Open surgical repair of a complex frontal sinus fracture, accessed through coronal or scalp incisions, typically involving comminuted or displaced bone requiring internal fixation.

Verified May 8, 2026 · 7 sources ↓

Medicare: $1,215.46
Total RVUs: 36.39
Global, days: 90
Region: Other

Drawn from CMSAaomsAAPCMdclarity

Documentation requirements

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

Source · Editorial brief grounded in 7 cited references ↓

Operative note must document the specific approach by name (e.g., coronal, bicoronal) — 'standard incision' will flag on audit
Describe complexity indicators: degree of comminution, number of fragments, posterior table involvement, and whether sinus obliteration was performed
Internal fixation details: type of hardware used (plates, screws, bone cement), number and anatomic placement
Imaging correlation: pre-operative CT scan findings documenting fracture pattern and complexity must be referenced in the operative note
If co-surgery with neurosurgery or plastics, each surgeon's distinct roles and operative contributions must be separately documented
Inpatient admission documentation required — 21344 is inpatient-only under Medicare; outpatient or ASC setting is not payable

Applicable modifiers

Modifiers commonly billed with this code.

Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual

22 Increased complexity 51 Multiple procedures 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

What this code covers

Source · Editorial summary grounded in 7 cited references ↓

CPT 21344 covers open treatment of a complex frontal sinus fracture — the kind that can't be managed percutaneously or through limited approaches. Access is typically gained through a coronal incision, allowing direct visualization and fixation of comminuted or severely displaced anterior and/or posterior table fragments. The complexity distinguishing 21344 from 21343 (open treatment, simple frontal sinus fracture) lies in the extent of fragmentation, involvement of posterior table structures, or the degree of sinus obliteration required.

This code carries a 90-day global period. All routine post-operative care through day 90 is bundled — separate E/M visits during that window require modifier 24 for unrelated problems. If a same-day decision for surgery is made during an E/M visit, attach modifier 57 to that E/M. CMS has assigned 21344 inpatient-only status (Status Indicator C), meaning it is not payable in the hospital outpatient or ASC setting under Medicare — the procedure must be performed in an inpatient hospital setting.

Because this is a craniofacial procedure, co-surgery with neurosurgery or plastic surgery is common. When two surgeons each perform a distinct portion of the procedure, modifier 62 applies to both claims. If an NCCI edit prevents separate reporting of a concurrent procedure at the same anatomical region, consider modifier 59 only when clinical documentation clearly supports a distinct procedural service. Per NCCI Chapter 4, if a closed reduction attempt is converted to open treatment at the same encounter, only 21344 (the more extensive procedure) is reportable.

RVU & reimbursement

Component RVUs and Medicare national rate. Actual payment varies by GPCI locality.

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	21.03
Practice expense RVU	12.31
Malpractice RVU	3.05
Total RVU	36.39
Medicare national rate	$1,215.46
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	$1,215.46
HOPD (APC 5165) Hospital outpatient department	$6,048.05
ASC (PI G2) Ambulatory surgical center (freestanding)	$3,025.62

Common denial reasons

The recurring reasons claims for CPT 21344 get rejected.

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

Site-of-service mismatch: CMS will not pay 21344 in an outpatient hospital or ASC setting — inpatient admission is required
Insufficient complexity documented to distinguish from 21343 (simple frontal sinus fracture, open treatment)
Bundling conflict when a concurrent craniofacial procedure is billed without appropriate modifier to bypass the NCCI edit
Missing or inadequate operative note — audit teams specifically flag notes that lack fracture complexity description or approach specificity
Modifier 62 co-surgery claim denied because each surgeon's distinct operative role was not separately documented in their own operative report

Frequently asked questions

Source · Generated from the editorial pipeline, verified against 7 cited references ↓

01What makes a frontal sinus fracture 'complex' enough to bill 21344 instead of 21343?

Complexity typically means comminuted or multi-fragment fractures, posterior table involvement, dural exposure risk, or requirement for sinus obliteration/cranialization. Document each of these elements explicitly — payers differentiate 21343 from 21344 on operative note content, not diagnosis code alone.

02Can 21344 be performed in an ASC or outpatient hospital setting under Medicare?

No. CMS assigns 21344 inpatient-only status (Status Indicator C). Medicare will not reimburse this code in the ASC or HOPD setting. The patient must be admitted as an inpatient. Verify commercial payer policies separately, as they may differ.

03When does modifier 62 apply for co-surgery on a frontal sinus fracture?

Use modifier 62 when two surgeons of different specialties — such as neurosurgery and craniofacial surgery — each perform a distinct, necessary portion of the same procedure. Both surgeons append modifier 62 to 21344 on their respective claims, and each must document their individual operative contributions.

04If a closed reduction is attempted first and then converted to open treatment, can both be billed?

No. Per NCCI Chapter 4, if a closed or percutaneous approach is converted to open treatment at the same encounter, only the more extensive open procedure (21344) is reportable. Do not bill the failed closed attempt separately.

05What modifier applies to a post-operative E/M visit unrelated to the frontal sinus fracture during the 90-day global?

Use modifier 24 on the E/M code. The documentation must clearly establish that the visit was for a condition unrelated to the frontal sinus fracture repair. Routine post-op care is bundled and not separately billable through day 90.

06When should modifier 22 be used with 21344?

Append modifier 22 when documented intraoperative complexity — such as unusual fragmentation, dural laceration management, or extreme surgical time — substantially exceeds typical work. Submit a cover letter with operative note detail supporting the additional effort; expect manual review and potential payer audit.

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 surgical approach (coronal/bicoronal), fracture complexity descriptors (comminution, fragment count, posterior table involvement), fixation method and hardware type, and whether sinus obliteration was performed. This prevents the most common audit flag for 21344 — operative notes that document only the fracture site without the complexity elements needed to justify this code over 21343.

See how Mira captures CPT 21344 documentation