Closed reduction of a nasal bone fracture by manual manipulation, without placement of any internal or external stabilizing device.
Verified May 8, 2026 · 5 sources ↓
- Medicare
- $159.99
- Total RVUs
- 4.79
- Global, days
- 0
- Region
- Other
Documentation requirements
What must appear in the operative or office note to support the claim.
Source · Editorial brief grounded in 5 cited references ↓
- Mechanism of injury and clinical presentation confirming acute nasal bone fracture
- Imaging (X-ray or CT) confirming displacement and fracture pattern, referenced in the note
- Description of the manual manipulation technique used to achieve reduction
- Explicit statement that no stabilization device (splint, stent, or internal fixation) was placed
- Clinical rationale for choosing closed treatment without stabilization
- Pre- and post-reduction assessment of nasal alignment and airway patency
Applicable modifiers
Modifiers commonly billed with this code.
Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual
What this code covers
Source · Editorial summary grounded in 5 cited references ↓
CPT 21315 covers closed treatment of a nasal bone fracture where the provider manually repositions the displaced nasal bones without making an incision and without applying a stabilizing splint, stent, or internal fixation. The distinction from 21320 is the absence of stabilization — if you place an external splint or internal device to hold the reduction, you're in 21320 territory. If you open the fracture site, you're looking at 21330 or 21335.
This code carries a 000-day global period, meaning there is no bundled postoperative care window. Follow-up visits billed after the procedure date stand on their own — no modifier needed to unbundle them from the fracture care. The code is used most often in the ED and office settings. When imaging (plain films or CT) is obtained during the same encounter, it bills separately; imaging is not bundled into 21315.
Payers vary on whether preauthorization is required when the procedure is performed in an office or ASC versus the ED. Document the mechanism of injury, the degree of displacement, the specific manipulation technique, and the clinical rationale for forgoing stabilization — those four elements answer the most common audit questions up front.
RVU & reimbursement
Component RVUs and Medicare national rate. Actual payment varies by GPCI locality.
Source · CMS Physician Fee Schedule, RVU26A · January 2026
| Work RVU | 0.94 |
| Practice expense RVU | 3.69 |
| Malpractice RVU | 0.16 |
| Total RVU | 4.79 |
| Medicare national rate | $159.99 |
| Global period | 0 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 | $159.99 |
HOPD (APC 5163) Hospital outpatient department | $1,585.19 |
ASC (PI A2) Ambulatory surgical center (freestanding) | $659.17 |
Common denial reasons
The recurring reasons claims for CPT 21315 get rejected.
Source · Editorial brief grounded in CMS NCCI edits, AAOS coding appeals, and cited references ↓
- Missing imaging documentation to confirm fracture diagnosis prior to manipulation
- Operative or procedure note does not distinguish closed-without-stabilization from closed-with-stabilization, triggering down-coding or denial
- Lack of medical necessity documentation when fracture displacement severity is not described
- Upcoding flag when note language implies a splint or packing was placed, conflicting with 21315
- Global period confusion — payers occasionally misapply a global period and deny follow-up visits, though the 000-day global is correct for this code
Frequently asked questions
Source · Generated from the editorial pipeline, verified against 5 cited references ↓
01What is the difference between 21315 and 21320?
02Does the 000-day global period mean I can bill a follow-up visit the next day without a modifier?
03Can I bill separately for nasal X-rays or a CT taken at the same encounter?
04Should I use modifier 52 if the provider reduced the fracture without instruments?
05Is 21315 appropriate for an old or healed nasal fracture requiring secondary manipulation?
06What ICD-10 diagnosis codes pair with 21315?
Sources & references
Editorial content was developed using the following public sources. Last verified May 8, 2026.
Mira AI Scribe
Mira's AI scribe captures the manipulation technique, absence of stabilization device, fracture displacement severity, and pre/post-reduction nasal alignment directly from the surgeon's dictation. That prevents the most common audit trigger for 21315 — a note that describes the reduction but omits explicit confirmation that no splint or stabilizing device was used, which auditors flag as insufficient to distinguish this code from 21320.
See how Mira captures CPT 21315 documentation