No office rate
Both involve open treatment of a nasoethmoid fracture. The distinguishing point is fixation: 21338 is without fixation, while 21339 is with fixation.
On this page
CMS RVU26D · Effective 2026-10-01
21338 Fracture repair Medicare reimbursement rates in Maine
Open surgical reduction of a nasoethmoid fracture without fixation, reported when the surgeon exposes and reduces the fracture but does not stabilize it. Compare 21338 office and facility rates across CMS payment localities in Maine.
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 21338 in Maine?
Maine has 2 payment localities in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the 2 payment areas shown below, using the same CMS release.
Office / nonfacility
No supported rate
Facility setting
$584.83–$611.40
2 of 2 localities have a supported rate.
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.
Facial fracture surgery
About 21338: Open nasoethmoid fracture reduction without fixation
Open surgical reduction of a nasoethmoid fracture without fixation, reported when the surgeon exposes and reduces the fracture but does not stabilize it.
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.
CMS billing rules for 21338
- 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
- Assistant at surgery is paid only with documentation of medical necessity.
- Co-surgeons
- Co-surgeons not permitted.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU6.70 · 36%
- Practice expense (office) RVU11.08 · 59%
- Malpractice RVU0.99 · 5%
18
Medicare services in 2024 · #5962 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.
21338 compared with similar codes
Office rates for Maine, from the same CMS release.
No office rate
This code is for percutaneous treatment of a nasoethmoid fracture. Use 21338 when treatment is performed through open surgical exposure.
No office rate
This code concerns open treatment of an uncomplicated nose fracture. Use 21338 when the documented fracture involves the nasoethmoid region.
No office rate
This code describes open treatment of a nose and septal fracture. It does not represent open treatment of a nasoethmoid fracture without fixation.
Compare 21338 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.
2 of 2 payment localities
Rest Of Maine →
Office / nonfacility
Unavailable
Facility
$584.83
Southern Maine →
Office / nonfacility
Unavailable
Facility
$611.40
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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 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.
1,94721335,,Open tx nose & septal fx,A,,8.79,9.31,NA,9.31,,1.33,19.43,19.43,0,090,0.10,0.69,0.21,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,94821336,,Open tx septal fx w/wo stabj,A,,6.60,9.88,NA,9.88,,0.98,17.46,17.46,0,090,0.10,0.69,0.21,2,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,94921337,,Closed tx septal&nose fx,A,,3.31,8.96,,4.63,,0.50,12.77,8.44,0,090,0.10,0.69,0.21,2,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,95021338,,Open nasoethmoid fx w/o fixj,A,,6.70,11.08,NA,11.08,,0.99,18.77,18.77,0,090,0.10,0.69,0.21,2,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,95121339,,Open nasoethmoid fx w/ fixj,A,,8.29,11.46,NA,11.46,,1.21,20.96,20.96,0,090,0.10,0.69,0.21,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,95221340,,Perq tx nasoethmoid fx,A,,11.20,6.93,NA,6.93,,1.63,19.76,19.76,0,090,0.10,0.69,0.21,2,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,95321343,,Open tx dprsd front sinus fx,A,,13.96,13.17,NA,13.17,,2.05,29.18,29.18,0,090,0.10,0.69,0.21,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00