Closed treatment of a nasal septal fracture, with or without stabilization — no surgical opening of the fracture site.

Verified May 8, 2026 · 6 sources ↓

Medicare: $426.53
Work RVU: 3.31
Global, days: 90
Region: Other

Drawn from EntnetAAPCNIHBedrockbillingCgsmedicare

Documentation requirements

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

Source · Editorial brief grounded in 6 cited references ↓

Mechanism of injury and date of the acute trauma causing the septal fracture
Clinical or radiographic confirmation of nasal septal fracture — note whether imaging was obtained or diagnosis was clinical
Description of stabilization method used, or explicit notation that no stabilization was applied
Confirmation that the treatment was closed (no incision into the septum or nasal bone fracture site)
Fracture site and any associated nasal bone involvement documented separately to support or rule out concurrent nasal bone fracture codes

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 52 Reduced services 57 Decision for surgery 58 Staged or related 78 Unplanned return — related 79 Unrelated during global 80 Assistant surgeon AS PA/NP/CNS assistant

What this code covers

Source · Editorial summary grounded in 6 cited references ↓

CPT 21337 covers closed (non-operative) management of a nasal septal fracture. 'With or without stabilization' means the code applies whether or not a splint, packing, or other stabilizing device is placed — there is no separate code distinction based on that variable for the septal fracture. The 90-day global period is the critical billing context: the surgery day, the day-before visit, and all routine post-op care through day 90 are bundled. Anything unrelated billed in that window requires modifier 24 (E/M) or 79 (procedure).

Know where 21337 sits in the nasal fracture code family. It is the closed septal fracture code. If you're treating only the nasal bone closed, look at 21315 or 21320. If the procedure involves open treatment of the septum, 21336 (open, with or without stabilization) or 21335 (open nasal fracture with concomitant open septal treatment) applies instead. Billing 21337 for a procedure that involved any incision into the septum is a misuse of the code and an audit target.

Diagnosis coding should align to an acute or recent nasal septal fracture — ICD-10 S02.2 family codes. If the septum was fractured intentionally as part of another procedure (e.g., during balloon dilation or rhinoplasty), 21337 does not apply; those situations require the primary procedure code, and any fracture created is incidental to that work. Document clearly that the injury is traumatic and acute.

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 (3.31) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (12.77) adds practice overhead and malpractice, and is what drives the Medicare payment below.

Work RVU	3.31
Practice expense RVU	8.96
Malpractice RVU	0.5
Total RVU	12.77
Medicare national rate	$426.53
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	$426.53
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 21337 get rejected.

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

Code billed with a non-acute or chronic septal deviation diagnosis rather than an acute fracture ICD-10 code
Procedure note describes an incision or open approach, making 21336 or 21335 more appropriate than 21337
Fracture was iatrogenic (created during a separate procedure) rather than traumatic — payers deny 21337 when the operative note shows the fracture was intentionally created
Routine post-op visit billed separately without modifier 24 during the 90-day global period
Missing documentation of stabilization decision — no notation of what was or was not placed, triggering medical necessity review

Frequently asked questions

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

01Can 21337 and a nasal bone fracture code (21315 or 21320) be billed together on the same day?

NCCI edits govern this pairing. Check the NCCI PTP tool for the current edit status. When both a nasal bone fracture and a septal fracture are treated separately and distinctly in the same encounter, a modifier may allow separate billing — but documentation must show each fracture was independently managed, not that one code describes the same work twice.

02What is the global period for 21337?

90 days. The surgery day, the day-before pre-op visit, and all routine post-operative care through day 90 are bundled into the fee. Unrelated E/M visits need modifier 24; unrelated procedures need modifier 79.

03Does 21337 apply when a surgeon intentionally fractures the septum during a rhinoplasty or balloon dilation?

No. 21337 is for treatment of a traumatic acute fracture, not an iatrogenic one created as part of another procedure. Bill the primary procedure code. Stacking 21337 on top is a known audit trigger.

04What is the difference between 21336 and 21337?

21336 is open treatment of a nasal septal fracture; 21337 is closed. Both include 'with or without stabilization' in their descriptors. The approach — whether the fracture site was surgically opened — determines which code applies, not whether a splint or packing was placed.

05Is modifier 22 ever appropriate for 21337?

Yes, if the clinical circumstances significantly exceeded typical work — for example, a severely comminuted septal fracture requiring extended manipulation time or unusual complexity. Documentation must quantify why the work was substantially greater than usual; a vague operative note will not support the modifier and will draw scrutiny.

06What ICD-10 codes support 21337?

Acute nasal septal fracture codes within the S02.2 family are the appropriate diagnosis anchor. A chronic septal deviation or deflection (J34.2) does not support 21337 — that pairing is a near-certain denial.

Sources & references

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

Mira Scribe

Mira's AI scribe captures the mechanism of injury, confirms the approach as closed, records whether stabilization (packing, splint, or none) was applied, and pulls the acute fracture diagnosis from the clinical note. That specificity prevents the two most common 21337 denials: wrong ICD-10 (chronic deviation instead of acute fracture) and approach mismatch (closed billed when the note implies open access).

See how Mira captures CPT 21337 documentation