Billing code 69604: Mastoid revisionMedicare rate & RVUs in Massachusetts
Revision mastoid surgery that includes tympanoplasty is reported when an otologic surgeon revises a previously operated mastoid and repairs the eardrum.
CMS doesn’t publish an office rate for 69604 in Massachusetts.
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 69604 covers
An otolaryngologist, often an otologist, uses this code for revision surgery on a previously operated mastoid that includes tympanoplasty. The operation addresses the mastoid and reconstructs the tympanic membrane; it is performed in an operating room, commonly for persistent or recurrent disease in an ear with prior mastoid surgery. The operative report should make clear that this is revision work and describe both the mastoid portion and the eardrum repair.
Report the code when the revision results in tympanoplasty, rather than selecting a sibling code based on a different resulting mastoid procedure. The 90-day global period includes the day-before preoperative visit and related postoperative care for 90 days. 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% reduction. For bilateral reporting with modifier 50, payment is 150%. Medicare does not pay an assistant at surgery; 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.
Where 69604 pays more and less in Massachusetts
| Payment locality | Office | Facility |
|---|---|---|
| Metropolitan Boston | Unavailable | $1,086.39 |
| Rest Of Massachusetts | Unavailable | $1,004.22 |
How the 69604 rate is calculated
Each of 69604’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 · 69604
RVUs × geographic indexes × conversion factor
Work13.85
13.85 RVUs× 1.000 GPCI
Practice expense13.66
13.66 RVUs× 1.000 GPCI
Malpractice2.02
2.02 RVUs× 1.000 GPCI
Adjusted RVUs
29.5300
Conversion factor
$33.4009
Medicare rate
$986.33
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 69604
69604 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 69604
Mastoid revision
| 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) | 1 | Bilateral with modifier 50 pays 150% of the fee schedule amount. |
| Assistant at surgery (80/81/82/AS) | 1 | Not paid (statutory restriction). |
| Co-surgeons (62) | 0 | Not permitted. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 0 | Physician service: no professional/technical split. |
| Split (54/55/56) | 0.07/0.79/0.14 | Share of the payment for pre-op, the procedure itself, and post-op care. |
Global surgery period · 69604
Mastoid revision
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 50 · payment effect
With and without the modifier
69604 without 50 · national facility
$986.33
Mastoid revision
69604-50 · Bilateral: 150%
$1,479.50
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).
69604 compared with similar codes
Compare codes · National
5 codes, side by side
How to choose
- 69601Mastoid revision
- Both describe revision mastoid surgery, but 69601 represents a different resulting mastoid procedure. Choose the code that matches the operative result; 69604 is the tympanoplasty-resulting service.
- 69603Mastoid revision
- This is a sibling revision mastoidectomy code for a different resulting procedure. Use 69604 when the revision includes tympanoplasty as its result.
- 69641Tympanoplasty
- 69641 describes tympanoplasty performed with mastoidectomy; 69604 is for revision of a previously operated mastoid resulting in tympanoplasty.
- 69631Tympanoplasty
- 69631 is tympanoplasty without mastoidectomy. Choose 69604 when the operation includes revision mastoid work as well as tympanoplasty.
69604 billing questions
How does this differ from codes 69601 through 69603?
Those sibling codes represent revision mastoid procedures resulting in other specified mastoidectomy types. Use 69604 when the revision results in tympanoplasty.
Can tympanoplasty be reported separately from the mastoid revision?
The tympanoplasty is part of the service represented by 69604. Do not separately report the same eardrum repair work.
What documentation supports reporting 69604?
The operative report should describe the prior mastoid surgery, the revision performed, and the tympanoplasty completed as part of the operation.
How is bilateral surgery reported?
Use modifier 50 for bilateral reporting; CMS pays the bilateral procedure at 150%.
Is an assistant surgeon payable for this procedure?
CMS applies a statutory restriction, so an assistant at surgery is not paid for 69604. Co-surgeons and team surgery are also 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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