Radical resection of the sternum — complete surgical removal of the breastbone, typically for malignancy, refractory infection, or severe trauma, often requiring chest wall reconstruction.
Verified May 8, 2026 · 5 sources ↓
- Medicare
- $1,170.70
- Total RVUs
- 35.05
- 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 ↓
- Operative report must name the specific indication — malignancy (with tumor type/stage), infection, or trauma — not just 'sternal pathology'
- Extent of resection documented explicitly: full sternal body, manubrium, xiphoid involvement, and any involved adjacent structures (ribs, cartilage, muscle)
- Reconstruction method described in detail: type of mesh, use of methyl methacrylate or titanium, flap source and harvest if applicable
- If concurrent rib resection was performed, number and laterality of ribs must be documented to support separate coding of those procedures
- Pathology specimen submission documented — permanent or frozen section, and whether intraoperative margins were assessed
- Pre-operative imaging (CT or PET) referenced in the note to establish disease extent and justify radical vs. partial approach
- If a co-surgeon participated, each surgeon's distinct and separable role must be documented to support modifier 62
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 21630 covers radical resection of the entire sternum. The procedure involves en bloc removal of the sternum along with involved soft tissue, portions of the pectoralis major, and the cartilaginous ends of the first several ribs as dictated by the extent of disease. Indications are most commonly sternal malignancy (primary sarcoma or metastatic disease), deep sternal wound infection unresponsive to debridement, or catastrophic trauma. Chest wall reconstruction — whether using synthetic mesh, methyl methacrylate composite, titanium plates, or autologous tissue flaps — is typically required to restore structural integrity.
When mediastinal lymphadenectomy is also performed, report 21632 instead of 21630. If a separately identifiable reconstructive procedure is performed by a different surgeon or requires distinct documentation of additional work, modifier 22 or co-surgery modifier 62 may apply. Do not separately report surgical access, exploratory incision, or biopsy used to confirm resectability — those are bundled per NCCI general policy. The 90-day global period covers all routine postoperative management; unrelated E/M services in that window need modifier 24.
This is a high-complexity, low-volume code almost exclusively performed in a hospital operating room. It does not appear in the ASC setting as a typical case despite an ASC payment rate existing in the fee schedule. Documentation requirements are extensive, and audit scrutiny is elevated given the RVU weight and the frequency of concurrent procedures (rib resections, flap reconstructions) that must each be independently supported in the operative report.
RVU & reimbursement
Component RVUs and Medicare national rate. Actual payment varies by GPCI locality.
Source · CMS Physician Fee Schedule, RVU26A · January 2026
| Work RVU | 18.7 |
| Practice expense RVU | 12.88 |
| Malpractice RVU | 3.47 |
| Total RVU | 35.05 |
| Medicare national rate | $1,170.70 |
| 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 | $1,170.70 |
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 21630 get rejected.
Source · Editorial brief grounded in CMS NCCI edits, AAOS coding appeals, and cited references ↓
- Operative note uses vague language like 'standard sternal resection' without documenting radical extent — payers downcode to 21620 (partial ostectomy)
- Concurrent rib resection or chest wall tumor excision billed without documentation establishing each as a separately identifiable procedure beyond the primary resection
- Modifier 22 appended without a cover letter quantifying increased time, complexity, or unusual anatomic findings — routinely denied without supporting documentation
- Biopsy reported separately when it was performed solely to confirm resectability rather than resulting in an immediate decision to proceed with a more extensive procedure
- Post-op E/M visits billed within the 90-day global without modifier 24, triggering automatic denial for unrelated visit claims missing the modifier
- Medical necessity not established when ICD-10 diagnosis code does not reflect malignancy, infection, or documented structural failure requiring radical approach
Frequently asked questions
Source · Generated from the editorial pipeline, verified against 5 cited references ↓
01When do I bill 21630 vs. 21632?
02Can I separately bill rib resections performed during the same case?
03Does 21630 include chest wall reconstruction?
04What modifier applies when two surgeons each perform distinct portions of the case?
05Is a pre-operative biopsy separately billable on the same date as 21630?
06What global period applies and how does it affect post-op care billing?
07Does modifier 50 (bilateral) ever apply to 21630?
Sources & references
Editorial content was developed using the following public sources. Last verified May 8, 2026.
- 01CMS Physician Fee Schedule 2026
- 02cms.govhttps://www.cms.gov/files/document/chapter1generalcorrectcodingpoliciesfinal11.pdf
- 03emedny.orghttps://www.emedny.org/ProviderManuals/Physician/PDFS/Physician_Procedure_Codes_Sect5_2021-4.pdf
- 04aapc.comhttps://www.aapc.com/discuss/threads/sternum-reconstruction.181193/
- 05genhealth.aihttps://genhealth.ai/code/cpt4/21630-radical-resection-of-sternum
Mira AI Scribe
Mira's AI scribe captures the surgical indication (tumor histology, infection severity, or trauma classification), the full extent of sternal resection including adjacent structures removed, reconstruction technique and materials used, and each surgeon's distinct operative role if co-surgery applies. That prevents the most common audit flag: an operative note that documents removal but not radical extent, which causes payers to downcode to the partial ostectomy code 21620.
See how Mira captures CPT 21630 documentation