Open surgical repair of a fractured nose involving both the nasal bones and the nasal septum
Verified May 8, 2026 · 5 sources ↓
- Medicare
- $648.98
- Work RVU
- 8.79
- Global, days
- 90
- 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 ↓
- Specify that an open approach was used — 'open reduction' or 'direct exposure of nasal bones and septum' — not just 'nasal fracture repair'
- Document both the nasal bone fracture and the septal fracture/dislocation as distinct findings, with imaging or intraoperative confirmation of each
- Record the mechanism and timing of injury to support fracture diagnosis and medical necessity for open (vs. closed) treatment
- Describe septal findings in detail: deviation, dislocation, cartilage fracture, or hematoma, and the specific repair technique performed
- If 30140 or 30420 is billed concurrently, include a separate operative note paragraph documenting the independent medical necessity and distinct work of each procedure
- Note any complicating factors (prior nasal surgery, comminution, delayed presentation) that would support modifier 22 if appended
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 21335 covers open operative treatment of a combined nasal and septal fracture — meaning the surgeon directly exposes and reduces the fractured nasal bones and repairs the deviated or disrupted septum through an open approach, as opposed to closed (21310–21320) or minimally open nasal-only repair (21330).
The 90-day global period applies. That window covers the day-before and day-of surgery plus all routine post-op visits, nasal packing removal, and splint care through day 90. Any evaluation for a new or unrelated condition during the global requires modifier 24 (E/M) or 25 (same-day E/M before procedure). A return to the OR for a complication during the global — infection, septal hematoma, persistent deformity — uses modifier 78 if related or modifier 79 if unrelated.
The most common NCCI bundling conflict is with 30140 (submucous resection). When both are performed and separately reportable, modifier 59 (or its X-subset) on 30140 is the standard approach, but commercial carriers vary on whether they accept the override — verify before filing. Likewise, 30420 (rhinoplasty with internal nasal work) triggers column 1/column 2 edits when billed same-session; document distinctly why each service was independently necessary.
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 (8.79) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (19.43) adds practice overhead and malpractice, and is what drives the Medicare payment below.
| Work RVU | 8.79 |
| Practice expense RVU | 9.31 |
| Malpractice RVU | 1.33 |
| Total RVU | 19.43 |
| Medicare national rate | $648.98 |
| 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 | $648.98 |
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 21335 get rejected.
Source · Editorial brief grounded in CMS NCCI edits, AAOS coding appeals, and cited references ↓
- Operative note describes 'nasal fracture repair' without clearly distinguishing open technique or septal involvement, causing downcode to 21320 or 21330
- NCCI edit fires on same-session 30140 (submucous resection) without modifier 59 or XS to establish distinct procedural service
- Payer bundles 21335 into a same-session rhinoplasty code (30400–30420) when documentation doesn't support separate distinct work
- Missing imaging or intraoperative description confirming septal fracture, leading payer to deny the higher-complexity code in favor of nasal-bone-only repair
- Claim filed during another surgeon's global period without appropriate modifier, triggering global period denial
Frequently asked questions
Source · Generated from the editorial pipeline, verified against 5 cited references ↓
01What's the difference between 21330 and 21335?
02Can 21335 and 30140 be billed together?
03Does modifier 50 apply to 21335?
04What global period applies and what does it cover?
05When is modifier 22 appropriate for 21335?
06How does site of service affect reimbursement for 21335?
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 operative approach (open), specific nasal bone and septal findings, repair technique for each structure, and any complicating factors from dictation — locking in the documentation needed to defend 21335 over a closed-reduction code and to support modifier 22 when complexity warrants it. This prevents the most common downcode scenario: a vague operative note that doesn't explicitly document open exposure of both the nasal bones and the septum.
See how Mira captures CPT 21335 documentation