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Billing code 69645: TympanoplastyMedicare rate & RVUs

Reports tympanic membrane and middle-ear repair performed with complete mastoidectomy when the surgeon does not reconstruct the ossicular chain.

CMS RVU26DEffective Oct 1, 2026109 payment localities363 Medicare services in 2024

Medicare pays $1,350.73 for 69645 nationally in a facility.

Medicare rate · 69645

Tympanoplasty

Work RVUs
16.29
Total RVUs
40.44
Global days
090

National rate · 2026

$1,350.73

Facility setting, before claim adjustments.

See every locality for 69645 →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 69645 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 69645 covers

An otolaryngologist uses this code for tympanoplasty combined with complete mastoidectomy, including associated work in the ear canal or middle ear. A typical clinical setting is surgery for chronic middle-ear disease or cholesteatoma involving the mastoid. The distinguishing feature is the extent of mastoid removal; ossicular chain reconstruction is not part of this service.

Choose the code from the operative report, which should support complete mastoidectomy and describe the tympanoplasty and middle-ear work performed. The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care. For bilateral surgery reported with modifier 50, CMS pays at 150%. When multiple procedures are performed in one session, the highest-valued procedure is paid in full and the others at 50%. CMS 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 69645 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

69645 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$1,224.93
Alaska*Unavailable$1,633.67
ArizonaUnavailable$1,316.59
ArkansasUnavailable$1,209.19
AtlantaUnavailable$1,380.22
AustinUnavailable$1,384.70
BakersfieldUnavailable$1,399.14
Baltimore/Surr. CntysUnavailable$1,431.58
BeaumontUnavailable$1,279.67
BrazoriaUnavailable$1,330.77

69645 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
69645 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 69645 rate is calculated

Each of 69645’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 · 69645

RVUs × geographic indexes × conversion factor

Work16.29

16.29 RVUs× 1.000 GPCI

Practice expense21.73

21.73 RVUs× 1.000 GPCI

Malpractice2.42

2.42 RVUs× 1.000 GPCI

Adjusted RVUs

40.4400

Conversion factor

$33.4009

Medicare rate

$1,350.73

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

Payment rules and modifiers for 69645

69645 has a 90-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 69645

Tympanoplasty

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)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)0.07/0.79/0.14Share of the payment for pre-op, the procedure itself, and post-op care.

Global surgery period · 69645

Tympanoplasty

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

69645 without 50 · national facility

$1,350.73

Tympanoplasty

69645-50 · Bilateral: 150%

$2,026.10

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

69645 compared with similar codes

Compare codes · National

4 codes, side by side

  • 69645

    Tympanoplasty16.29 wRVU

    Not priced

  • 69641

    Tympanoplasty12.57 wRVU

    Not priced

  • 69646

    Ear revision surgery17.91 wRVU

    Not priced

  • 69631

    Tympanoplasty9.8 wRVU

    Not priced

How to choose

69641Tympanoplasty
Both describe tympanoplasty with mastoidectomy without ossicular chain reconstruction. Choose 69645 when the operative report supports complete mastoidectomy.
69646Ear revision surgery
Both include complete mastoidectomy; 69646 is the related variant that includes ossicular chain reconstruction.
69631Tympanoplasty
69631 describes tympanoplasty without mastoidectomy. Use 69645 when the surgeon also performs complete mastoidectomy.

Codes related to 69645

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

Codes related to 69645
CodeHow it relatesNational office range
Same family
69641TympanoplastyTympanoplasty with mastoidectomy without the complete-mastoidectomy distinction.No office rate
69642TympanoplastyRelated tympanoplasty-mastoidectomy service that includes ossicular chain reconstruction.No office rate
69644TympanoplastyRelated tympanoplasty-mastoidectomy variant distinguished by canal-wall status.No office rate
69646Ear revision surgeryComplete-mastoidectomy variant that includes ossicular chain reconstruction.No office rate
Used instead
69631TympanoplastyTympanoplasty without mastoidectomy when mastoid surgery is not performed.No office rate

69645 billing questions

How does 69645 differ from 69641?

69645 identifies tympanoplasty with complete mastoidectomy and no ossicular chain reconstruction. Use 69641 for the corresponding tympanoplasty-mastoidectomy service when the operative report does not support complete mastoidectomy.

Can 69645 be reported when the ossicular chain is reconstructed?

No. This code describes the service without ossicular chain reconstruction; select the applicable complete-mastoidectomy code that includes reconstruction when the surgeon performs it.

Does 69645 include tympanoplasty and mastoid work?

Yes. It represents the combined tympanoplasty and complete mastoidectomy service, including associated canal or middle-ear work described for the procedure.

How is bilateral surgery reported?

Report modifier 50 for bilateral surgery. CMS pays this bilateral procedure at 150%.

How does the multiple-procedure reduction affect 69645?

When multiple procedures are performed in the same session, CMS pays the highest-valued procedure in full and the other procedures at 50%.

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 69645PPRRVU2026_Oct_nonQPP.csv, line 7,635 (RVU26D)

Open CMS sourceHow we calculate rates

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