Open surgical treatment of a nasal bone fracture with application of skeletal fixation hardware to stabilize the fracture site.

Verified May 8, 2026 · 6 sources ↓

Medicare: $490.33
Work RVU: 5.65
Global, days: 90
Region: Other

Drawn from CMSAAOSBedrockbilling

Documentation requirements

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

Source · Editorial brief grounded in 6 cited references ↓

Explicit documentation of a surgical incision to expose the nasal fracture site — not just instrument manipulation through the nares
Identification of the specific skeletal fixation device used (plates, screws, wires) and anatomic placement site
Pre-operative imaging (CT or plain films) confirming displaced nasal fracture warranting open fixation
Operative note must distinguish this from a combined nasal/septal fracture, which codes separately to 21335
If modifier 22 is appended, document specific factors increasing operative complexity — comminution, prior repair, or significant soft tissue involvement

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 58 Staged or related 78 Unplanned return — related 79 Unrelated during global 80 Assistant surgeon LT Left side RT Right side

What this code covers

Source · Editorial summary grounded in 6 cited references ↓

CPT 21330 covers open reduction of a nasal fracture where the surgeon makes an incision to directly access the fracture site, reduces the displaced bone segments, and applies internal fixation — plates, screws, or wires — to hold the nasal bones in anatomic position during healing. This distinguishes it from 21325 (open, uncomplicated, no fixation) and from closed approaches (21315, 21320). The skeletal fixation component is the defining criterion: if no hardware is placed, 21330 is not the right code.

The 90-day global period means all routine post-op visits, wound checks, and hardware-related follow-up through day 90 are bundled. Anything unrelated to the nasal fracture repair — say, a concurrent sinus issue — requires modifier 24 on E/M services billed in that window. If the same surgeon later removes hardware that was causing problems, that's a related return to the OR and bills with modifier 78.

Code selection between 21325, 21330, and 21335 (nasal plus septal fracture) is a frequent audit trigger. The operative note must document both the open approach and the specific fixation method used. Notes that describe blunt instrument manipulation without incision — regardless of how the surgeon characterizes the approach — don't support 21330.

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 (5.65) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (14.68) adds practice overhead and malpractice, and is what drives the Medicare payment below.

Work RVU	5.65
Practice expense RVU	8.2
Malpractice RVU	0.83
Total RVU	14.68
Medicare national rate	$490.33
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	$490.33
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 21330 get rejected.

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

Operative note describes closed or percutaneous manipulation only — insufficient to support the open approach required by 21330
No documentation of skeletal fixation hardware; procedure downcoded to 21325 (open, uncomplicated)
Unbundling 21330 with 21336 or 30520 without adequate documentation that each procedure addressed a distinct, separately identifiable injury or site
Billing 21330 for a combined nasal and septal fracture repair that should be coded to 21335
Missing pre-op imaging or inadequate diagnosis linking the documented fracture to the open fixation approach

Frequently asked questions

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

01What separates 21330 from 21325?

21325 is open treatment without skeletal fixation. 21330 requires hardware — plates, screws, or wires applied to the nasal bones. If the surgeon opens the site but relies on external splinting alone, use 21325.

02Can 21330 and 21336 (open septal fracture) be billed together?

Only if the nasal and septal fractures are clearly documented as separate injuries requiring separate open procedures. In many cases the correct single code is 21335 (open treatment of nasal and septal fractures). Check NCCI edits before billing both.

03Can 21330 be billed with 30520 (septoplasty) on the same date?

NCCI edits bundle these. Separate billing requires modifier 59 or an XS modifier with documentation that the septoplasty addressed a distinct, pre-existing condition unrelated to the acute fracture — a high audit risk that demands solid medical record support.

04What modifier applies if the surgeon returns to the OR to remove the fixation hardware within the 90-day global?

Modifier 78 — an unplanned return to the OR for a complication or issue related to the original procedure. If hardware removal was pre-planned and staged, use modifier 58.

05Is 21330 subject to a 90-day global period?

Yes. The 90-day global bundles all routine post-op visits through day 90. Use modifier 24 on any E/M for unrelated problems billed during that window, with documentation clearly distinguishing the unrelated condition.

06Does the site of service affect reimbursement for 21330?

Yes. HOPD and ASC payments differ significantly from the physician fee schedule facility rate. The surgeon's professional fee is the same regardless of setting, but the facility component varies — see the Site of Service comparison table.

Sources & references

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

Mira Scribe

Mira's AI scribe captures the surgical approach (open incision vs. instrument-only manipulation), the fixation hardware type and placement site, and the specific nasal bones reduced — details that distinguish 21330 from 21325 and prevent downcoding audits. It also flags when a septal fracture is addressed in the same session, prompting the coder to evaluate 21335 instead.

See how Mira captures CPT 21330 documentation