Closed treatment of a nasal bone fracture requiring manipulation to realign the fracture fragments and stabilization to maintain that alignment.

Verified May 8, 2026 · 6 sources ↓

Medicare: $220.78
Work RVU: 1.55
Global, days: 0
Region: Other

Drawn from CMSMdclarityAaomsAAOSFindacode

Documentation requirements

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

Source · Editorial brief grounded in 6 cited references ↓

Explicit statement that manual manipulation was performed to realign fracture fragments — not just splint placement
Type of stabilization applied (external splint, nasal packing, internal stent) and laterality if relevant
Clinical indication including mechanism of injury, onset, and physical exam findings confirming displaced fracture
Imaging results (X-ray or CT) confirming nasal bone fracture and post-reduction alignment where obtained
Anesthesia type used (local, conscious sedation, general) — required if billed in a facility setting
Patient follow-up plan, especially since global period is 000 and subsequent visits are separately billable

Applicable modifiers

Modifiers commonly billed with this code.

Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual

22 Increased complexity 24 Unrelated E/M during global 25 Significant separate E/M 51 Multiple procedures 52 Reduced services 57 Decision for surgery 76 Repeat, same physician 77 Repeat, another physician 78 Unplanned return — related 79 Unrelated during global 80 Assistant surgeon

What this code covers

Source · Editorial summary grounded in 6 cited references ↓

CPT 21320 describes closed (non-surgical) reduction of a nasal bone fracture where the treating physician manually manipulates the fractured segments back into acceptable alignment and applies stabilization — typically an external nasal splint, internal packing, or both — to hold the reduction. This distinguishes it from 21310 (without manipulation) and from open treatment codes that require incision.

The global period is 000, meaning all follow-up care beyond the day of the procedure is separately billable. That's a short window, so if you see the patient the next day for a splint check or packing removal, bill an appropriate E/M with modifier 24. Documentation must clearly establish that manipulation was performed — not just that a splint was applied — or payers will downcode to 21310.

Site of service matters significantly here. The HOPD and ASC facility payment rates differ substantially (see the Site of Service comparison table). Most straightforward cases are performed in the ED, office, or ASC. If the procedure is done under general anesthesia in a facility setting, confirm the anesthesia code matches the surgical CPT and that medical necessity for anesthesia is 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 (1.55) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (6.61) adds practice overhead and malpractice, and is what drives the Medicare payment below.

Work RVU	1.55
Practice expense RVU	4.83
Malpractice RVU	0.23
Total RVU	6.61
Medicare national rate	$220.78
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	$220.78
HOPD (APC 5164) Hospital outpatient department	$3,387.27
ASC (PI A2) Ambulatory surgical center (freestanding)	$1,480.50

Common denial reasons

The recurring reasons claims for CPT 21320 get rejected.

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

Downcode to 21310 when the note documents splint application but lacks an explicit statement that manipulation was performed
Medical necessity denial when imaging is absent or doesn't confirm a displaced fracture requiring reduction
Bundling denial when an E/M on the same date lacks modifier 25, particularly in ED or urgent care settings
Global period confusion — payers denying same-day or next-day E/M visits that are actually billable because the global is 000, not 010 or 090
Site-of-service mismatches when the place-of-service code doesn't align with the facility claim or the anesthesia documentation

Frequently asked questions

Source · Generated from the editorial pipeline, verified against 6 cited references ↓

01What's the difference between 21310 and 21320?

21310 is closed treatment without manipulation — the fracture is stable or minimally displaced and only stabilization is applied. 21320 requires documented manual manipulation to realign the fracture. If your note doesn't explicitly describe the reduction maneuver, expect a downcode to 21310.

02Can I bill a same-day E/M with 21320?

Yes, but append modifier 25 to the E/M. The E/M must be a separately identifiable service beyond the decision to treat the fracture — typically the initial evaluation establishing diagnosis and medical necessity. Modifier 57 is not appropriate here because 21320 carries a 000 global, not a major surgery global.

03What does the 000 global period mean for follow-up billing?

It means only the day of the procedure is included in the global package. Any visit after the procedure date — splint check, packing removal, re-evaluation — is separately billable with an appropriate E/M code. You do not need modifier 24 for those subsequent visits unless you're within the global of a different procedure performed the same day.

04Is modifier 50 appropriate for bilateral nasal fractures?

The nose is a midline structure, so bilateral billing with modifier 50 is rarely appropriate and payers routinely deny it. If the fracture complexity involves both nasal bones and significantly increases procedural work, modifier 22 with a supporting narrative is the more defensible approach. Confirm with your MAC before attempting bilateral reporting.

05When is modifier 22 justified for 21320?

Modifier 22 applies when the manipulation required substantially more work than typical — for example, severely comminuted or multiply displaced fragments, significant post-traumatic edema requiring multiple reduction attempts, or a previously fractured nose with scarring. Document the specific factors that increased time and intensity; a bare modifier 22 without a narrative will be ignored or denied.

06Does anesthesia type affect CPT code selection for 21320?

No — 21320 is the correct code regardless of whether the procedure is done under local, conscious sedation, or general anesthesia. Anesthesia type affects facility billing, the anesthesia CPT reported by the anesthesia provider, and medical necessity justification for the site of service, but not the surgical CPT itself.

Sources & references

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

Mira Scribe

Mira's AI scribe captures the physician's dictated description of manual manipulation technique, the type and duration of stabilization applied, anesthesia used, and post-reduction assessment — the specific documentation layer that separates 21320 from 21310. This prevents the most common denial pattern: a note that documents the splint but omits explicit language about fracture reduction, triggering an automatic downcode.

See how Mira captures CPT 21320 documentation