No office rate
Both concern sternal fractures, but 21825 is for open treatment. Choose this code for closed treatment without manipulation.
On this page
CMS RVU26D · Effective 2026-10-01
21820 Sternum fracture care Medicare reimbursement rates in Kentucky
Reports closed management of a sternum fracture without manipulation, typically when the fracture is treated nonoperatively after chest trauma. Compare 21820 office and facility rates across CMS payment localities in Kentucky.
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 21820 in Kentucky?
Kentucky 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
$164.93
1 of 1 localities have a supported rate.
Payment area: Kentucky
One mapped payment locality.
Facility setting
$155.43
1 of 1 localities have a supported rate.
Payment area: Kentucky
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.
Thoracic surgery
About 21820: Closed sternum fracture treatment
Reports closed management of a sternum fracture without manipulation, typically when the fracture is treated nonoperatively after chest trauma.
This service covers nonoperative management of a fractured sternum without manipulating the fracture. It is generally performed by a surgeon or trauma physician caring for a patient after blunt chest trauma, such as a motor vehicle collision. Management may include clinical assessment and a plan for conservative care; the fracture site and treatment approach distinguish this service from operative repair.
Report the code when the documented treatment is closed and does not involve manipulation. The note should identify the sternal fracture and support the treatment performed. CMS assigns a 90-day global period, which includes the day-before preoperative visit and related postoperative care during that period. 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 multiple-procedure reduction. Medicare does not pay an assistant at surgery for this code; co-surgeons and team surgery are not permitted.
CMS billing rules for 21820
- 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
- Statutory restriction: assistant at surgery is not paid.
- Co-surgeons
- Co-surgeons not permitted.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU1.33 · 25%
- Practice expense (office) RVU3.76 · 70%
- Malpractice RVU0.29 · 5%
91
Medicare services in 2024 · #4945 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.
21820 compared with similar codes
Office rates for Kentucky, from the same CMS release.
No office rate
This code concerns a sternum fracture. Code 21811 is for internal fixation of one to three rib fractures.
No office rate
This code concerns a sternum fracture. Code 21812 is for internal fixation of four to six rib fractures.
No office rate
This code concerns a sternum fracture. Code 21813 is for internal fixation of seven or more rib fractures.
Compare 21820 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
Kentucky →
Office / nonfacility
$164.93
Facility
$155.43
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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 21820 in Kentucky.
PPRRVU2026_Oct_nonQPP.csv
2,030
- Code
- 21820
- Physician work
- 1.33
- Practice expense
- 3.76
- Malpractice
- 0.29
GPCI2026.csv
55
- Locality
- Kentucky
- Physician work
- 1.000
- Practice expense
- 0.889
- Malpractice
- 0.915
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 1.33 | × 1.000 | 1.3300 |
| Practice expense | 3.76 | × 0.889 | 3.3426 |
| Malpractice | 0.29 | × 0.915 | 0.2653 |
| Total RVUs | 4.9380 | ||
| Conversion factor | × 33.4009 | ||
Office / nonfacility rate, Kentucky$164.93
Explore RVUs, geographic factors and the full formula
Office / nonfacility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 1.33 | 1 |
| Practice expense | 3.76 | 0.889 |
| Malpractice | 0.29 | 0.915 |
(1.33 × 1 + 3.76 × 0.889 + 0.29 × 0.915) × $33.4009 = $164.93
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 1.33 | 1 |
| Practice expense | 3.44 | 0.889 |
| Malpractice | 0.29 | 0.915 |
(1.33 × 1 + 3.44 × 0.889 + 0.29 × 0.915) × $33.4009 = $155.43
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.
21820 billing questions
When should this code be chosen over 21825?
Use this code for closed treatment without manipulation. Code 21825 describes open treatment of a sternal fracture, with or without fixation.
What documentation supports reporting this service?
Document the sternum as the fracture site and describe the closed treatment performed without manipulation.
Does the global period include related follow-up care?
Yes. The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care.
How are other procedures in the same session paid?
The highest-valued procedure is paid in full; other procedures in the same session are subject to the standard multiple-procedure reduction.
Can an assistant or co-surgeon be reported?
Medicare does not pay an assistant at surgery for this code. Co-surgeons and team surgery 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 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.
2,02721811,,Optx of rib fx w/fixj scope,A,,10.52,3.19,NA,3.19,,2.60,16.31,16.31,0,000,0.00,0.00,0.00,2,1,2,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
2,02821812,,Treatment of rib fracture,A,,12.68,3.87,NA,3.87,,3.07,19.62,19.62,0,000,0.00,0.00,0.00,2,1,2,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
2,02921813,,Treatment of rib fracture,A,,17.17,4.92,NA,4.92,,4.60,26.69,26.69,0,000,0.00,0.00,0.00,2,1,2,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
2,03021820,,Treat sternum fracture,A,,1.33,3.76,,3.44,,0.29,5.38,5.06,0,090,0.10,0.69,0.21,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
2,03121825,,Treat sternum fracture,A,,7.57,7.44,NA,7.44,,1.87,16.88,16.88,0,090,0.10,0.69,0.21,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
2,03221899,,Unlisted px neck/thorax,C,,0.00,0.00,,0.00,,0.00,0.00,0.00,0,YYY,0.00,0.00,0.00,2,0,0,1,1,9,,33.4009,09,0,99,0.00,0.00,0.00
2,03321920,,Biopsy soft tissue of back,A,,2.06,5.54,,1.90,,0.30,7.90,4.26,0,010,0.10,0.80,0.10,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5208102,IN,00,INDIANA,1.000,0.927,0.486
5305102,IA,00,IOWA,1.000,0.915,0.397
5405202,KS,00,KANSAS,1.000,0.904,0.504
5515102,KY,00,KENTUCKY,1.000,0.889,0.915
5607202,LA,01,NEW ORLEANS,1.000,0.941,1.136
5707202,LA,99,REST OF LOUISIANA,1.000,0.885,0.958
5814112,ME,03,SOUTHERN MAINE,1.000,0.991,0.631