Surgical repair or stabilization of a fractured sternum, performed as an open procedure to restore chest wall integrity.

Verified May 8, 2026 · 6 sources ↓

Medicare: $563.81
Work RVU: 7.57
Global, days: 90
Region: Other

Drawn from CMSAAPCMdclarity

Documentation requirements

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

Source · Editorial brief grounded in 6 cited references ↓

Specify fracture mechanism and imaging findings confirming sternal fracture diagnosis
Document that the procedure was performed for a true traumatic sternal fracture, not sternotomy closure from a concurrent cardiothoracic procedure
Describe fixation method, hardware used, and approach in the operative note — vague references to 'standard repair' are an audit flag
If modifier 22 is appended, include specific narrative in the operative note detailing what made the procedure significantly more complex than typical
Record pre- and post-operative chest imaging results supporting clinical necessity
Document any comorbidities or anatomical factors (e.g., osteoporosis, prior sternotomy) that affected the repair

Applicable modifiers

Modifiers commonly billed with this code.

Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual

22 Increased complexity 51 Multiple procedures 59 Distinct service 76 Repeat, same physician 77 Repeat, another physician 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 6 cited references ↓

CPT 21825 covers open surgical treatment of a sternal fracture — fixation, reduction, or stabilization of a broken sternum. It carries a 90-day global period, meaning all routine follow-up through day 90 is bundled. The code is most frequently billed by thoracic, cardiac, and general surgeons managing traumatic sternal fractures from blunt chest trauma.

The single most important bundling rule for 21825: CMS NCCI policy explicitly prohibits reporting 21825 (or anywhere in the 21820–21825 range) for closure or repair of a median sternotomy made during a cardiothoracic procedure. If a surgeon opens the chest via sternotomy for CABG or valve surgery, that sternal repair is integral to the cardiothoracic procedure — not separately reportable. This is a hard NCCI rule, not a payer judgment call.

When 21825 is legitimately billed alongside a cardiothoracic procedure because the sternal repair represented distinctly more work than routine closure, modifier 51 applies. Modifier 22 is defensible only when operative documentation clearly describes complexity exceeding the standard repair — for example, severely comminuted fracture patterns requiring unusual fixation technique. Without that documentation, carriers will strip the modifier and reduce payment.

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 (7.57) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (16.88) adds practice overhead and malpractice, and is what drives the Medicare payment below.

Work RVU	7.57
Practice expense RVU	7.44
Malpractice RVU	1.87
Total RVU	16.88
Medicare national rate	$563.81
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	$563.81
HOPD (APC 5114) Hospital outpatient department	$7,413.38
ASC (PI J8) Ambulatory surgical center (freestanding)	$4,682.29

Common denial reasons

The recurring reasons claims for CPT 21825 get rejected.

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

Billed alongside a cardiothoracic procedure with median sternotomy — NCCI bundles 21825 into the primary procedure and denies it as separately reportable
Modifier 22 appended without supporting operative note narrative describing increased complexity, leading to payer downcoding or denial of the increased payment
Missing or insufficient imaging documentation to confirm a true sternal fracture diagnosis prior to surgery
Incorrect use of 21825 for sternal wound debridement, which is reported with 21750 — wrong code selection triggers denial
Billing 21825 during a 90-day global period of a prior cardiothoracic procedure without modifier 79 when the sternal fracture repair is a truly unrelated new event

Frequently asked questions

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

01Can 21825 be billed when the sternum is repaired after a CABG that used a median sternotomy approach?

No. CMS NCCI policy is explicit: repair of a sternotomy made to perform a cardiothoracic procedure is not separately reportable. CPT codes 21820–21825 cannot be reported for that closure. The only exception is a true sternal fracture that is a distinct, separately documented condition from the sternotomy itself.

02What is the global period for 21825, and what does it include?

21825 carries a 90-day global period. That covers the day before surgery, the procedure day, and all routine post-operative visits, wound checks, and fracture management through day 90. Services unrelated to the sternal fracture repair billed in that window require modifier 24.

03When does modifier 22 actually hold up for 21825?

Modifier 22 requires the operative note to specifically describe what made the procedure more complex than usual — for example, severely comminuted fracture requiring multi-level plating, or significant scarring from prior sternotomy complicating the repair. A generic statement that the case was difficult will not survive audit.

04What is the difference between 21825 and 21750?

21750 describes sternal wound debridement and reconstruction — typically used for infected or dehisced sternotomy wounds. 21825 is for fracture repair. Using 21825 for a debridement procedure is incorrect code selection and will generate a denial or audit finding.

05If a patient had CABG six weeks ago and now sustains a traumatic sternal fracture in a fall, can 21825 be billed?

Yes — but you need modifier 79 (unrelated procedure during the global period of the prior surgery) appended to 21825 to indicate this is a new, unrelated condition. Document the trauma mechanism and new imaging clearly to distinguish the fracture from the prior sternotomy.

06Which specialties most commonly bill 21825?

Per CMS Physician Utilization File data, thoracic surgery, general surgery, and cardiac surgery account for the large majority of 21825 claims. Orthopedic surgeons occasionally bill this code for traumatic sternal fractures managed outside a cardiothoracic setting.

Sources & references

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

Mira Scribe

Mira's AI scribe captures the fracture mechanism, imaging confirmation, fixation technique, hardware description, and an explicit statement that the sternotomy was not created as part of a concurrent cardiothoracic procedure. That last point directly prevents the most common NCCI-driven denial — carriers audit 21825 aggressively when it appears on the same claim as CABG or valve codes.

See how Mira captures CPT 21825 documentation