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    OpenPayerBilling CodesFracture and/or Dislocation Procedures on the Neck (Soft Tissues) and ThoraxCPT cpt-21820-sternal-fracture-manipulation
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    CPT 21820: Closed Manipulation of Sternal Fracture

    Medicare pays $186 on average nationally for this procedure.

    CPT code 21820 describes closed manipulation of a fractured sternum (breastbone) following traumatic injury, a surgical manipulation procedure typically performed in an operating room or other procedural setting to realign sternal bone fragments and restore chest wall stability; this service involves manual or instrument-assisted repositioning of the sternum under appropriate anesthesia and perioperative care.

    For related coverage guidance, see recent payer policy updates: Orthopedic Joint Procedures of the Knee for Managed Medicaid (MMC), Health and Recovery Plan (HARP), Child Health Plus (CHP), and Essential Plan (EP) Members, Autologous Chondrocyte Transplantation or Implantation Corporate Medical Policy, Autologous Platelet-Derived Growth Factors (Platelet-Rich Plasma [PRP]).

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    Clinical & Coding Specifications

    Clinical Context

    A typical patient is an adult who sustained blunt chest trauma, such as from a motor vehicle collision, fall from height, or direct blow during an industrial accident, presenting with anterior chest pain, localized tenderness over the sternum, and possible instability or palpable deformity. Initial evaluation in the emergency department or trauma bay includes airway/breathing/circulation assessment, chest radiography and/or CT scan to confirm a sternal fracture and assess for associated thoracic injuries (e.g., rib fractures, pneumothorax, cardiac contusion). When the fracture is displaced or causes persistent severe pain or respiratory compromise, the orthopedic or thoracic surgery team performs closed or open manipulation and stabilization of the sternum. The procedure typically occurs in an operating room or procedure suite under monitored anesthesia care or general anesthesia with fluoroscopic guidance as needed. Intra-procedural documentation includes indication, informed consent, anesthesia type, technique of manipulation or fixation, any implants used, estimated blood loss, and post-procedure neurovascular and respiratory status. Postoperative care involves pain control, respiratory therapy, monitoring for wound or hardware complications, and outpatient follow-up with imaging to confirm alignment and healing.

    Related CPT Codes

    CPT CodeDescriptionRelationship to This Procedure
    11010Debridement, skin, subcutaneous tissue, and muscle of chest wall (if performed)May be performed prior to or with 21820 if open wounds or devitalized tissue require debridement.
    11011Debridement, muscle and/or fascia (extensive)Use for more extensive debridement of the chest wall during open sternal procedures when documented.
    19307Mastectomy, partial (repair of chest wall defects rarely)Occasionally used in complex chest wall reconstruction when adjacent breast tissue is involved; related in multidisciplinary cases.
    20680Removal of deep implant; e.g., hardware removalMay be performed later if sternal hardware is removed after healing from 21820 when fixation devices are used.
    77002Fluoroscopic guidance for needle placement (single)Fluoroscopy may be used intraoperatively to guide manipulation or fixation of the sternum during 21820.
    99291Critical care, evaluation and management of the critically ill patient, first 30-74 minutesUsed when pre- or post-procedure critical care is required for trauma patients undergoing 21820.

    Related Modifiers

    12 rows

    ModifierDescriptionWhen to Use
    22Modifier –22 (Increased Procedural Services) is used when a reported procedure is substantially more extensive than normally required. The CPT Manual and CMS state it may be appended only when the…- When to use: Append modifier -22 to a procedural CPT code when the service performed is substantially more extensive than the usual service described by that code — i.e., the procedure required…
    23Modifier -23 (Unusual Anesthesia) is used on anesthesia service CPT codes when a procedure that normally requires no anesthesia or only local anesthesia must be performed under general anesthesia…- Use modifier -23 only on anesthesia CPT codes (00100–01999) when a procedure that normally requires no anesthesia or only local anesthesia must be performed under general anesthesia because of…
    26Modifier 26 (Professional Component) identifies and bills only the professional portion of a split service — the physician’s interpretation, report, and medical judgment — when the technical…- Use CPT Modifier -26 when you are billing only the professional component (PC) of a split‑bill eligible service—i.e., you performed the physician interpretation, medical judgment and prepared a…
    50Modifier –50 (Bilateral Procedure) is appended to a CPT code when an identical procedure is performed on paired anatomical structures during the same operative session. The AMA states to add…- Use modifier -50 when the same CPT surgical, diagnostic, or radiology procedure is performed on paired anatomical structures (both sides of the body) during the same operative/session by the same…
    51Modifier –51 (Multiple Procedures) is used when the same provider performs multiple procedures in the same session to identify secondary, non‑exempt procedures and indicate payment reduction logic…- Use modifier -51 when the same provider performs multiple distinct procedures during the same patient encounter: report the highest‑valued procedure first (no modifier) and append -51 to…
    52Modifier ‑52 (Reduced Services) indicates that a service or procedure was partially reduced or omitted at the provider’s discretion, allowing reporting of the basic procedure number with a qualifier…- Use modifier -52 when a physician or qualified health professional electively reduces or omits part of a procedure or service (for example, performing fewer required views or omitting a portion of…
    53Modifier 53 (Discontinued Procedure) signals that a surgical or diagnostic service was begun by the physician but terminated because of extenuating circumstances that threatened the patient’s…- Use modifier -53 when a physician/qualified healthcare professional has started a surgical or diagnostic procedure (e.g., anesthesia administered, incision or scope insertion) and then discontinues…
    59Modifier 59 indicates a distinct procedural service when two procedures that are not normally billed together are clinically and procedurally separate. The CPT definition (as reiterated by CMS)…- Use modifier -59 to report a distinct procedural service when documentation supports that the procedure reported is not normally billed together with another service on the same day because of a…
    62Modifier 62 indicates that two surgeons function as co‑surgeons, each performing distinct parts of the same primary surgical procedure. It is appended to the primary procedure code (and any…- Use modifier -62 when two surgeons act as co‑surgeons (both primary surgeons) on a single definitive primary procedure, each performing distinct parts of the same surgical procedure (append -62 to…
    78CPT modifier -78 indicates an unplanned, related return to the operating or procedure room by the same provider during the global postoperative period. It is appended when treatment for a…- Use modifier -78 when an unplanned, related complication during the original procedure’s global postoperative period requires the patient to return to a formal operating or procedure room and the…

    Showing 1–10 of 12

    Related Provider Taxonomies

    8 rows

    Taxonomy Code
    207P00000X
    207L00000X
    208000000X
    207R00000X
    207PE0005X
    163WX1500X
    332100000X
    261QA1903X

    Related ICD-10-CM Codes

    16 rows

    ICD-10-CM CodeDescription
    M80.00XAAge-related osteoporosis with current pathological fracture, unspecified site, initial encounter for fracture
    M81.0Age-related osteoporosis without current pathological fracture
    S22.32XAFracture of one rib, left side, initial encounter for closed fracture
    S22.32XDFracture of one rib, left side, subsequent encounter for fracture with routine healing
    S22.39XAFracture of one rib, unspecified side, initial encounter for closed fracture
    S22.39XDFracture of one rib, unspecified side, subsequent encounter for fracture with routine healing
    S27.1XXATraumatic hemothorax, initial encounter
    S27.1XXDTraumatic hemothorax, subsequent encounter
    S29.011AStrain of muscle and tendon of front wall of thorax, initial encounter
    S29.011DStrain of muscle and tendon of front wall of thorax, subsequent encounter

    Showing 1–10 of 16

    Related Payer Policy Updates

    Specialty: Orthopedics/Musculoskeletal1 / 3

    10 rows

    PolicyPayerEffective Date
    Orthopedic Joint Procedures of the Knee for Managed Medicaid (MMC), Health and Recovery Plan (HARP), Child Health Plus (CHP), and Essential Plan (EP) Membersuniverahealthcare2027-01-01
    Autologous Chondrocyte Transplantation or Implantation Corporate Medical Policybcbsvermont2026-12-01
    Autologous Platelet-Derived Growth Factors (Platelet-Rich Plasma [PRP])Cigna2026-10-15
    Metatarsophalangeal Joint ReplacementCigna2026-10-15
    Shoulder Arthroplasty (Total, Partial, Reverse, Revision and Resurfacing)univerahealthcare2026-10-15
    Hip Arthroplasty (partial and total hip replacement)univerahealthcare2026-10-15
    Artificial Lumbar Intervertebral Disc (Lumbar Total Disc Arthroplasty)univerahealthcare2026-10-15
    Osteochondral Grafting of the Kneeuniverahealthcare2026-10-15
    Metal-on-Metal Total Hip Resurfacinguniverahealthcare2026-10-15
    Lumbar Fusion (arthrodesis) with decompressionuniverahealthcare2026-10-15

    Related Codes

    CPT-21811-RIB-FRACTURE-OPEN-FIXATION

    CPT 21811: Open Surgical Rib Fixation (1–3 Ribs)

    CPT-21812-OPEN-RIB-FIXATION-WITH-THORACOSCOPY

    CPT 21812: Open Internal Fixation of Multiple Rib Fractures

    CPT-21813-OPEN-RIB-FIXATION-SEVEN-OR-MORE-RIBS

    CPT 21813: Open Fixation of Seven or More Rib Fractures

    CPT-21825-STERNAL-FRACTURE-OPEN-REPAIR-FIXATION

    CPT 21825: Open Treatment of Sternal Fracture

    Frequently Asked Questions

    References

    1. 1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
    2. 2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
    3. 3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.
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