Billing code 21825: Sternal fracture repairMedicare rate & RVUs in Illinois
Open surgical treatment of a sternal fracture, with or without fixation, is reported when the fracture is managed through operative exposure.
CMS doesn’t publish an office rate for 21825 in Illinois.
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 21825 covers
This code describes operative exposure and treatment of a fractured sternum, including restoring the fracture’s position; skeletal fixation may be used but is not required. A thoracic or orthopedic surgeon typically performs the repair in a hospital operating room, often for a fracture that requires surgical stabilization. A separate rib fracture treated during the same session is coded according to its own procedure and code.
Choose this code for open surgical treatment, not closed management of the sternum fracture. The operative report should identify the sternal fracture and document the open approach and treatment performed, including fixation when used. The service has a 90-day global period that includes the day-before preoperative visit and 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. Modifier 50 is inappropriate for this single sternum. An assistant at surgery may be paid; co-surgeon payment requires supporting documentation, and team surgery is 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 21825 pays more and less in Illinois
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
| Payment locality | Office | Facility |
|---|---|---|
| Chicago | Unavailable | $647.70 |
| East St. Louis | Unavailable | $607.26 |
| Rest Of Illinois | Unavailable | $577.35 |
| Suburban Chicago | Unavailable | $620.51 |
How the 21825 rate is calculated
Each of 21825’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 · 21825
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 7.57Practice expense 7.44Malpractice 1.87
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 21825
21825 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 21825
Sternal 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) | 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 · 21825
Sternal 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
21825 without 51 · national facility
$563.81
Sternal fracture repair
21825-51 · Second procedure: 50%
$281.91
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%).
21825 compared with similar codes
Compare codes
21825 vs 21820 vs 21812 vs 21813: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 21820Sternum fracture care
- Use 21825 for open operative treatment of the sternum fracture. Use 21820 when treatment is closed and does not involve an open surgical approach.
- 21812Rib fracture fixation
- This code treats a rib fracture, not a sternal fracture. Select it only for the rib procedure performed, even when both injuries are treated in one session.
- 21813Rib fracture fixation
- This code is for rib-fracture treatment rather than open treatment of the sternum. The injured bone and procedure performed determine which code applies.
21825 billing questions
How does this differ from 21820?
21825 is for open surgical treatment of the sternal fracture. Use 21820 for closed treatment without an open operative approach.
Is fixation required to report 21825?
No. The code covers open treatment with or without skeletal fixation. Document the open treatment and specify fixation when performed.
Can a separately treated rib fracture be reported too?
Yes, when a distinct rib fracture is treated in the same session, report the applicable rib-fracture procedure separately. The multiple-procedure reduction may affect payment.
Should modifier 50 be used for a sternal fracture?
No. Modifier 50 is inappropriate for this code because the sternum is a single midline structure.
What postoperative care is included?
The 90-day global period includes the day-before preoperative visit and related postoperative care.
Can an assistant or co-surgeon be reported?
Assistant-at-surgery payment may be available. Co-surgeon payment requires supporting documentation; team surgery is 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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