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Billing code 69421: MyringotomyMedicare rate & RVUs

Reports an eardrum incision to access or drain the middle ear when the myringotomy is performed under general anesthesia, without tube placement.

CMS RVU26DEffective Oct 1, 2026109 payment localities365 Medicare services in 2024

Medicare pays $137.95 for 69421 nationally in a facility.

Medicare rate · 69421

Myringotomy

Work RVUs
1.74
Total RVUs
4.13
Global days
010

National rate · 2026

$137.95

Facility setting, before claim adjustments.

See every locality for 69421 →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.

On this page 10 sections
  1. Medicare rate
  2. What 69421 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 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

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

109 of 109 payment localities

69421 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$125.39
Alaska*Unavailable$167.90
ArizonaUnavailable$134.53
ArkansasUnavailable$123.82
AtlantaUnavailable$140.94
AustinUnavailable$141.26
BakersfieldUnavailable$142.65
Baltimore/Surr. CntysUnavailable$146.07
BeaumontUnavailable$130.92
BrazoriaUnavailable$135.93

69421 rates by state

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

MEWIVTNHMTNDMNMINYMARIWAIDWYSDIAILINOHPANJCTORNVUTCONEMOKYWVVAMDDECAAZNMKSOKARTNNCSCDCTXLAMSALGAFLAKHI

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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
69421 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 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

RuleCMS valueWhat it means
Global period010Minor procedure: the day of the procedure plus 10 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)1Not paid (statutory restriction).
Co-surgeons (62)0Not permitted.
Team surgery (66)0Not permitted.
Professional/technical0Physician service: no professional/technical split.
Split (54/55/56)0.10/0.80/0.10Share of the payment for pre-op, the procedure itself, and post-op care.

Global surgery period · 69421

Myringotomy

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.

SurgeryVisit
Sep 28, 2026Oct 14, 2026

What modifiers do to the payment

Modifier 50 · payment effect

With and without the modifier

69421 without 50 · national facility

$137.95

Myringotomy

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).

When to use modifier 50

69421 compared with similar codes

Compare codes · National

4 codes, side by side

  • 69421

    Myringotomy1.74 wRVU

    Not priced

  • 69420

    Eardrum incision1.35 wRVU

    $191.72

  • 69433

    Ear tube placement1.53 wRVU

    $202.41

  • 69436

    Tympanostomy1.96 wRVU

    Not priced

How to choose

69420Eardrum incision
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 placement
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.
69436Tympanostomy
69436 includes ventilating-tube insertion under general anesthesia. Use 69421 when no tube is placed.

Codes related to 69421

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

Codes related to 69421
CodeHow it relatesNational office range
Same family
69420Eardrum incisionMyringotomy without the general-anesthesia distinction.$168.75–$255.44
Used instead
69433Ear tube placementMyringotomy with ventilating-tube insertion under local or topical anesthesia.$178.66–$268.55
69436TympanostomyMyringotomy with ventilating-tube insertion under general anesthesia.No office rate

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
RVUs for 69421PPRRVU2026_Oct_nonQPP.csv, line 7,603 (RVU26D)

Open CMS sourceHow we calculate rates

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