Percutaneous treatment of a nasoethmoid complex fracture using splint, wire, or headcap fixation, including repair of the canthal ligaments and/or nasolacrimal apparatus as needed.

Verified May 8, 2026 · 6 sources ↓

Medicare: $660.00
Work RVU: 11.2
Global, days: 90
Region: Other

Drawn from CMSBedrockbillingAaomsFastrvuEmedny

Documentation requirements

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

Source · Editorial brief grounded in 6 cited references ↓

Specify the fixation method used: splint, wire, or headcap — not just 'external fixation'
Document whether canthal ligament repair and/or nasolacrimal apparatus repair was performed, since both are included in the code scope
CT imaging confirming nasoethmoid complex fracture with sufficient detail to justify percutaneous approach over open treatment
Operative note must describe percutaneous technique explicitly; notes that only reference 'fracture repair' without approach detail are audit targets
If modifier 22 is appended, include a narrative quantifying additional time, complexity, or anatomical factors beyond typical nasoethmoid repair
For same-session facial fracture repairs, document each fracture site separately and confirm medical necessity for each procedure billed

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 50 Bilateral procedure 51 Multiple procedures 52 Reduced services 57 Decision for surgery 58 Staged or related 59 Distinct service 62 Co-surgeons 78 Unplanned return — related 79 Unrelated during global 80 Assistant surgeon AS PA/NP/CNS assistant LT Left side RT Right side

What this code covers

Source · Editorial summary grounded in 6 cited references ↓

CPT 21340 covers the minimally invasive, percutaneous repair of a nasoethmoid complex fracture — the zone where the nasal bones meet the ethmoid, between the orbits. The procedure uses external stabilization (splint, wire, or headcap fixation) rather than open exposure, and explicitly includes repair of the medial canthal ligaments and nasolacrimal apparatus when performed. That bundled scope matters: you cannot separately bill canthal ligament repair or nasolacrimal repair when reported with 21340.

The 90-day global period runs from the day of surgery and absorbs all routine postoperative care. Unrelated E/M visits within that window require modifier 24; a separately identifiable E/M on the day of surgery requires modifier 25. If a concomitant open nasoethmoid procedure is performed at the same session, check NCCI edits carefully — 21340 has over 1,000 CCI edit pairs, with 1,048 instances as the column 1 (dominant) code.

When multiple facial fractures are repaired in the same session, list 21340 first if it carries the highest RVU, append modifier 51 to secondary procedure codes, and verify each pairing against NCCI. If an NCCI edit prohibits unbundling, consider modifier 22 with a supporting operative narrative instead of appending modifier 59. Modifier 50 applicability for bilateral repair should be confirmed with the specific payer before billing — Medicare rules on bilateral payment adjustments apply, and some payers require LT/RT instead.

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 (11.2) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (19.76) adds practice overhead and malpractice, and is what drives the Medicare payment below.

Work RVU	11.2
Practice expense RVU	6.93
Malpractice RVU	1.63
Total RVU	19.76
Medicare national rate	$660.00
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	$660.00
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 21340 get rejected.

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

Unbundling denial when canthal ligament or nasolacrimal repair is billed separately — both are included in 21340
NCCI edit conflict when 21340 is billed alongside a column 2 code without a valid modifier or supporting documentation
Missing or insufficient CT imaging documentation to substantiate fracture diagnosis and need for surgical intervention
Global period violation when routine post-op visits are billed without modifier 24 within the 90-day window
Modifier 22 denied due to absence of operative narrative explaining the increased work above typical procedure

Frequently asked questions

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

01Can I bill separately for canthal ligament repair when performing 21340?

No. Repair of the canthal ligaments and nasolacrimal apparatus is included in the 21340 code descriptor. Billing those separately will trigger an NCCI bundling denial.

02What is the global period for 21340?

90 days. The global covers the day-before preoperative visit, the surgery day, and all routine postoperative care through day 90. Unrelated services in that window need modifier 24 or 25.

03How does 21340 differ from 21338 and 21339?

21338 is open treatment without external fixation; 21339 is open treatment with external fixation; 21340 is the percutaneous approach with splint, wire, or headcap fixation. Approach and fixation method drive the code selection.

04When is modifier 22 appropriate for 21340?

Use modifier 22 when documented factors — comminuted fracture pattern, prior surgery, excessive bleeding, anatomical complexity — required substantially more physician work than a standard nasoethmoid repair. Include a written narrative with the claim; payers routinely deny modifier 22 without one.

05Can 21340 be billed bilaterally with modifier 50?

Confirm with the payer first. Medicare applies bilateral payment adjustments, and some payers require LT/RT modifiers on separate lines instead of modifier 50 on a single line. Do not assume bilateral reporting rules are uniform across payers.

06What happens when 21340 is billed with other facial fracture codes in the same session?

List 21340 first if it has the highest RVU. Append modifier 51 to secondary procedure codes. Check each code pair against NCCI — 21340 is the column 1 dominant code in over 1,000 CCI edits. If an edit cannot be bypassed with modifier 59, consider modifier 22 with a supporting narrative instead.

Sources & references

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

Mira Scribe

Mira's AI scribe captures the fixation method (splint, wire, or headcap), documents whether canthal ligament repair or nasolacrimal apparatus repair was performed, and records the percutaneous approach explicitly from surgeon dictation. This prevents the most common audit flag — operative notes that omit approach details or fail to account for bundled anatomical repairs — and supports modifier 22 if increased complexity is dictated.

See how Mira captures CPT 21340 documentation