No office rate
Both address open frontal sinus fracture treatment. Use 21344 for a complicated fracture pattern; 21343 is for a depressed frontal sinus fracture.
On this page
CMS RVU26D · Effective 2026-10-01
21344 Frontal sinus repair Medicare reimbursement rates in Vermont
Open repair of a complicated frontal sinus fracture, reported for operative treatment of a complex fracture pattern involving the sinus or adjacent structures. Compare 21344 office and facility rates across CMS payment localities in Vermont.
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 21344 in Vermont?
Vermont 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
No supported rate
Facility setting
$1161.02
1 of 1 localities have a supported rate.
Payment area: Vermont
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.
Facial fracture surgery
About 21344: Complicated frontal sinus fracture repair
Open repair of a complicated frontal sinus fracture, reported for operative treatment of a complex fracture pattern involving the sinus or adjacent structures.
Code 21344 represents open operative repair of a complex fracture involving the frontal sinus, the air space behind the forehead. Facial trauma, otolaryngology, oral and maxillofacial, or neurosurgical specialists may perform the repair in an operating room. The injury may involve sinus walls, the drainage pathway, or adjacent cranial structures and require surgical exposure and reconstruction. A posterior-table injury with intracranial risk is one representative complex pattern, but selection follows the documented fracture and operative treatment, not one finding alone.
Choose 21344 for open treatment of a complicated frontal sinus fracture; a depressed frontal sinus fracture treated openly may instead fit the distinct 21343 pathway. The operative report should identify the fracture pattern and involved structures, explain the open repair, and describe reduction, reconstruction, and fixation when performed. CMS assigns a 90-day major-surgery global period, including the day-before preoperative visit and 90 days of related postoperative care. For same-session multiple procedures, the highest-valued procedure is paid in full and additional procedures at 50%. Assistant-at-surgery payment and co-surgeons are permitted; team surgery is not permitted.
CMS billing rules for 21344
- 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 may be paid.
- Co-surgeons
- Co-surgeons permitted.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU21.03 · 58%
- Practice expense (office) RVU12.31 · 34%
- Malpractice RVU3.05 · 8%
27
Medicare services in 2024 · #5724 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.
21344 compared with similar codes
Office rates for Vermont, from the same CMS release.
No office rate
21339 treats an open nasoethmoid fracture with fixation. It is not the code for open repair of the frontal sinus fracture.
No office rate
21346 addresses open treatment of a nasomaxillary fracture with fixation, rather than a complicated frontal sinus fracture.
No office rate
21385 describes open treatment of an orbital fracture through a transantral approach; 21344 addresses the frontal sinus fracture.
Compare 21344 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
Vermont →
Office / nonfacility
Unavailable
Facility
$1161.02
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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 21344 in Vermont.
PPRRVU2026_Oct_nonQPP.csv
1,954
- Code
- 21344
- Physician work
- 21.03
- Practice expense
- 12.31
- Malpractice
- 3.05
GPCI2026.csv
105
- Locality
- Vermont
- Physician work
- 1.000
- Practice expense
- 0.990
- Malpractice
- 0.506
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 21.03 | × 1.000 | 21.0300 |
| Practice expense | 12.31 | × 0.990 | 12.1869 |
| Malpractice | 3.05 | × 0.506 | 1.5433 |
| Total RVUs | 34.7602 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Vermont$1161.02
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 21.03 | 1 |
| Practice expense | 12.31 | 0.99 |
| Malpractice | 3.05 | 0.506 |
(21.03 × 1 + 12.31 × 0.99 + 3.05 × 0.506) × $33.4009 = $1161.02
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.
21344 billing questions
How do I distinguish 21344 from 21343?
21344 is for open treatment of a complicated frontal sinus fracture. Code 21343 describes open treatment of a depressed frontal sinus fracture; choose based on the documented fracture pattern and operative service.
Does fixation support reporting 21344?
Fixation may be part of the open fracture repair. Document the fracture anatomy, operative approach, and reduction or fixation performed.
What postoperative care is included?
The 90-day global includes the day-before preoperative visit and 90 days of related postoperative care.
Can an assistant or co-surgeon be reported?
CMS indicates assistant-at-surgery payment may be made and permits co-surgeons. Team surgery is not permitted for this code.
Should modifier 50 be appended?
No. The descriptor and anatomy make modifier 50 inappropriate for this service.
How are other procedures in the same session paid?
Under the standard multiple-procedure reduction, the highest-valued procedure is paid in full and additional procedures are paid at 50%.
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.
1,95121339,,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
1,95421344,,Open tx compl front sinus fx,A,,21.03,12.31,NA,12.31,,3.05,36.39,36.39,0,090,0.10,0.69,0.21,2,0,2,2,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,95521345,,Closed tx nose/jaw fx,A,,8.83,13.81,,6.89,,1.29,23.93,17.01,0,090,0.10,0.69,0.21,2,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,95621346,,Opn tx nasomax fx w/fixj,A,,11.16,14.57,NA,14.57,,1.63,27.36,27.36,0,090,0.10,0.69,0.21,2,0,1,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,95721347,,Opn tx nasomax fx multple,A,,13.19,13.01,NA,13.01,,1.92,28.12,28.12,0,090,0.10,0.69,0.21,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
10204412,TX,18,HOUSTON,1.008,0.993,1.376
10304412,TX,99,REST OF TEXAS,1.000,0.949,0.903
10403502,UT,09,UTAH,1.000,0.940,0.898
10514512,VT,50,VERMONT,1.000,0.990,0.506
10611302,VA,00,VIRGINIA,1.000,0.983,0.706
10709202,VI,50,VIRGIN ISLANDS,1.000,1.011,0.985
10802402,WA,02,SEATTLE (KING CNTY),1.050,1.227,0.817