Surgical realignment of an uncomplicated nasal fracture performed through an open incision, restoring bony alignment without the complexity requiring internal or external skeletal fixation.

Verified May 8, 2026 · 6 sources ↓

Medicare: $413.50
Work RVU: 4.08
Global, days: 90
Region: Other

Drawn from AAPCEntnetFindacodeMdclarityCMS

Documentation requirements

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

Source · Editorial brief grounded in 6 cited references ↓

Specify that the fracture is acute, not healed or old — date of injury must appear in the operative note
Document the open surgical approach explicitly, including incision location and direct visualization of nasal bones
Confirm no internal or external skeletal fixation was used — if fixation is applied, 21325 is the wrong code
Record the displacement pattern and alignment achieved post-reduction, including any intraoperative imaging used
If septum was addressed, document whether it involved a concurrent open septal fracture or a separate pathology, as this determines code selection

Applicable modifiers

Modifiers commonly billed with this code.

Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual

22 Increased complexity 51 Multiple procedures 52 Reduced services 59 Distinct service 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 21325 covers open reduction of an uncomplicated nasal fracture — meaning the surgeon makes an incision to directly visualize and reposition displaced nasal bones without requiring internal or external fixation hardware. The 090-day global period means all routine follow-up through day 90 is bundled; anything unrelated to the fracture in that window needs modifier 24 or 25.

Code selection within the nasal fracture family hinges on complexity. Use 21325 for uncomplicated open cases; step up to 21330 when internal or external skeletal fixation is required, or 21335 when the surgeon simultaneously addresses an open septal fracture. Closed reductions go to 21315 or 21320 depending on whether stabilization is used — both carry 010-day globals. Use 21325 only for acute fractures; healed or old nasal deformities belong under rhinoplasty codes (e.g., 30420).

A critical NCCI bundling rule: 21325 is a Column 2 code to 30520 (septoplasty). No modifier breaks that edit. If septoplasty is the more extensive service performed, report 30520 only. Attempting to bill both will result in denial of 21325 regardless of payer.

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 (4.08) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (12.38) adds practice overhead and malpractice, and is what drives the Medicare payment below.

Work RVU	4.08
Practice expense RVU	7.71
Malpractice RVU	0.59
Total RVU	12.38
Medicare national rate	$413.50
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	$413.50
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 21325 get rejected.

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

21325 billed same-day as 30520 (septoplasty) — NCCI bundles 21325 as Column 2; no modifier override is allowed
Code used for a healed or chronic nasal deformity rather than an acute fracture — rhinoplasty codes apply instead
Insufficient documentation of open approach — notes that reference 'nasal reduction' without specifying incision and direct bone visualization will be flagged
Global period violation — E/M or related services billed during the 90-day global without modifier 24 or 25

Frequently asked questions

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

01Can I bill 21325 and 30520 together with modifier 59?

No. NCCI lists 21325 as a Column 2 code to 30520, and no modifier is permitted to unbundle the pair. If septoplasty is the more extensive service, report 30520 only and drop 21325.

02What's the difference between 21325 and 21330?

21325 is for uncomplicated open nasal fracture reduction with no fixation. 21330 applies when internal and/or external skeletal fixation is used during the open repair. Using 21325 when fixation was placed is an undercoding error.

03Can 21325 be used for an old or healed nasal fracture?

No. 21325 is appropriate only for acute fractures. A healed nasal deformity treated surgically should be coded with the appropriate rhinoplasty code, such as 30420, even if the original injury involved a fracture.

04What global period applies to 21325, and what does it include?

21325 carries a 90-day global period. That covers the day before surgery, the operative day, and all routine post-op visits through day 90. Unrelated E/M services in that window require modifier 24; related E/M on the same day as surgery requires modifier 25 if billed pre-operatively.

05When is modifier 22 appropriate for 21325?

Use modifier 22 when documented intraoperative complexity substantially exceeds the typical uncomplicated open nasal fracture — for example, severe comminution requiring extensive manipulation beyond routine reduction. The operative note must explicitly support the increased work; a vague reference to 'difficult case' will not survive audit.

06Should I use 21325 or 21335 when the nasal septum is also fractured and treated open?

If the surgeon performs open treatment of both the nasal fracture and a fractured septum during the same session, report 21335 — not 21325 plus a separate septal code. 21335 is the specific code for that combined scenario.

Sources & references

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

Mira Scribe

Mira's AI scribe captures the injury date, fracture acuity, open approach details, incision location, absence of fixation hardware, and post-reduction alignment from dictation — the exact elements auditors check to confirm 21325 over a rhinoplasty code and to defend against NCCI bundling challenges with 30520.

See how Mira captures CPT 21325 documentation