CPT Code 19020: Mastotomy with exploration or drainage of abscess
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Last Updated: August 13, 2026
Key takeaways
CPT code 21235 covers the harvest of autogenous ear cartilage and its transfer as a graft to the nose or ear.
The code carries a 90-day global surgical period, so routine post-operative visits inside that window are bundled into the surgical payment.
21235 is not separately payable when the graft is harvested on the same side as a tympanoplasty, under NCCI bundling rules.
For 2026, CMS lists 22.07 total RVUs in the non-facility setting and 15.15 in a facility.
Practice management software like Pabau helps ENT and facial plastic surgery practices catch bundling and modifier errors before a claim goes out.
CPT code 21235 covers the harvest of autogenous ear cartilage and its transfer as a graft to the nose or ear. The descriptor includes obtaining the graft, so the harvest itself is never a separate line on the claim. ENT surgeons, facial plastic surgeons, and Mohs reconstructive surgeons all report it.
The code carries a 90-day global period and 22.07 total RVUs in the non-facility setting for 2026. Its most common denial comes from NCCI bundling with a same-side tympanoplasty.
Below you will find the official descriptor, the current RVU values, modifier rules, bundling logic, and the ICD-10 codes payers accept.
CPT Code 21235: Official description and procedure category
The American Medical Association places CPT code 21235 in the musculoskeletal system section of the CPT codebook. It sits in the Head subsection, codes 21000 to 21499.
The official descriptor reads: Graft; ear cartilage, autogenous, to nose or ear (includes obtaining graft).
Three elements of that descriptor matter for correct billing. First, the graft must be autogenous, meaning the patient’s own cartilage. Second, the harvest site is the ear. Third, the code includes obtaining the graft, so the harvest cannot be billed as a separate service.
Which procedures use an ear cartilage graft?
Surgeons harvest auricular cartilage from the tragus, concha, or antihelix, then transfer it to the nose or the ear. Five clinical contexts account for most 21235 claims.
- Rhinoplasty structural support: Tragal or conchal cartilage is shaped into columellar struts, lateral crural grafts, or tip grafts during nasal reconstruction.
- Tympanic membrane repair: Tragal cartilage reinforces a thinned or perforated eardrum, often alongside tympanoplasty. See the bundling rules below before you bill it.
- Ear reconstruction: Harvested conchal cartilage rebuilds the structural framework after trauma or in congenital deformity.
- Nasal valve repair: Cartilage battens from the concha correct internal or external nasal valve collapse.
- Mohs nasal reconstruction: Conchal cartilage restores nasal support after skin cancer excision, so dermatology practices bill this code too.
The facial plastic surgery specialty accounts for the majority of 21235 claims. Otolaryngologists most often pair the code with tympanoplasty, which is where the common denial pattern starts.
Billing attributes at a glance
The table below lists the billing attributes CMS publishes for this code. Figures come from the 2026 Medicare Physician Fee Schedule, which is refreshed every January. Check the CMS lookup tool at the start of each plan year.
Two rows there decide how the claim is built. 21235 is a standalone code, so it takes modifier -51 when it follows a higher-valued procedure. True add-on codes such as 20938 are exempt from -51 and are never reported alone.
Reimbursement and 2026 RVU values
Medicare pays for CPT 21235 by multiplying its relative value units by an annual conversion factor. RVUs split into three parts. Those are physician work, practice expense, and malpractice. The figures below are the 2026 national values from the CMS relative value files.
Site of service moves the payment more than anything else on this claim. A non-facility case pays about $737 at the national rate, against roughly $506 in a facility. Hospital and surgery center cases carry the lower figure because the site bills its own facility fee.
What the payment indicators change on your claim
Three fee schedule indicators decide what actually lands in the bank. None of them show up in a standard descriptor lookup.
- Multiple procedure indicator 2: the standard reduction applies, so 21235 pays at 50% when a higher-valued procedure sits above it on the claim.
- Bilateral surgery indicator 0: bilateral rules do not apply, so modifier 50 earns no 150% adjustment even when both ears are harvested.
- Assistant at surgery indicator 1: an assistant is not paid unless the documentation establishes why one was medically necessary.
Commercial insurers often reimburse at a percentage of the Medicare fee schedule. That makes the MPFS figure a useful baseline in contract talks. An automated underpayment check flags a short-paid claim against your contracted rate faster than a month-end review ever will.
Pro Tip
Run CPT 21235 through your payer contract matrix before each case. Some commercial plans apply a multiple-procedure reduction even when 21235 is the only separately billable procedure on the claim. Catching this before submission prevents a partial-payment surprise.
Global surgical period and post-operative care
CPT code 21235 carries a 90-day global surgical period under the Medicare Physician Fee Schedule. Three groups of services are bundled into that global payment.
- Pre-operative care: evaluation and management on the day before and the day of surgery.
- Intra-operative services: every surgical step performed during the operative session.
- Post-operative care: follow-up visits related to normal recovery inside the 90-day window.
Modifiers let you break out services that fall outside the global package. That covers post-operative care beyond normal recovery, plus any separate problem needing attention inside the window. Practices running surgical schedules across sites use multi-location tools to keep every post-op visit attached to the right case.
Modifier guidance for the graft claim
Modifiers justify separate payment for services a payer would otherwise bundle or deny. Three of them cover almost every 21235 claim.
Modifier -59 carries the highest audit risk. Payers expect documentation that establishes a different encounter, a different procedure, or a different anatomical site.
Using it to unbundle a same-side tympanoplasty graft is a standing audit trigger. NCCI edits change quarterly, so check the current tables before you apply -59.
Tympanoplasty bundling rules explained
A tragal graft harvested from the same ear during a tympanoplasty is not separately payable. CMS NCCI edits bundle the harvest into tympanoplasty codes 69641 to 69646 when both happen on the same side.
The reasoning is that the tympanoplasty package already includes any tissue harvest needed to finish the repair on that field. Billing 21235 alongside 69641-69646 on the same side is usually denied, even with modifier -59 attached.
- Same side, same session: 21235 is not separately billable and is bundled into the tympanoplasty code.
- Contralateral side: 21235 may be reported with modifier -59 and clear anatomical documentation of the harvest site.
- Separate operative session: 21235 on a different date is separately billable, with a global-period modifier where one applies.
Confirm the active edits for 21235 before each submission through the CMS NCCI edit files. The tables are republished quarterly and a code pair’s status can change.
Commonly paired CPT codes with 21235
CPT code 21235 rarely appears on a claim alone. The table below lists the codes reported with it most often, plus the bundling status and the modifier each pairing needs.
Supported ICD-10 diagnosis codes
Payers need a supported diagnosis code to establish medical necessity for CPT 21235. The ICD-10-CM codes below are the ones most commonly accepted. Cosmetic-only cases are frequently denied, so document the reconstructive basis clearly.
Always pick the most specific ICD-10-CM code available. Side-specific entries such as S01.341A are preferable to unspecified variants. Coverage rules vary by Medicare Administrative Contractor, so read your MAC’s local coverage determination before the first claim of the year.
Payer coverage and LCD considerations
Coverage for CPT 21235 turns on whether the procedure is cosmetic or reconstructive. Your documentation is what settles that question.
Reconstructive indications, typically covered: congenital deformities, traumatic injuries, and correction of functional impairment such as nasal valve collapse or a perforated eardrum. Payers expect documentation that links the graft harvest to a reconstructive goal.
Cosmetic indications, typically denied: purely aesthetic rhinoplasty with no functional defect, and elective ear reshaping without a congenital or traumatic basis. Some MAC coverage determinations exclude cosmetic procedures from 21235 outright.
- Read your MAC’s local coverage determination for 21235 or related ENT surgical codes before the first claim of the year.
- Document the functional or reconstructive indication in the operative report and in the pre-operative history and physical.
- For nasal valve repair paired with 21235, get prior authorization from commercial payers who apply medical necessity criteria to rhinoplasty.
Compliance tools with payer policy alerts flag a claim carrying a cosmetic diagnosis before it leaves the practice. Fixing one at the desk takes minutes. Appealing the same claim after a denial takes weeks.
Documentation the operative note must carry
A 21235 claim survives an audit on the strength of its operative note. The note does not need to be long, but it must address four elements.
- Graft site: name the exact harvest site, whether tragus, conchal bowl, or antihelix. “Ear cartilage” alone is not enough for some payers.
- Reason for harvest: state why ear cartilage suited this patient and this procedure, such as structural characteristics or available anatomy.
- Amount harvested: record approximate dimensions or weight. This matters most when one graft serves several purposes in the same case.
- Destination of the graft: state how the cartilage was used, such as a columellar strut, an eardrum buttress, or an auricular framework.
The operative note should stand alone as a billing document. An auditor reading only that report should find all four elements without pulling other records. Structured templates inside your clinical forms keep the wording consistent across every surgeon in the practice.
A shared pre-operative checklist helps as well. The WHO surgical safety checklist gives the team a repeatable place to confirm site and side before the graft is taken. Well-structured medical forms cut the missing detail that becomes a denial weeks later.
Pro Tip
Build a structured operative dictation template with a dedicated section for the four 21235 elements. Consistent wording lowers audit exposure, and it makes an appeal far quicker to assemble when a denial does land.
How Pabau keeps 21235 claims clean from note to payment
Most practices find a 21235 bundling problem after the remittance arrives. The operative note sits in one system and the claim in another, and nobody compares the two until a denial code shows up.
Practice management software like Pabau holds the operative note, the coded claim, and the payer rules on one record.
Claims management checks run before submission, so a same-side tympanoplasty pairing or a missing modifier surfaces at the desk. Post-operative visits inside the 90-day window attach to the original case on their own.
The result is fewer reworked claims and a shorter wait between surgery and payment. Every Pabau subscription includes the full feature set, so claims, charting, and reporting are not separate purchases.
Reduce CPT 21235 denials with smarter claims tracking
Pabau’s claims management tools help ENT and facial plastic surgery practices track bundling rules, flag modifier issues before submission, and follow up on denials automatically.
Conclusion
Whether a 21235 claim gets paid comes down to three things. The side the graft came from settles the bundling question. The operative note settles the audit. The stated indication settles coverage.
The reflex to reach for modifier -59 is where practices lose the most money. It holds up when the harvest is genuinely contralateral or genuinely a separate session, and fails everywhere else. Put that check into your submission routine rather than your appeals routine.
Book a demo to see how Pabau tracks bundling rules, modifiers, and global-period visits for ENT and facial plastic surgery practices.
Continue your research
Coding another graft harvest? CPT 20972 walks through a free osteocutaneous flap claim, where the harvest is bundled the same way.
Billing an autograft as an add-on? CPT 20938 shows how a modifier -51 exempt add-on code behaves next to its primary procedure.
Reconstructing the nose or ear after skin cancer? CPT 17284 covers the lesion destruction claim that often precedes a cartilage graft.
Documenting a surgical complication? Y69 explains how to report an unspecified misadventure during surgical care.
Comparing claims platforms? Pabau vs Waystar weighs two claims workflows for practices billing high-value surgical procedures.
Frequently asked questions
What does CPT code 21235 cover?
CPT code 21235 covers the harvest of autogenous ear cartilage and its transfer to the nose or ear. Obtaining the graft is included in the code. ENT surgeons and facial plastic surgeons report it for rhinoplasty, tympanoplasty, nasal valve repair, and auricular reconstruction.
Is CPT 21235 separately billable with tympanoplasty?
No. On the same side as a tympanoplasty in the same session, 21235 is bundled under NCCI rules. It can be reported separately when the graft comes from the contralateral ear or from a distinct session. Modifier -59 and supporting documentation are required.
What are the global days for CPT 21235?
CPT 21235 carries a 90-day global surgical period. Routine post-operative visits inside that window are bundled into the surgical payment. Use modifier -79 for an unrelated procedure during the global period, and check the current fee schedule entry each January.
Is a tragal cartilage graft payable on the same side as a tympanoplasty?
No. A tragal graft harvested on the same side as a tympanoplasty is bundled into the tympanoplasty code under NCCI edits. Separate billing needs the graft taken from the contralateral ear, or a clearly distinct operative session. Modifier -59 without that documentation basis is an audit risk.
What ICD-10 codes support CPT 21235?
Commonly accepted diagnosis codes include Q17.3 for congenital ear malformation, Q17.2 for microtia, and H72.90 for tympanic membrane perforation. J34.2 and J34.89 cover deviated septum and nasal valve collapse. Always use the most specific side-specific code, and check your MAC’s coverage determination.
Can CPT 21235 be billed with CPT codes 30400-30420?
Yes. CPT 21235 is generally separately reportable alongside rhinoplasty codes 30400-30420 with modifier -51. The operative note must document the ear cartilage harvest as a distinct component of the case. Verify current NCCI edits and payer policy, since some commercial plans bundle differently from Medicare.
