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CPT code 21616: Rib excision, with sympathectomy2026 Medicare rate & RVUs

Reports operative removal of a first rib, cervical rib, or both with sympathectomy, typically as decompression surgery for thoracic outlet symptoms.

CMS RVU26DEffective Oct 1, 2026109 payment localities

Medicare pays $666.01 for 21616 nationally in a facility.

Medicare rate · 21616

Rib excision, with sympathectomy

Office or facility?

Work RVUs
12.37
Total RVUs
19.94
Global days
090

National rate · 2026

$666.01

Facility setting, before claim adjustments.

See every locality for 21616 →Billed by an NP, PA or therapist? →

Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.

Your location

Medicare pays by the payment locality where the service is performed.

On this page 10 sections
  1. Medicare rate
  2. What 21616 covers
  3. By payment locality
  4. Rate map
  5. How it’s calculated
  6. Payment rules
  7. Similar codes
  8. Related codes
  9. Billing questions
  10. Sources

What 21616 covers

This open operation removes the first rib, a cervical rib, or both, and includes sympathectomy. Thoracic and vascular surgeons may perform it in an operating room for selected patients with thoracic outlet compression symptoms. The operative report should identify the rib or ribs removed and document that sympathectomy was performed; removal of a rib alone is not this service.

Report one unit for the operative service, with documentation supporting the anatomy and the included sympathectomy. The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care. When multiple procedures are performed in the same session, the highest-valued procedure is paid in full and other procedures are subject to the standard multiple-procedure reduction. For bilateral reporting, modifier 50 is paid at 150%. An assistant at surgery may be paid; co-surgeons and team surgery are not permitted.

This summary was written with AI assistance from CMS physician fee schedule data and checked against the CMS billing rules shown here. Rates on this page come directly from CMS files.

Where 21616 pays more and less

The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.

109 of 109 payment localities

21616 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$601.79
AlaskaUnavailable$834.78
ArizonaUnavailable$646.25
ArkansasUnavailable$594.05
Atlanta, GAUnavailable$690.83
Austin, TXUnavailable$663.35
Bakersfield, CAUnavailable$646.74
Baltimore area, MDUnavailable$708.39
Beaumont, TXUnavailable$645.26
Brazoria, TXUnavailable$644.77

21616 rates by state

Office rate range in each state. Select a state to see its payment localities.

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Local rates. Clear comparisons.

Hover or focus a tile to see its rate range. Select it to open the state’s fee schedule.

View every state and territory as a table
21616 office rate range by state
State / territoryOffice rate rangeLocalities
AKNo published base rate1
ALNo published base rate1
ARNo published base rate1
AZNo published base rate1
CANo published base rate29
CONo published base rate1
CTNo published base rate1
DCNo published base rate1
DENo published base rate1
FLNo published base rate3
GANo published base rate2
GUNo published base rate1
HINo published base rate1
IANo published base rate1
IDNo published base rate1
ILNo published base rate4
INNo published base rate1
KSNo published base rate1
KYNo published base rate1
LANo published base rate2
MANo published base rate2
MDNo published base rate3
MENo published base rate2
MINo published base rate2
MNNo published base rate1
MONo published base rate3
MSNo published base rate1
MTNo published base rate1
NCNo published base rate1
NDNo published base rate1
NENo published base rate1
NHNo published base rate1
NJNo published base rate2
NMNo published base rate1
NVNo published base rate1
NYNo published base rate5
OHNo published base rate1
OKNo published base rate1
ORNo published base rate2
PANo published base rate2
PRNo published base rate1
RINo published base rate1
SCNo published base rate1
SDNo published base rate1
TNNo published base rate1
TXNo published base rate8
UTNo published base rate1
VANo published base rate2
VINo published base rate1
VTNo published base rate1
WANo published base rate2
WINo published base rate1
WVNo published base rate1
WYNo published base rate1

How the 21616 rate is calculated

Each of 21616’s three RVUs is multiplied by a geographic index (GPCI) for the payment locality, added up, and multiplied by the conversion factor. Drag the indexes or enter a ZIP to see what moves the rate.

How the rate is built · 21616

RVUs × geographic indexes × conversion factor

Office or facility?

Work12.37

12.37 RVUs× 1.000 GPCI

Practice expense4.41

4.41 RVUs× 1.000 GPCI

Malpractice3.16

3.16 RVUs× 1.000 GPCI

Adjusted RVUs

19.9400

Conversion factor

$33.4009

Medicare rate

$666.01

Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.

Payment rules and modifiers for 21616

21616 has a 90-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 21616

Rib excision, with sympathectomy

RuleCMS valueWhat it means
Global period090Major surgery: the day before, the day of, and 90 days after are included.
Multiple procedures2Standard reduction: highest-valued procedure at 100%, others at 50%.
Bilateral (modifier 50)1Bilateral with modifier 50 pays 150% of the fee schedule amount.
Assistant at surgery (80/81/82/AS)2Paid.
Co-surgeons (62)0Not permitted.
Team surgery (66)0Not permitted.
Professional/technical0Physician service: no professional/technical split.
Split (54/55/56)0.10/0.69/0.21Share of the payment for pre-op, the procedure itself, and post-op care.

Global surgery period · 21616

Rib excision, with sympathectomy

90-day global period ends

Dec 30, 2026

Covers Sep 30, 2026 through Dec 30, 2026 (92 days, including the day before surgery).

Visit on Oct 31, 2026

Day 30 of the 90-day post-op period: related follow-up care is included in the surgical payment.

  • 24Unrelated E/M visit by the same physician
  • 79Unrelated procedure (starts its own global period)
  • 58Staged, more extensive, or therapy procedure that was planned
  • 78Unplanned return to the operating room for a related complication
SurgeryVisit
Sep 23, 2026Jan 10, 2027

Pre-op dayGlobal period

What modifiers do to the payment

Modifier 50 · payment effect

With and without the modifier

21616 without 50 · national facility

$666.01

Rib excision, with sympathectomy

21616-50 · Bilateral: 150%

$999.02

Both sides on one line with modifier 50 are paid at 150% of the fee schedule amount (subject to multiple-procedure rules with other procedures).

When to use modifier 50

21616 compared with similar codes

Compare codes · National

4 codes, side by side

Office or facility?

  • 21616

    Rib excision, with sympathectomy12.37 wRVU

    Not priced

  • 21615

    Rib excision, first and/or cervical rib10.19 wRVU

    Not priced

  • 21600

    Rib excision, partial rib removal7.08 wRVU

    Not priced

  • 21601

    Chest wall excision, tumor excision including ribs17.34 wRVU

    Not priced

How to choose

21615Rib excisionFirst and/or cervical rib
Choose 21616 when the rib excision includes sympathectomy; choose 21615 when it does not.
21600Rib excisionPartial rib removal
21600 describes partial rib removal generally. 21616 is specific to first and/or cervical rib excision performed with sympathectomy.
21601Chest wall excisionTumor excision including ribs
21601 is for chest-wall tumor excision involving ribs. It is not the code for rib removal with sympathectomy for thoracic outlet decompression.

Codes related to 21616

Related codes aren’t interchangeable: bill the code that matches the service performed.

Codes related to 21616
CodeHow it relatesNational office range
Same family
21615Rib excision, first and/or cervical ribSibling rib-excision service for first and/or cervical rib removal without sympathectomy.No office rate
Used instead
21600Rib excision, partial rib removalPartial rib removal code for cases not described by first or cervical rib excision with sympathectomy.No office rate
Often billed with
64713Nerve revision, major peripheral nerve, armBrachial plexus neuroplasty may be performed during thoracic outlet decompression.No office rate

21616 billing questions

How does this differ from 21615?

21616 includes sympathectomy with the rib excision. Use 21615 when the first and/or cervical rib is excised without sympathectomy.

Can the rib removal and sympathectomy be reported separately?

The sympathectomy is included in 21616; it is not a separately described service within this code. The operative note should support that both parts of the operation were performed.

How is bilateral surgery reported?

Report bilateral performance with modifier 50. CMS pays the bilateral procedure at 150%.

What postoperative care is included?

The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care.

Can an assistant surgeon be reported?

An assistant at surgery may be paid for this procedure. CMS does not permit co-surgeons or team surgery.

Where these rates come from

FeeBase calculates base physician payments from CMS work, practice-expense and malpractice RVUs, adjusted by each locality’s geographic indexes and the conversion factor. Services without a published rate are labeled, never given a made-up amount. Amounts are Medicare allowed amounts before claim adjustments: not a patient’s bill or a commercial rate.

CMS RVU26D · effective Oct 1, 2026 through the day before Jan 1, 2027

Show the CMS file lines behind this rate
RVUs for 21616PPRRVU2026_Oct_nonQPP.csv, line 2,014 (RVU26D)

Open CMS sourceHow we calculate rates

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