Billing code 69643: TympanoplastyMedicare rate & RVUs in Massachusetts
Report this operation for tympanic membrane repair with mastoid surgery when the canal wall is preserved or reconstructed and the ossicular chain is not rebuilt.
CMS doesn’t publish an office rate for 69643 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 69643 covers
An otolaryngologist typically performs this operation in an operating room for chronic middle-ear or mastoid disease, including cases requiring removal of diseased tissue and repair of a tympanic membrane defect. The procedure combines tympanoplasty with mastoid work; its distinguishing features are an intact or reconstructed ear canal wall and no ossicular chain reconstruction. Canalplasty and related middle-ear work may be part of the operation.
Select the code from the operative report: it should support the tympanoplasty and mastoidectomy, the canal-wall approach, and the absence of ossicular chain reconstruction. This major surgery has a 90-day global period, including 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 others at 50%. 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 69643 pays more and less in Massachusetts
| Payment locality | Office | Facility |
|---|---|---|
| Metropolitan Boston | Unavailable | $1,197.79 |
| Rest Of Massachusetts | Unavailable | $1,106.98 |
How the 69643 rate is calculated
Each of 69643’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 · 69643
RVUs × geographic indexes × conversion factor
Work15.20
15.20 RVUs× 1.000 GPCI
Practice expense15.09
15.09 RVUs× 1.000 GPCI
Malpractice2.27
2.27 RVUs× 1.000 GPCI
Adjusted RVUs
32.5600
Conversion factor
$33.4009
Medicare rate
$1,087.53
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 69643
69643 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 69643
Tympanoplasty
| 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 · 69643
Tympanoplasty
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
69643 without 50 · national facility
$1,087.53
Tympanoplasty
69643-50 · Bilateral: 150%
$1,631.30
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).
69643 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 69641Tympanoplasty
- Both describe tympanoplasty with mastoidectomy without ossicular chain reconstruction. 69643 is distinguished by an intact or reconstructed canal wall.
- 69644Tympanoplasty
- This is the canal-wall counterpart when ossicular chain reconstruction is performed; 69643 is for the operation without that reconstruction.
- 69631Tympanoplasty
- 69631 describes tympanoplasty without mastoidectomy. Choose 69643 when mastoidectomy is part of the operation and the canal wall is intact or reconstructed.
69643 billing questions
How does 69643 differ from 69641?
Both involve tympanoplasty with mastoidectomy without ossicular chain reconstruction. Choose 69643 when the canal wall is intact or reconstructed; the operative report should establish that feature.
When is 69644 reported instead?
Use 69644 when the canal wall is intact or reconstructed and the operation also includes ossicular chain reconstruction. Code 69643 describes the corresponding canal-wall approach without that reconstruction.
Can canalplasty or middle-ear work be reported separately?
Canalplasty and related middle-ear work may be included in this tympanoplasty-mastoidectomy service. The operative report should identify any separate procedure as distinct rather than an integral part of the operation.
What documentation supports 69643?
Document the tympanoplasty and mastoidectomy, whether the canal wall was preserved or reconstructed, and whether the ossicular chain was reconstructed. These details distinguish 69643 from nearby codes.
How does Medicare handle bilateral reporting and other procedures in the same session?
With modifier 50, a bilateral procedure is paid at 150%. For multiple procedures in one session, the highest-valued procedure is paid in full and the others at 50%.
Is an assistant surgeon or co-surgeon payable?
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 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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