No office rate
Use 21811 for internal fixation of one to three ribs; 21813 requires fixation of seven or more.
On this page
CMS RVU26D · Effective 2026-10-01
21813 Rib fracture fixation Medicare reimbursement rates in Massachusetts
Reports operative internal fixation of seven or more rib fractures, including thoracoscopic visualization when performed, for patients requiring surgical stabilization. Compare 21813 office and facility rates across CMS payment localities in Massachusetts.
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 21813 in Massachusetts?
Massachusetts 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
$878.17–$929.96
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.
Thoracic surgery
About 21813: Open fixation of seven or more rib fractures
Reports operative internal fixation of seven or more rib fractures, including thoracoscopic visualization when performed, for patients requiring surgical stabilization.
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.
CMS billing rules for 21813
- Global period
- Minor procedure with a 0-day global period: same-day preoperative and postoperative care is 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 procedure with modifier 50 is paid at 150%.
- Assistant at surgery
- Assistant at surgery may be paid.
- Co-surgeons
- Co-surgeons not permitted.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU17.17 · 64%
- Practice expense (office) RVU4.92 · 18%
- Malpractice RVU4.60 · 17%
68
Medicare services in 2024 · #5159 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.
21813 compared with similar codes
Office rates for Massachusetts, from the same CMS release.
No office rate
Use 21812 when four to six ribs are treated with internal fixation; 21813 is the seven-or-more-rib level.
$185.10–$204.82
This code concerns treatment of a sternum fracture, not rib-fracture fixation.
No office rate
This code is for open treatment of a sternum fracture; 21813 is for internal fixation of seven or more ribs.
Compare 21813 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
Metropolitan Boston →
Office / nonfacility
Unavailable
Facility
$929.96
Rest Of Massachusetts →
Office / nonfacility
Unavailable
Facility
$878.17
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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 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.
2,02621750,,Repair of sternum separation,A,,11.12,5.93,NA,5.93,,2.73,19.78,19.78,0,090,0.10,0.69,0.21,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
2,02721811,,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