Billing code 21813: Rib fracture fixationMedicare rate & RVUs in Guam
Reports operative internal fixation of seven or more rib fractures, including thoracoscopic visualization when performed, for patients requiring surgical stabilization.
CMS doesn’t publish an office rate for 21813 in Guam.
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 21813 covers
This code describes operative stabilization of seven or more fractured ribs using internal fixation. Thoracic or trauma surgeons typically perform the procedure in a hospital operating room for patients whose rib injuries require surgical stabilization. Thoracoscopic visualization, when used during the operation, is included in the service. The code is selected by the number of ribs treated with fixation, not simply the total number of fractured ribs documented.
The operative report should identify the ribs treated and describe the fixation performed. This is a minor procedure with a 0-day global period, so same-day preoperative and postoperative care is included. When another procedure is performed in the same session, the highest-valued procedure is paid in full and the others are subject to the standard 50% multiple-procedure reduction. For bilateral reporting with modifier 50, CMS pays this procedure at 150%. An assistant at surgery may be paid; 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.
21813 in Hawaii, Guam
| Payment locality | Office | Facility |
|---|---|---|
| Hawaii, Guam | Unavailable | $849.30 |
How the 21813 rate is calculated
Each of 21813’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 · 21813
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 17.17Practice expense 4.92Malpractice 4.60
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 21813
The CMS indicators that decide how 21813 is paid alongside other services.
CMS payment indicators · 21813
Rib fracture fixation
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 000 | Same-day global: pre- and post-op care on the day of the procedure is included. |
| Multiple procedures | 2 | Standard reduction: highest-valued procedure at 100%, others at 50%. |
| Bilateral (modifier 50) | 1 | Bilateral with modifier 50 pays 150% of the fee schedule amount. |
| Assistant at surgery (80/81/82/AS) | 2 | Paid. |
| Co-surgeons (62) | 0 | Not permitted. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 0 | Physician service: no professional/technical split. |
What modifiers do to the payment
Modifier 50 · payment effect
With and without the modifier
21813 without 50 · national facility
$891.47
Rib fracture fixation
21813-50 · Bilateral: 150%
$1,337.21
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).
21813 compared with similar codes
Compare codes
21813 vs 21811 vs 21812 vs 21820 vs 21825: national Medicare rates
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How to choose
- 21811Rib fixation
- Use 21811 for internal fixation of one to three ribs; 21813 requires fixation of seven or more.
- 21812Rib fracture fixation
- Use 21812 when four to six ribs are treated with internal fixation; 21813 is the seven-or-more-rib level.
- 21820Sternum fracture care
- This code concerns treatment of a sternum fracture, not rib-fracture fixation.
- 21825Sternal fracture repair
- This code is for open treatment of a sternum fracture; 21813 is for internal fixation of seven or more ribs.
21813 billing questions
How is 21813 distinguished from 21811 and 21812?
Choose by the number of ribs treated with internal fixation: 21813 is for seven or more, 21812 for four to six, and 21811 for one to three.
Does the code include thoracoscopic visualization?
Yes. Thoracoscopic visualization, when performed as part of the rib-fracture fixation, is included.
What documentation supports reporting 21813?
The operative report should identify the ribs actually treated and document internal fixation. The count must support treatment of seven or more ribs.
How is bilateral treatment reported?
For a bilateral procedure, report modifier 50; CMS pays the procedure at 150%.
Can an assistant surgeon be reported?
CMS permits payment for an assistant at surgery. Co-surgeons and team surgery are not permitted for this code.
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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