No office rate
Both address open frontal sinus fracture treatment, but 21344 is for the complex fracture category. Use the operative findings and repair details to support the distinction.
On this page
CMS RVU26D · Effective 2026-10-01
21343 Frontal sinus repair Medicare reimbursement rates in Colorado
Open repair of a depressed frontal sinus fracture, reported when the surgeon surgically exposes and restores the position or contour of the injured sinus region. Compare 21343 office and facility rates across CMS payment localities in Colorado.
Amounts below use the non-QP conversion factor for participating physicians. These are base physician payments before claim-level adjustments, not patient costs or total hospital charges.
What does Medicare pay for 21343 in Colorado?
Colorado has 1 payment locality in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the payment area shown below, using the same CMS release.
Office / nonfacility
No supported rate
Facility setting
$993.39
1 of 1 localities have a supported rate.
Payment area: Colorado
One mapped payment locality.
These are locality ranges, not averages or address-specific quotes. A facility-setting amount covers the physician service; it does not include a hospital’s separate bill. Choose a locality below to inspect its calculation, compare other payment areas, or price a percentage of Medicare.
Facial fracture surgery
About 21343: Open repair of depressed frontal sinus fracture
Open repair of a depressed frontal sinus fracture, reported when the surgeon surgically exposes and restores the position or contour of the injured sinus region.
This code describes open surgical treatment of a depressed fracture involving the frontal sinus, the air space behind the forehead. The surgeon exposes the fracture and restores the depressed bone’s position or contour. Otolaryngologists, facial plastic surgeons, oral and maxillofacial surgeons, and neurosurgeons may perform this repair, typically in an operating room after facial trauma. The operative report should identify the frontal sinus fracture and describe the open approach and repair performed.
Select this code for the depressed frontal sinus fracture repair rather than a code for a different facial bone or a more complex frontal sinus fracture. 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 50% reduction. An assistant at surgery may be paid; co-surgeon payment requires supporting documentation, and team surgery is not permitted. The anatomy is not reported with modifier 50.
CMS billing rules for 21343
- Global period
- Major surgery with a 90-day global period: the day-before preoperative visit and 90 days of related postoperative care are included.
- Multiple procedures
- Standard multiple procedure reduction: the highest-valued procedure is paid in full and others at 50% when performed in the same session.
- Bilateral procedures
- Bilateral adjustment does not apply; the descriptor or anatomy makes modifier 50 inappropriate.
- Assistant at surgery
- Assistant at surgery may be paid.
- Co-surgeons
- Co-surgeons paid only with supporting documentation.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU13.96 · 48%
- Practice expense (office) RVU13.17 · 45%
- Malpractice RVU2.05 · 7%
23
Medicare services in 2024 · #5830 by national volume
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.
21343 compared with similar codes
Office rates for Colorado, from the same CMS release.
No office rate
This code treats an open nasoethmoid fracture without fixation; 21343 is for a depressed frontal sinus fracture. Distinguish the injured bone and repair.
No office rate
This code addresses an open nasoethmoid fracture with fixation, not a depressed frontal sinus fracture.
No office rate
This code is for open treatment of an uncomplicated nasal fracture. Code 21343 concerns the frontal sinus rather than the nose.
Compare 21343 by payment locality
Find the payment area for your service address, then open its rate page for calculation inputs, release history and the percentage-of-Medicare tool. A city may cross payment-area boundaries; the ZIP lookup above helps resolve the location.
1 of 1 payment localities
Colorado →
Office / nonfacility
Unavailable
Facility
$993.39
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How this local rate is calculated
Each RVU component is multiplied by its own geographic practice cost index (GPCI). The three adjusted components are added, then multiplied by the conversion factor. These are the inputs used for 21343 in Colorado.
PPRRVU2026_Oct_nonQPP.csv
1,953
- Code
- 21343
- Physician work
- 13.96
- Practice expense
- 13.17
- Malpractice
- 2.05
GPCI2026.csv
37
- Locality
- Colorado
- Physician work
- 1.012
- Practice expense
- 1.064
- Malpractice
- 0.781
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 13.96 | × 1.012 | 14.1275 |
| Practice expense | 13.17 | × 1.064 | 14.0129 |
| Malpractice | 2.05 | × 0.781 | 1.6010 |
| Total RVUs | 29.7415 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Colorado$993.39
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 13.96 | 1.012 |
| Practice expense | 13.17 | 1.064 |
| Malpractice | 2.05 | 0.781 |
(13.96 × 1.012 + 13.17 × 1.064 + 2.05 × 0.781) × $33.4009 = $993.39
The office and facility calculations use their respective practice-expense RVUs. The facility amount here is the physician fee, not a separate hospital or facility bill.
21343 billing questions
How is this code distinguished from 21344?
Use 21343 for open repair of a depressed frontal sinus fracture. Code 21344 describes the complex frontal sinus fracture repair; the operative documentation should support the applicable fracture and repair classification.
Can a separate code be reported for the surgeon’s postoperative visits?
Related postoperative care is included in this code’s 90-day global period, along with the day-before preoperative visit.
How are other procedures in the same session paid?
Under the standard multiple procedure reduction, the highest-valued procedure is paid in full and other procedures are paid at 50% when performed in the same session.
Can an assistant or co-surgeon be reported?
Assistant-at-surgery payment may be available. Co-surgeon payment requires supporting documentation, and team surgery is not permitted.
Should modifier 50 be used for fractures on both sides?
No. The code’s descriptor and anatomy make modifier 50 inappropriate.
Where these rates come from
FeeBase calculates base physician payments from CMS work, practice-expense, and malpractice RVUs, adjusted by each locality’s geographic indices and the applicable conversion factor. Unavailable or separately priced services are labeled rather than assigned a made-up amount.
Source: RVU26D. Effective 2026-10-01 through the day before 2027-01-01.
1,95021338,,Open nasoethmoid fx w/o fixj,A,,6.70,11.08,NA,11.08,,0.99,18.77,18.77,0,090,0.10,0.69,0.21,2,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,95121339,,Open nasoethmoid fx w/ fixj,A,,8.29,11.46,NA,11.46,,1.21,20.96,20.96,0,090,0.10,0.69,0.21,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,95221340,,Perq tx nasoethmoid fx,A,,11.20,6.93,NA,6.93,,1.63,19.76,19.76,0,090,0.10,0.69,0.21,2,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,95321343,,Open tx dprsd front sinus fx,A,,13.96,13.17,NA,13.17,,2.05,29.18,29.18,0,090,0.10,0.69,0.21,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,95421344,,Open tx compl front sinus fx,A,,21.03,12.31,NA,12.31,,3.05,36.39,36.39,0,090,0.10,0.69,0.21,2,0,2,2,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,95521345,,Closed tx nose/jaw fx,A,,8.83,13.81,,6.89,,1.29,23.93,17.01,0,090,0.10,0.69,0.21,2,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,95621346,,Opn tx nasomax fx w/fixj,A,,11.16,14.57,NA,14.57,,1.63,27.36,27.36,0,090,0.10,0.69,0.21,2,0,1,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
3401112,CA,69,VISALIA,1.017,1.096,0.536
3501112,CA,70,YUBA CITY,1.017,1.096,0.536
3601112,CA,75,REST OF CALIFORNIA,1.017,1.096,0.536
3704112,CO,01,COLORADO,1.012,1.064,0.781
3813102,CT,00,CONNECTICUT,1.020,1.077,1.210
3912202,DC,01,DC + MD/VA SUBURBS,1.054,1.178,1.113
4012102,DE,01,DELAWARE,1.005,0.988,0.899