CPT code 69421: Myringotomy, general anesthesia, no tube2026 Medicare rate & RVUs in New York
Reports an eardrum incision to access or drain the middle ear when the myringotomy is performed under general anesthesia, without tube placement.
CMS doesn’t publish an office rate for 69421 in New York.
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 69421 covers
An otolaryngologist makes an opening in the tympanic membrane to access or drain the middle ear, often for middle-ear fluid or pressure problems. The service may include aspiration of middle-ear contents. This code is for a myringotomy performed under general anesthesia and does not represent placement of a ventilating tube. It is commonly performed in an operating room or ambulatory surgery setting, including for patients who cannot tolerate the procedure awake.
Report the service when the operative documentation supports the eardrum incision and general anesthesia; distinguish it from a myringotomy performed without general anesthesia and from procedures that also place a tube. Medicare assigns a 10-day global period, so related postoperative visits during that period are 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. For bilateral treatment, modifier 50 is paid at 150%. Medicare does not pay an assistant at surgery for this code; 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 69421 pays more and less in New York
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
| Payment locality | Office | Facility |
|---|---|---|
| Manhattan, NY | Unavailable | $158.14 |
| NYC suburbs and Long Island, NY | Unavailable | $162.33 |
| Poughkeepsie and northern NYC suburbs, NY | Unavailable | $149.10 |
| Queens, NY | Unavailable | $158.37 |
| Rest of New York | Unavailable | $131.89 |
How the 69421 rate is calculated
Each of 69421’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 · 69421
RVUs × geographic indexes × conversion factor
Work1.74
1.74 RVUs× 1.000 GPCI
Practice expense2.14
2.14 RVUs× 1.000 GPCI
Malpractice0.25
0.25 RVUs× 1.000 GPCI
Adjusted RVUs
4.1300
Conversion factor
$33.4009
Medicare rate
$137.95
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 69421
69421 has a 10-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 69421
Myringotomy, general anesthesia, no tube
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 010 | Minor procedure: the day of the procedure plus 10 days after are 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) | 1 | Not paid (statutory restriction). |
| Co-surgeons (62) | 0 | Not permitted. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 0 | Physician service: no professional/technical split. |
| Split (54/55/56) | 0.10/0.80/0.10 | Share of the payment for pre-op, the procedure itself, and post-op care. |
Global surgery period · 69421
Myringotomy, general anesthesia, no tube
10-day global period ends
Oct 11, 2026
Covers Oct 1, 2026 through Oct 11, 2026 (11 days).
Visit on Oct 31, 2026
After the global period ends: visits and procedures are billed normally.
What modifiers do to the payment
Modifier 50 · payment effect
With and without the modifier
69421 without 50 · national facility
$137.95
Myringotomy, general anesthesia, no tube
69421-50 · Bilateral: 150%
$206.93
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).
69421 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 69420Eardrum incisionNo ventilating tube
- Choose 69421 for a myringotomy performed under general anesthesia. 69420 is the related code when the procedure is performed without that anesthesia distinction.
- 69433Ear tube placementLocal or topical anesthesia
- 69433 includes insertion of a ventilating tube and is performed under local or topical anesthesia. 69421 covers the incision without tube placement under general anesthesia.
- 69436TympanostomyTube insertion, general anesthesia
- 69436 includes ventilating-tube insertion under general anesthesia. Use 69421 when no tube is placed.
69421 billing questions
How does 69421 differ from 69420?
Both describe a myringotomy without tube placement. Use 69421 when the procedure requires general anesthesia; 69420 is the corresponding service without that anesthesia distinction.
Should 69421 be reported when a ventilating tube is inserted?
Use the applicable tube-placement code when a ventilating tube is inserted. 69421 describes the incision and middle-ear access without tube placement.
Can the service be reported for both ears?
For bilateral treatment, report modifier 50; CMS pays the bilateral procedure at 150%.
Are postoperative visits separately payable during the global period?
Related postoperative visits for 10 days are included in the 10-day global period.
Can an assistant surgeon or co-surgeon be billed?
Medicare does not pay an assistant at surgery for 69421. Co-surgeons and team surgery are not permitted.
What happens if another procedure is performed in the same session?
The highest-valued procedure is paid in full, and other procedures are subject to the standard multiple-procedure reduction.
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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