separately identifiable E/M on the day of surgery requires modifier 25 on the E/M. Payers — particularly commercial plans — scrutinize medical necessity aggressively here because the same anatomy and diagnosis codes appear in purely cosmetic rhinoplasty cases. A diagnosis code reflecting functional impairment or congenital/traumatic deformity is non-negotiable for coverage; cosmetic-only procedures are categorically excluded.

The code appears most often billed by otolaryngologists and facial plastic surgeons, and it is performed almost exclusively in outpatient hospital or ASC settings. When 21235 is billed alongside a tympanoplasty code (e.g., 69633), expect bundling scrutiny — many payers treat the cartilage graft as integral to the tympanoplasty unless a separate incision and distinct reconstructive indication are clearly documented.

RVU & reimbursement

Component RVUs and Medicare national rate. Actual payment varies by GPCI locality.

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU vs. total RVU

The work RVU (7.31) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (22.07) adds practice overhead and malpractice, and is what drives the Medicare payment below.

Work RVU	7.31
Practice expense RVU	13.74
Malpractice RVU	1.02
Total RVU	22.07
Medicare national rate	$737.16
Global period	90 days

Payment by site of service

Medicare pays different rates by setting. HOPD typically pays substantially more than ASC for the same procedure.

Source · CMS OPPS Addendum B·ASC HCPCS payment rates·2026

Setting	Medicare rate (national)
Office (PFS non-facility) Procedure performed in physician's office	$737.16
HOPD (APC 5165) Hospital outpatient department	$6,048.05
ASC (PI A2) Ambulatory surgical center (freestanding)	$3,025.62

Common denial reasons

The recurring reasons claims for CPT 21235 get rejected.

Source · Editorial brief grounded in CMS NCCI edits, AAOS coding appeals, and cited references ↓

Cosmetic diagnosis: ICD-10 code reflects aesthetic concern without documented functional impairment or congenital/traumatic deformity
Bundling with tympanoplasty (e.g., 69633): payer treats cartilage graft as integral to the tympanoplasty when a separate incision and distinct reconstructive purpose are not clearly documented
Non-autogenous material: claim billed as 21235 but operative note describes allograft or synthetic implant rather than the patient's own auricular cartilage
Missing prior authorization: many commercial and Medicaid managed-care plans require pre-authorization for reconstructive head and neck procedures; absence triggers automatic denial
Incomplete operative documentation: note fails to identify harvest site, graft dimensions, or recipient-site structural deficit, leaving medical necessity unsupported

Frequently asked questions

Source · Generated from the editorial pipeline, verified against 5 cited references ↓

01Does 21235 include the cartilage harvest, or do I bill that separately?

Harvest is bundled. The code descriptor explicitly includes obtaining the graft, so billing a separate harvest code alongside 21235 will be denied as unbundling.

02Can I bill 21235 with a tympanoplasty code like 69633 on the same claim?

Only if the operative note documents a separate incision for cartilage harvest and a distinct reconstructive indication beyond what the tympanoplasty covers. Without that documentation, payers treat the graft as integral to 69633 and deny 21235. Modifier 59 may be required, but documentation must support the distinction first.

03What ICD-10 codes support medical necessity for 21235?

Codes reflecting congenital ear deformity (Q17.x series), nasal valve collapse with functional obstruction (J34.89, J34.2), post-traumatic nasal/ear deformity (e.g., M95.0, S09.xx sequela), or post-surgical structural deficit. Cosmetic diagnosis codes alone will trigger denial.

04Is prior authorization typically required for 21235?

Yes, for most commercial and Medicaid managed-care payers. Verify with the specific plan before scheduling. Reconstructive head and neck procedures are high-prior-auth-requirement territory; approval usually requires clinical notes demonstrating functional impairment and failed conservative management.

05How does the 90-day global period affect billing when a patient returns with a complication?

An unplanned return to the OR for a complication related to 21235 — such as graft displacement or infection requiring surgical drainage — bills with modifier 78. An unrelated surgical procedure performed within the 90-day window uses modifier 79. Do not swap these: modifier 78 signals a related return; modifier 79 signals an unrelated one.

06Can 21235 be billed bilaterally?

Technically modifier 50 applies if cartilage is grafted to both sides in the same session, but bilateral ear cartilage grafting is uncommon. If it occurs, document each recipient site distinctly and be prepared for payer requests for operative documentation supporting bilateral necessity.

Sources & references

Editorial content was developed using the following public sources. Last verified May 8, 2026.

Mira Scribe

Mira's AI scribe captures the graft harvest site (e.g., conchal bowl, posterior auricular), the recipient site, the structural defect etiology (congenital, traumatic, post-resection, prior graft failure), confirmation that autologous auricular cartilage was used, and any objective functional impairment findings documented during the encounter. That detail prevents the two most common denials: cosmetic-diagnosis downcoding and allografting misidentification.

See how Mira captures CPT 21235 documentation