Summary & Overview

CPT 21235: Autogenous Ear Cartilage Graft for Nasal or Auricular Repair

CPT code 21235 represents autogenous cartilage grafting using the patient’s own ear cartilage to repair nasal or auricular deformities from trauma, oncologic resection, or congenital anomalies. Nationally, this code is important for surgical reconstructive practices in otolaryngology and facial plastic surgery because it captures procedures that restore anatomy and function while minimizing graft rejection risk. Payers commonly involved in coverage for such reconstructive services include Aetna, Blue Cross Blue Shield, Cigna, UnitedHealthcare, and Medicare. This publication summarizes clinical context for the procedure, common sites of service, and the payer landscape relevant to coverage and billing.

Readers will find concise benchmarks and policy-oriented content including typical service settings, billing considerations tied to reconstructive cartilage grafting, and a high-level overview of payer coverage patterns. The guide also outlines what clinicians and billing teams should expect in claims submissions and documentation focus areas for national payers. Data not available in the input is noted where applicable.

AetnaBlue Cross Blue ShieldCignaUnitedHealthcareMedicareCPT 21235autogenous cartilage graftnasal reconstructionauricular reconstructionreconstructive surgeryfacial plastic surgerysurgical billingambulatory surgeryhospital outpatient

Billing Code Overview

CPT code 21235 describes application of an autogenous cartilage graft harvested from the patient’s ear to the nose or ear to repair deformity caused by fracture, injury, tumor resection, or congenital defect. The procedure involves harvesting cartilage from the patient (autogenous) and implanting it to reconstruct or restore form and function of nasal or auricular structures.

Service type: Autologous cartilage grafting for reconstructive repair
Typical site of service: Ambulatory surgical center or hospital outpatient/inpatient surgical setting depending on procedure complexity and patient condition

Data not available in the input.

Clinical & Coding Specifications

Clinical Context

A 42-year-old male presents to an otolaryngology/plastic surgery clinic after sustaining a nasal fracture with comminuted collapse of the lower nasal vault following an assault. Physical exam demonstrates loss of tip support and a septal cartilage deficit; the surgeon plans open nasal reconstruction using autogenous auricular cartilage graft harvested from the patient’s ear. The clinical workflow includes preoperative evaluation and imaging as needed, informed consent discussing donor-site morbidity, intraoperative harvesting of conchal cartilage, shaping and fixation of the cartilage graft to repair nasal framework deformity, closure of donor and recipient sites, and routine postoperative care with instructions for wound care and follow-up visits.

Coding Specifications

Modifier	Description	When to Use
`22`	Increased procedural services	Use when the procedure requires substantially greater work than usual (extensive dissection, prolonged graft shaping or fixation).
`51`	Multiple procedures	Use when `21235` is billed on the same date as additional distinct procedures during the same session.
`52`	Reduced services	Use when the procedure is partially reduced or not completed as originally planned.
`59`	Distinct procedural service	Use to indicate a separate and distinct procedure when multiple services on the same date might be bundled.
`62`	Two surgeons	Use when two surgeons work together as primary surgeons performing distinct portions of the reconstruction.
`76`	Repeat procedure by same physician	Use if the same procedure is repeated by the same provider during the postoperative period (note: `76` is not in the input list; do not use).
`78`	Unplanned return to the operating room for a related procedure during the postoperative period	Use when the patient returns to the OR for a complication related to the initial graft or reconstruction.
`79`	Unrelated procedure or service by the same physician during the postoperative period	Use when an unrelated procedure is performed during the global period.
`26`	Professional component	Use when billing only the professional component in settings where a global service is split (rare for this code).
`TC`	Technical component	Use when billing only the technical component (not typically applicable to surgeon-performed grafting).
`50`	Bilateral procedure	Use when identical procedures are performed on both sides (e.g., bilateral auricular donor sites).
`LT`	Left side	Use to identify left-sided donor or recipient site when laterality reporting is required.
`RT`	Right side	Use to identify right-sided donor or recipient site when laterality reporting is required.
`59`	See above; duplicate entries should be avoided.

Taxonomy Code	Specialty	Notes
207P00000X	Otolaryngology	Common specialty performing nasal reconstruction and cartilage grafting.
208700000X	Plastic Surgery	Frequently performs reconstructive rhinoplasty and auricular cartilage harvest.
2080P0200X	Facial Plastic Surgery	Subspecialists focused on nasal framework reconstruction.
163W00000X	General Surgery	May perform ear cartilage harvest in combined reconstructive cases.
2084P0800X	Oral & Maxillofacial Surgery	Occasionally involved when facial trauma is treated with cartilage grafting.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`S02.2X`	Fracture of nasal bones (unspecified)	Nasal fractures with deformity often require structural grafting with auricular cartilage.
`S02.6`	Fracture of zygoma and maxilla	Midface fractures may compromise nasal support and require cartilage grafting during reconstruction.
`S01.4`	Open wound of external ear	Traumatic ear injury can necessitate cartilage harvest from the auricle and reconstruction of nasal defects.
`C43.9`	Malignant melanoma of skin, unspecified	Tumor resection of nasal skin or cartilage may require reconstruction with autogenous cartilage graft.
`Q67.4`	Other congenital deformities of nose	Congenital nasal deformities (e.g., cleft nasal deformity) may be repaired using auricular cartilage grafts.
`T81.89`	Other complications of procedures, not elsewhere classified	Used when complications arise postoperatively related to graft or donor site.
`S01.2`	Laceration of nose and nasal structures	Complex lacerations with structural loss may require cartilage graft reconstruction.
`M95.0`	Postprocedural complications and disorders of the nose	Includes sequelae after nasal surgery that may need revisional cartilage grafting.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`21230`	Reconstruction of mandible or maxilla, with autograft; craniofacial (including obtaining graft)	May be used for more extensive craniofacial autograft procedures in trauma contexts; not specific to auricular cartilage.
`30465`	Repair, complex, nasal tip, with cartilage graft(s) (separate procedure)	Often performed in conjunction with `21235` when structural tip support reconstruction is needed.
`30400`	Rhinoplasty, primary; minor revision to nasal tip or septum	Performed in aesthetic or reconstructive nasal procedures alongside cartilage grafting.
`15734`	Muscle, myocutaneous, or fasciocutaneous flap with microvascular anastomosis (free flap)	Used in more extensive soft tissue reconstruction when cartilage grafting alone is insufficient.
`12052`	Repair, intermediate, wounds of scalp, axillae, trunk and/or extremities (2.5 cm to 7.5 cm)	Representative of closure techniques for donor-site wounds after auricular cartilage harvest.