$226.26
21315 is for closed treatment without manipulation. Choose 21320 when the physician manipulates the nasal fracture and stabilizes it.
On this page
CMS RVU26D · Effective 2026-10-01
21315 Nasal fracture treatment Medicare reimbursement rates in Rhode Island
Reports closed treatment of a nasal bone fracture when the physician manages the fracture without repositioning the bone. Compare 21315 office and facility rates across CMS payment localities in Rhode Island.
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 21315 in Rhode Island?
Rhode Island 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
$164.08
1 of 1 localities have a supported rate.
Payment area: Rhode Island
One mapped payment locality.
Facility setting
$54.36
1 of 1 localities have a supported rate.
Payment area: Rhode Island
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.
Fracture treatment
About 21315: Closed nasal fracture treatment without manipulation
Reports closed treatment of a nasal bone fracture when the physician manages the fracture without repositioning the bone.
Code 21315 describes closed care for a nasal bone fracture when the physician does not manipulate the fracture to reposition it. An otolaryngologist, plastic surgeon, or facial trauma surgeon may provide this treatment after blunt nasal trauma, in an office or facility setting. The documented clinical findings should support treatment without manipulation rather than reduction or open repair.
Choose this code when the nasal bone fracture is treated without repositioning; use a different code when treatment includes manipulation, fixation, or open repair. Same-day preoperative and postoperative care is included in the 0-day global period. When multiple procedures are performed in the same session, the highest-valued procedure is paid in full and the others at 50%. Do not append modifier 50 for bilateral nasal fractures. Medicare does not pay for an assistant at surgery for this service, and co-surgeon or team-surgery billing is not permitted.
CMS billing rules for 21315
- 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 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 RVU0.94 · 20%
- Practice expense (office) RVU3.69 · 77%
- Malpractice RVU0.16 · 3%
475
Medicare services in 2024 · #3610 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.
21315 compared with similar codes
Office rates for Rhode Island, from the same CMS release.
No office rate
21325 describes open treatment of a nasal bone fracture. Use 21315 for closed treatment without manipulation.
No office rate
21330 involves open treatment with skeletal fixation. It is distinct from closed treatment without repositioning under 21315.
$436.70
21337 is for closed treatment involving both nasal and septal fractures. Code 21315 addresses the nasal bone fracture without manipulation.
Compare 21315 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
Rhode Island →
Office / nonfacility
$164.08
Facility
$54.36
Need rates for a whole code list?
Fee-sheet and API access are in early access. Tell us which codes and locations your team needs.
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 21315 in Rhode Island.
PPRRVU2026_Oct_nonQPP.csv
1,943
- Code
- 21315
- Physician work
- 0.94
- Practice expense
- 3.69
- Malpractice
- 0.16
GPCI2026.csv
92
- Locality
- Rhode Island
- Physician work
- 1.019
- Practice expense
- 1.033
- Malpractice
- 0.892
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 0.94 | × 1.019 | 0.9579 |
| Practice expense | 3.69 | × 1.033 | 3.8118 |
| Malpractice | 0.16 | × 0.892 | 0.1427 |
| Total RVUs | 4.9123 | ||
| Conversion factor | × 33.4009 | ||
Office / nonfacility rate, Rhode Island$164.08
Explore RVUs, geographic factors and the full formula
Office / nonfacility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 0.94 | 1.019 |
| Practice expense | 3.69 | 1.033 |
| Malpractice | 0.16 | 0.892 |
(0.94 × 1.019 + 3.69 × 1.033 + 0.16 × 0.892) × $33.4009 = $164.08
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 0.94 | 1.019 |
| Practice expense | 0.51 | 1.033 |
| Malpractice | 0.16 | 0.892 |
(0.94 × 1.019 + 0.51 × 1.033 + 0.16 × 0.892) × $33.4009 = $54.36
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.
21315 billing questions
How does 21315 differ from 21320?
Use 21315 when the fracture is treated without repositioning. Code 21320 describes closed treatment that includes manipulation and stabilization.
Can 21315 be reported for fractures of both nasal bones?
Do not append modifier 50 for bilateral nasal fractures under this code.
Is routine same-day care separately reportable?
Same-day preoperative and postoperative care is included in the 0-day global period. A separately identifiable E/M service requires distinct documentation and must meet applicable E/M reporting requirements.
How does Medicare handle 21315 with another procedure in the same session?
The highest-valued procedure is paid in full, and other procedures in that session are paid at 50% under the standard multiple procedure reduction.
Can an assistant or co-surgeon be billed for 21315?
Medicare does not pay for an assistant at surgery for this service. 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.
1,94021295,,Revision of jaw muscle/bone,A,,1.85,3.43,NA,3.43,,0.26,5.54,5.54,0,090,0.10,0.69,0.21,2,1,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,94121296,,Revision of jaw muscle/bone,A,,4.66,5.74,NA,5.74,,0.67,11.07,11.07,0,090,0.10,0.69,0.21,2,1,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,94221299,,Unlisted cranfcl&maxlfcl px,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
1,94321315,,Clsd tx nsl fx mnpj wo stblj,A,,0.94,3.69,,0.51,,0.16,4.79,1.61,0,000,0.00,0.00,0.00,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,94421320,,Clsd tx nsl fx w/mnpj&stablj,A,,1.55,4.83,,0.67,,0.23,6.61,2.45,0,000,0.00,0.00,0.00,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,94521325,,Open tx nose fx uncomplicatd,A,,4.08,7.71,NA,7.71,,0.59,12.38,12.38,0,090,0.10,0.69,0.21,2,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,94621330,,Open tx nose fx w/skele fixj,A,,5.65,8.20,NA,8.20,,0.83,14.68,14.68,0,090,0.10,0.69,0.21,2,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
8912502,PA,01,METROPOLITAN PHILADELPHIA,1.018,1.041,1.193
9012502,PA,99,REST OF PENNSYLVANIA,1.000,0.918,0.945
9109202,PR,20,PUERTO RICO,1.000,1.011,0.985
9214412,RI,01,RHODE ISLAND,1.019,1.033,0.892
9311202,SC,01,SOUTH CAROLINA,1.000,0.924,0.850
9403402,SD,02,SOUTH DAKOTA**,1.000,1.000,0.336
9510312,TN,35,TENNESSEE,1.000,0.909,0.537