Billing code 21338: Fracture repairMedicare rate & RVUs in Delaware
Open surgical reduction of a nasoethmoid fracture without fixation, reported when the surgeon exposes and reduces the fracture but does not stabilize it.
CMS doesn’t publish an office rate for 21338 in Delaware.
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 9 sections
What 21338 covers
This service treats a fracture involving the nasoethmoid region through surgical exposure and reduction, without fixation. It is generally performed in an operating room by a facial trauma surgeon, such as an otolaryngologist or plastic surgeon, when the fracture pattern requires open access but the surgeon does not place fixation. The work is distinct from treatment of an isolated nasal fracture or a nasoethmoid fracture stabilized with fixation.
Report the code when the operative documentation supports open treatment of the nasoethmoid fracture and confirms that fixation was not used. 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% multiple-procedure reduction. Do not append modifier 50. Assistant-at-surgery payment requires documented medical necessity; 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.
21338 in Delaware
| Payment locality | Office | Facility |
|---|---|---|
| Delaware | Unavailable | $620.27 |
How the 21338 rate is calculated
Each of 21338’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 · 21338
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 6.70Practice expense 11.08Malpractice 0.99
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 21338
21338 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 21338
Fracture repair
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 090 | Major surgery: the day before, the day of, and 90 days after are included. |
| Multiple procedures | 2 | Standard reduction: highest-valued procedure at 100%, others at 50%. |
| Bilateral (modifier 50) | 0 | The 150% bilateral adjustment doesn’t apply. |
| Assistant at surgery (80/81/82/AS) | 0 | Not paid without supporting documentation. |
| 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) | 0.10/0.69/0.21 | Share of the payment for pre-op, the procedure itself, and post-op care. |
Global surgery period · 21338
Fracture repair
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.
Pre-op dayGlobal period
What modifiers do to the payment
Modifier 51 · payment effect
With and without the modifier
21338 without 51 · national facility
$626.93
Fracture repair
21338-51 · Second procedure: 50%
$313.47
When this isn’t the highest-valued procedure in the session, Medicare pays 50% of its fee schedule amount (the highest is paid at 100%).
21338 compared with similar codes
Compare codes
21338 vs 21339 vs 21340 vs 21325 vs 21335: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 21339Nasoethmoid repair
- Both involve open treatment of a nasoethmoid fracture. The distinguishing point is fixation: 21338 is without fixation, while 21339 is with fixation.
- 21340Nasoethmoid fracture
- This code is for percutaneous treatment of a nasoethmoid fracture. Use 21338 when treatment is performed through open surgical exposure.
- 21325Nasal fracture repair
- This code concerns open treatment of an uncomplicated nose fracture. Use 21338 when the documented fracture involves the nasoethmoid region.
- 21335Nasal fracture repair
- This code describes open treatment of a nose and septal fracture. It does not represent open treatment of a nasoethmoid fracture without fixation.
21338 billing questions
How does this code differ from 21339?
Both describe open treatment of a nasoethmoid fracture. Use 21338 when the fracture is treated without fixation; 21339 describes treatment with fixation.
When would 21340 be considered instead?
21340 describes percutaneous treatment of a nasoethmoid fracture. Choose the code that matches the documented treatment approach rather than reporting open treatment for a percutaneous procedure.
What documentation supports reporting 21338?
The operative report should identify the nasoethmoid fracture, document open exposure and reduction, and make clear that fixation was not used.
Should modifier 50 be appended?
No. CMS identifies modifier 50 as inappropriate for this code; report the documented fracture treatment without modifier 50.
Can an assistant surgeon be paid for this service?
Assistant-at-surgery payment is available only when the record documents medical necessity. Co-surgeon and team-surgery billing are not permitted.
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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