Surgical removal of the first rib and/or a cervical rib, typically performed to decompress the thoracic outlet.

Verified May 8, 2026 · 7 sources ↓

Medicare: $582.51
Work RVU: 10.19
Global, days: 90
Region: Other

Drawn from CMSAAPCNIHCgsmedicareGenhealth

Documentation requirements

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

Source · Editorial brief grounded in 7 cited references ↓

Specify which rib(s) excised: first rib, cervical rib, or both — vague operative notes are an audit target.
Document the surgical approach by name (transaxillary, supraclavicular, posterior thoracotomy) — 'standard approach' is insufficient.
Record the clinical indication driving resection (e.g., neurogenic TOS, vascular TOS, arterial compression) with supporting imaging referenced.
Note neurovascular structures identified and preserved intraoperatively, particularly subclavian vessels and brachial plexus.
Document laterality explicitly (left or right) to support LT or RT modifier assignment.
Include preoperative imaging reports (X-ray, MRI, CT, or vascular studies) confirming rib anomaly or compression.
If concurrent scalenectomy performed, document it as a distinct element to support separate coding of 21700 or 21705.

Applicable modifiers

Modifiers commonly billed with this code.

Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual

22 Increased complexity 50 Bilateral procedure 51 Multiple procedures 59 Distinct service 62 Co-surgeons 76 Repeat, same physician 77 Repeat, another physician 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 7 cited references ↓

CPT 21615 covers excision of the first rib, a cervical rib, or both when they cause neurovascular compression — most commonly in thoracic outlet syndrome (TOS). The surgeon accesses the rib through a transaxillary or supraclavicular incision, dissects surrounding musculature and neurovascular structures, and resects the offending rib. Operative time averages over three hours when rib resection is combined with scalenectomy, and hospital stays typically run two to four days.

This code covers rib resection alone. If the surgeon also performs an anterior scalenectomy without cervical rib involvement, add 21700. If the scalenectomy addresses a cervical rib, use 21705 instead. When both first rib resection (21615) and anterior scalenectomy (21700) are performed together, both codes are reportable — confirm NCCI edits at the time of billing. The 90-day global period covers all routine post-op care; unrelated services in that window require modifier 79, and complications requiring a return to the OR require modifier 78.

The procedure carries a 90-day global period and a total RVU value of 17.44 under the CMS Physician Fee Schedule 2026. HOPD and ASC payment differentials are significant — see the Site of Service comparison on this page. Laterality modifiers LT and RT are routinely expected; bilateral performance in one session is anatomically rare but would require modifier 50 with documentation justifying the medical necessity.

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 (10.19) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (17.44) adds practice overhead and malpractice, and is what drives the Medicare payment below.

Work RVU	10.19
Practice expense RVU	4.71
Malpractice RVU	2.54
Total RVU	17.44
Medicare national rate	$582.51
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	$582.51
HOPD (APC 5114) Hospital outpatient department	$7,413.38
ASC (PI G2) Ambulatory surgical center (freestanding)	$3,695.53

Common denial reasons

The recurring reasons claims for CPT 21615 get rejected.

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

Missing or ambiguous laterality — claim submitted without LT or RT modifier, triggering payer edits.
Medical necessity not established — no documented imaging or clinical findings confirming thoracic outlet compression prior to surgery.
NCCI bundling conflict when 21615 is billed same-day with scalenectomy codes (21700/21705) without verifying modifier allowance.
Insufficient operative note detail — failure to name the approach or confirm which rib was resected leads to downcoding or denial on audit.
Global period violations — post-op E/M visits billed within the 90-day global without modifier 24 for unrelated conditions.

Frequently asked questions

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

01What's the difference between CPT 21615 and 21616?

21615 covers excision of the first and/or cervical rib alone. 21616 adds a sympathectomy to that resection. If the operative note documents sympathectomy, 21616 is the correct code — don't bill 21615 with a separate sympathectomy code.

02Can I bill 21615 and 21700 together for rib resection plus scalenectomy?

Yes, when both procedures are performed and documented as distinct components of the operation. Verify the current NCCI PTP edit status for this pair before submitting, and apply modifier 59 or an X-modifier if required by the edit's modifier indicator.

03Which laterality modifier is required — LT, RT, or 50?

Bill LT or RT for a unilateral procedure. Modifier 50 applies only if both sides are resected in the same operative session, which is anatomically rare in TOS surgery. Most payers expect laterality on every claim for this code.

04What ICD-10 diagnoses support medical necessity for 21615?

Thoracic outlet syndrome (G54.0) is the primary driver. Cervical rib anomaly (Q76.5) and vascular compression diagnoses are also used. Payers routinely require documented failure of conservative treatment prior to authorizing surgical resection.

05Does the 90-day global include the post-op PT visits ordered after rib resection?

No. Physical therapy billed under a PT's NPI is not part of the surgical global. Only services billed by the operating surgeon (or their group) for routine post-op care fall inside the global. PT is billed separately regardless of timing.

06When is modifier 22 appropriate for 21615?

Use modifier 22 when the resection required substantially more work than typical — for example, dense adhesions from prior surgery, anomalous vascular anatomy, or intraoperative complication management that significantly extended operative time. Document the specific factors and time increase in the operative note; payers will request records.

07Is 21615 typically performed inpatient or outpatient, and does that affect payment?

Most cases are performed in an inpatient or on-campus outpatient hospital setting given the complexity and average 1–3 day hospital stay. The site of service significantly affects payment — HOPD and ASC facility rates differ substantially. See the Site of Service comparison on this page for current figures.

Sources & references

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

Mira Scribe

Mira's AI scribe captures the rib(s) resected (first, cervical, or both), named surgical approach, laterality, and neurovascular structures identified intraoperatively from dictation. It flags when the operative note lacks explicit rib identification or approach nomenclature — the two documentation gaps most likely to trigger an audit or medical necessity denial. If a concurrent scalenectomy is dictated, the scribe surfaces the appropriate companion code for coder review.

See how Mira captures CPT 21615 documentation