Billing code 21343: Frontal sinus repairMedicare rate & RVUs in Delaware
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.
CMS doesn’t publish an office rate for 21343 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 21343 covers
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.
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 in Delaware
| Payment locality | Office | Facility |
|---|---|---|
| Delaware | Unavailable | $964.78 |
How the 21343 rate is calculated
Each of 21343’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 · 21343
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 13.96Practice expense 13.17Malpractice 2.05
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 21343
21343 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 21343
Frontal sinus 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) | 2 | Paid. |
| Co-surgeons (62) | 1 | Permitted with supporting documentation. |
| 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 · 21343
Frontal sinus 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
21343 without 51 · national facility
$974.64
Frontal sinus repair
21343-51 · Second procedure: 50%
$487.32
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%).
21343 compared with similar codes
Compare codes
21343 vs 21344 vs 21338 vs 21339 vs 21325: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 21344Frontal sinus repair
- 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.
- 21338Fracture repair
- This code treats an open nasoethmoid fracture without fixation; 21343 is for a depressed frontal sinus fracture. Distinguish the injured bone and repair.
- 21339Nasoethmoid repair
- This code addresses an open nasoethmoid fracture with fixation, not a depressed frontal sinus fracture.
- 21325Nasal fracture repair
- This code is for open treatment of an uncomplicated nasal fracture. Code 21343 concerns the frontal sinus rather than the nose.
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 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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