CPT code 21812: Rib fracture fixation, four to six ribs2026 Medicare rate & RVUs in Texas
Reports open stabilization with internal fixation of four to six fractured ribs, commonly performed for multiple displaced fractures or flail chest.
CMS doesn’t publish an office rate for 21812 in Texas.
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
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What 21812 covers
This service involves surgically exposing fractured ribs and stabilizing four to six ribs with internal fixation, such as plates. Thoracic or trauma surgeons commonly perform it in a hospital setting for selected patients with multiple displaced rib fractures or flail chest. Thoracoscopy performed as part of the stabilization is included. The code level is based on the number of ribs treated, not simply the total number of fractures identified.
The operative report should identify the ribs stabilized, confirm internal fixation, and describe the approach and any thoracoscopic assistance. Choose the sibling code for one to three ribs or seven or more ribs when the treated-rib count falls in those ranges. This minor procedure has a 0-day global period, so same-day preoperative and postoperative care is included. When multiple procedures occur in the same session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% reduction. Bilateral reporting with 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 21812 pays more and less in Texas
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
8 of 8 payment localities
| Payment locality | Office | Facility |
|---|---|---|
| Austin, TX | Unavailable | $651.98 |
| Beaumont, TX | Unavailable | $636.41 |
| Brazoria, TX | Unavailable | $634.99 |
| Dallas, TX | Unavailable | $644.06 |
| Fort Worth, TX | Unavailable | $644.10 |
| Galveston, TX | Unavailable | $640.17 |
| Houston, TX | Unavailable | $696.36 |
| Rest of Texas | Unavailable | $638.79 |
How the 21812 rate is calculated
Each of 21812’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 · 21812
RVUs × geographic indexes × conversion factor
Work12.68
12.68 RVUs× 1.000 GPCI
Practice expense3.87
3.87 RVUs× 1.000 GPCI
Malpractice3.07
3.07 RVUs× 1.000 GPCI
Adjusted RVUs
19.6200
Conversion factor
$33.4009
Medicare rate
$655.33
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 21812
The CMS indicators that decide how 21812 is paid alongside other services.
CMS payment indicators · 21812
Rib fracture fixation, four to six ribs
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 000 | Same-day global: pre- and post-op care on the day of the procedure is included. |
| Multiple procedures | 2 | Standard reduction: highest-valued procedure at 100%, others at 50%. |
| Bilateral (modifier 50) | 1 | Bilateral with modifier 50 pays 150% of the fee schedule amount. |
| Assistant at surgery (80/81/82/AS) | 2 | Paid. |
| Co-surgeons (62) | 0 | Not permitted. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 0 | Physician service: no professional/technical split. |
What modifiers do to the payment
Modifier 50 · payment effect
With and without the modifier
21812 without 50 · national facility
$655.33
Rib fracture fixation, four to six ribs
21812-50 · Bilateral: 150%
$983.00
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).
21812 compared with similar codes
Compare codes · National
21812 vs 21811 vs 21813: Medicare rates
How to choose
21812 billing questions
How is this code distinguished from 21811 and 21813?
Select this level when internal fixation is performed on four to six ribs. Code 21811 is the one-to-three-rib level, and 21813 is for seven or more ribs.
Does the rib count refer to fractures or ribs stabilized?
Count the ribs treated with internal fixation. Document the rib levels and number stabilized in the operative report.
Is thoracoscopy separately reported when used during fixation?
Thoracoscopy performed as part of the rib stabilization is included in this service.
When is modifier 50 used?
For bilateral performance, report modifier 50; CMS pays this bilateral procedure at 150%.
How does the multiple procedure reduction affect payment?
When multiple procedures are performed in the same session, the highest-valued procedure is paid in full and the others are subject to the standard 50% reduction.
Can an assistant or another surgeon be reported?
An assistant at surgery may be paid. Co-surgeons and team surgery are not permitted for this code.
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
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