Closed treatment of a sternal fracture without surgical intervention, relying on physical stabilization and pain management to allow natural bone healing.

Verified May 8, 2026 · 5 sources ↓

Medicare: $179.70
Work RVU: 1.33
Global, days: 90
Region: Other

Drawn from CMSAAPCAaoms

Documentation requirements

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

Source · Editorial brief grounded in 5 cited references ↓

Mechanism of injury and trauma history supporting a non-surgical sternal fracture diagnosis
Imaging report (X-ray or CT) confirming fracture location, displacement status, and absence of operative indication
Fracture management plan including pain control regimen and stabilization method (e.g., chest binder/wrap)
Explicit documentation that closed treatment — not open reduction or surgical fixation — was performed
Follow-up plan with monitoring schedule and activity restrictions noted in the record
Confirmation that sternotomy was NOT the access method; if post-cardiothoracic, 21820 cannot be 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 52 Reduced services 57 Decision for surgery 58 Staged or related 59 Distinct service 76 Repeat, same physician 77 Repeat, another physician 78 Unplanned return — related 79 Unrelated during global 80 Assistant surgeon

What this code covers

Source · Editorial summary grounded in 5 cited references ↓

CPT 21820 covers nonsurgical management of a sternum fracture. The treating physician assesses fracture severity, initiates pain control, and may apply a chest binder or wrap for stabilization. No incision, fixation hardware, or anesthesia is required. Follow-up imaging and clinical monitoring are part of the global period care.

The 90-day global period includes the day-before visit, the treatment encounter, and all routine follow-up through day 90. Any E/M visit for an unrelated condition during that window requires modifier 24. A new and unrelated procedure requires modifier 79. Do not bill casting or strapping codes separately — NCCI policy folds initial immobilization into the fracture care code.

Critical exclusion: 21820 cannot be reported when a sternotomy was performed as access for a cardiothoracic procedure. Per the CMS NCCI 2026 Policy Manual Chapter 5, codes 21820–21825 are expressly prohibited as a way to bill repair of a surgical sternotomy. If a median sternotomy incision is the mechanism, the repair is bundled into the cardiothoracic procedure and is not separately 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 vs. total RVU

The work RVU (1.33) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (5.38) adds practice overhead and malpractice, and is what drives the Medicare payment below.

Work RVU	1.33
Practice expense RVU	3.76
Malpractice RVU	0.29
Total RVU	5.38
Medicare national rate	$179.70
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	$179.70
HOPD (APC 5111) Hospital outpatient department	$252.01
ASC (PI A2) Ambulatory surgical center (freestanding)	$135.54

Common denial reasons

The recurring reasons claims for CPT 21820 get rejected.

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

Code billed after median sternotomy for a cardiothoracic procedure — expressly excluded by NCCI 2026 Chapter 5
Casting or strapping codes billed separately on the same date; those services are bundled into 21820 under NCCI policy
ICD-10 diagnosis code does not specify traumatic sternal fracture or lacks laterality/displacement detail required by payer
E/M service billed same-day without modifier 25 to distinguish a separately identifiable evaluation
Missing imaging documentation to support medical necessity of the closed treatment visit

Frequently asked questions

Source · Generated from the editorial pipeline, verified against 5 cited references ↓

01Can 21820 be billed after open heart surgery that required a sternotomy?

No. The CMS NCCI 2026 Policy Manual Chapter 5 explicitly states that 21820–21825 cannot be reported for repair of a surgical sternotomy. The sternotomy repair is bundled into the cardiothoracic procedure code.

02Can a separate casting or chest strapping code be billed with 21820?

No. NCCI policy bundles initial casting, splinting, and strapping into fracture care codes. Billing a strapping or binder application code alongside 21820 on the same date will be denied.

03What modifier is needed for an E/M visit billed on the same day as 21820?

Use modifier 25 on the E/M code to show it was a separately identifiable service beyond the decision to treat the fracture. Without modifier 25, the E/M will be denied as bundled.

04What modifier covers an unrelated procedure performed during the 90-day global period?

Modifier 79 designates an unrelated procedure by the same physician during the postoperative global period. Do not use modifier 78 here — that applies only to unplanned returns for a complication related to the original procedure.

05Should modifier 22 ever be used with 21820?

Only when documented circumstances — such as severe displacement requiring prolonged manipulation, or management complicated by associated injuries — made the work substantially greater than typical. Include a written narrative with the claim; without it, payers routinely ignore modifier 22 and pay at the standard rate.

06Does 21820 cover follow-up imaging and office visits during healing?

Routine post-treatment office visits and monitoring within the 90-day global period are included in the global package and cannot be billed separately. Imaging ordered during global follow-up can still be billed under the applicable radiology code by the interpreting physician.

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, fracture displacement status from imaging, stabilization method applied (chest binder, wrap, or none), pain management plan, and the explicit statement that no surgical intervention was performed. It also flags if a cardiothoracic sternotomy was mentioned anywhere in the note — triggering an alert that 21820 cannot be reported in that context. This prevents the most common audit flag: billing closed sternal fracture treatment as a standalone code when the sternum was actually divided for cardiac access.

See how Mira captures CPT 21820 documentation