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CPT 69433: Myringotomy with Ventilating Tube, Local/Topical Anesthesia

CPT code 69433 represents a myringotomy with insertion of a ventilating tube performed under local or topical anesthesia. This minor surgical procedure is an important outpatient intervention to restore middle ear aeration and reduce recurrent middle ear effusion, impacting pediatric and adult patients with eustachian tube dysfunction or chronic otitis media. Nationally, the procedure is commonly performed in ambulatory surgical centers, physician offices, and outpatient clinics, and has implications for access, anesthetic choice, and setting of care.

Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find clinical context about the procedure, typical sites of service, and operational considerations relevant to outpatient delivery. The publication summarizes benchmarks and payment-related observations, highlights relevant policy and coverage themes that affect utilization and site-of-service decisions, and outlines common billing and documentation considerations tied to this procedure. Data not available in the input will be noted where applicable.

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Billing Code Overview

CPT code 69433 describes a procedure in which the provider creates a small opening in the tympanic membrane (eardrum) and inserts a ventilating tube under local or topical anesthesia. This procedure is a form of middle ear ventilation commonly performed to relieve recurrent otitis media with effusion or eustachian tube dysfunction.

Service type: Minor surgical procedure (myringotomy with tube insertion)
Typical site of service: Outpatient clinic, ambulatory surgical center, or physician office under local or topical anesthesia

Data not available in the input.

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CPT 69433: Myringotomy with Ventilating Tube, Local/Topical Anesthesia

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Billing Code Overview

Service type: Minor surgical procedure (myringotomy with tube insertion)
Typical site of service: Outpatient clinic, ambulatory surgical center, or physician office under local or topical anesthesia

Data not available in the input.

Clinical & Coding Specifications

Clinical Context

A 3-year-old child with recurrent otitis media and persistent middle ear effusion presents to a pediatric otolaryngology clinic after failing a trial of medical management including antibiotics and nasal steroid therapy. The child has conductive hearing loss noted on screening audiometry and parental reports of speech delay and ear pain. After clinic evaluation and tympanometry confirming Type B (flat) tympanogram consistent with effusion, the surgeon schedules outpatient myringotomy with placement of a ventilating (tympanostomy) tube under local or topical anesthesia.

The clinical workflow: preoperative evaluation in clinic with history, tympanometry and brief audiometry; informed consent and documentation of indications (recurrent acute otitis media or chronic otitis media with effusion); preoperative nursing check and local/topical anesthesia applied in procedure room; the provider performs 69433 (small myringotomy with insertion of ventilating tube) and documents operative note including laterality, tube type, anesthesia, and estimated blood loss; postoperative instructions and follow-up audiology and ear checks scheduled.

Coding Specifications

Modifier	Description	When to Use
`59`	Distinct procedural service	Use when `69433` is performed with another separate procedure on the same day that is not typically bundled, and documentation supports distinctness.
`52`	Reduced services	Use when a partial or less than standard procedure is performed (for example, if tube placement is attempted but not completed).
`53`	Discontinued procedure	Use when the myringotomy/tube placement is started but terminated for patient safety reasons.
`50`	Bilateral procedure	Use when `69433` is performed on both ears during the same session if payer requires a bilateral modifier rather than reporting as two units.
`RT`	Right side	Use to indicate the procedure was performed on the right ear when laterality is reported per-payer.
`LT`	Left side	Use to indicate the procedure was performed on the left ear when laterality is reported per-payer.
`22`	Unusual procedural services	Use when the procedure requires substantially greater effort or time than usual and documentation supports increased work.
`52`	Reduced services	(Included above as commonly applicable)
`26`	Professional component	Use when reporting only the physician’s professional component separate from a technical component billed by another entity.
`TC`	Technical component	Use when reporting only the technical component (e.g., facility) separate from the physician’s professional component.
`23`	Unusual anesthesia	Use when a general anesthesia is required for a procedure normally performed under local/topical anesthesia (rare for `69433`).
`24`	Unrelated E/M by same physician during postoperative period	Use when an unrelated evaluation is performed during the global period and is separately billable.
`79`	Unrelated procedure/service by the same physician during the postoperative period	Use when an unrelated procedure is performed during the global period.
`76`	Repeat procedure by same physician	Use when an identical procedure is repeated by the same physician subsequent to the original on the same day.

Taxonomy Code	Specialty	Notes
207V00000X	Otolaryngology (ENT)	Primary specialty performing myringotomy with tube placement.
2080P0222X	Pediatric Otolaryngology	Subspecialty for pediatric patients with recurrent otitis media.
208000000X	General Pediatrics	Pediatricians may diagnose and refer; occasionally perform in-office procedures in select settings.
207LP2900X	Neurotology	For complex ear disease or patients with inner ear pathology.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`H65.3`	Chronic serous otitis media	Common indication for ventilation tube placement for persistent middle ear effusion.
`H66.91`	Otitis media, unspecified, right ear	Acute or recurrent otitis media prompting evaluation and possible tube placement on the right.
`H66.92`	Otitis media, unspecified, left ear	Acute or recurrent otitis media prompting evaluation and possible tube placement on the left.
`H70.21`	Mastoiditis due to otitis media, right ear	Complication that may require ENT intervention; tympanostomy may be part of management in select cases.
`H90.3`	Sensorineural hearing loss, bilateral	May be evaluated in conjunction with middle ear disease; tube placement addresses conductive component if present.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`69436`	Tympanostomy (ventilation tube) placement, general anesthesia	Alternative technique when general anesthesia is used instead of local/topical; used for younger or uncooperative children.
`92550`	Tympanometry and acoustic reflex testing	Preoperative diagnostic test to document middle ear effusion and guide indication for `69433`.
`92551`	Pure tone audiometry (threshold evaluation)	Hearing assessment performed pre- or post-procedure to quantify conductive hearing loss.
`69210`	Removal of impacted cerumen (if performed prior to visualization)	May be performed immediately prior to myringotomy to allow ear canal access.
`69200`	Removal of foreign body from external ear canal	Performed when an obstructing object must be removed to permit tube placement.
`99024`	Postoperative follow-up visit global period waived	Used by some payers for significant, separately billable postoperative care; documentation must support.

CPT 69420: Myringotomy with Aspiration and Eustachian Tube Inflation

CPT-69421-MYRINGOTOMY-MIDDLE-EAR-ASPIRATION-ET-INFLATION

CPT 69421: Myringotomy with Middle Ear Aspiration and Eustachian Tube Inflation

CPT-69424-VENTILATING-TUBE-REMOVAL-UNDER-GENERAL-ANESTHESIA

CPT 69424: Removal of Ventilating Tube From Ear Under General Anesthesia

CPT-69436-TYMPANOSTOMY-WITH-VENTILATION-TUBE-GENERAL-ANESTHESIA

CPT 69436: Tympanostomy with Ventilation Tube, General Anesthesia

CPT-69440-MIDDLE-EAR-EXPLORATION-POSTAURICULAR-TRANSCANAL-APPROACH

CPT 69440: Exploration of Middle Ear via Postauricular or Canal Incision

CPT-69450-TYMPANIC-MEMBRANE-ADHESION-DESTRUCTION

CPT 69450: Destruction of Tympanic Membrane Adhesions

Frequently Asked Questions

References

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.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.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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Clinical & Coding Specifications

Clinical Context

Coding Specifications

Modifier	Description	When to Use
`59`	Distinct procedural service	Use when `69433` is performed with another separate procedure on the same day that is not typically bundled, and documentation supports distinctness.
`52`	Reduced services	Use when a partial or less than standard procedure is performed (for example, if tube placement is attempted but not completed).
`53`	Discontinued procedure	Use when the myringotomy/tube placement is started but terminated for patient safety reasons.
`50`	Bilateral procedure	Use when `69433` is performed on both ears during the same session if payer requires a bilateral modifier rather than reporting as two units.
`RT`	Right side	Use to indicate the procedure was performed on the right ear when laterality is reported per-payer.
`LT`	Left side	Use to indicate the procedure was performed on the left ear when laterality is reported per-payer.
`22`	Unusual procedural services	Use when the procedure requires substantially greater effort or time than usual and documentation supports increased work.
`52`	Reduced services	(Included above as commonly applicable)
`26`	Professional component	Use when reporting only the physician’s professional component separate from a technical component billed by another entity.
`TC`	Technical component	Use when reporting only the technical component (e.g., facility) separate from the physician’s professional component.
`23`	Unusual anesthesia	Use when a general anesthesia is required for a procedure normally performed under local/topical anesthesia (rare for `69433`).
`24`	Unrelated E/M by same physician during postoperative period	Use when an unrelated evaluation is performed during the global period and is separately billable.
`79`	Unrelated procedure/service by the same physician during the postoperative period	Use when an unrelated procedure is performed during the global period.
`76`	Repeat procedure by same physician	Use when an identical procedure is repeated by the same physician subsequent to the original on the same day.

Taxonomy Code	Specialty	Notes
207V00000X	Otolaryngology (ENT)	Primary specialty performing myringotomy with tube placement.
2080P0222X	Pediatric Otolaryngology	Subspecialty for pediatric patients with recurrent otitis media.
208000000X	General Pediatrics	Pediatricians may diagnose and refer; occasionally perform in-office procedures in select settings.
207LP2900X	Neurotology	For complex ear disease or patients with inner ear pathology.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`H65.3`	Chronic serous otitis media	Common indication for ventilation tube placement for persistent middle ear effusion.
`H66.91`	Otitis media, unspecified, right ear	Acute or recurrent otitis media prompting evaluation and possible tube placement on the right.
`H66.92`	Otitis media, unspecified, left ear	Acute or recurrent otitis media prompting evaluation and possible tube placement on the left.
`H70.21`	Mastoiditis due to otitis media, right ear	Complication that may require ENT intervention; tympanostomy may be part of management in select cases.
`H90.3`	Sensorineural hearing loss, bilateral	May be evaluated in conjunction with middle ear disease; tube placement addresses conductive component if present.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`69436`	Tympanostomy (ventilation tube) placement, general anesthesia	Alternative technique when general anesthesia is used instead of local/topical; used for younger or uncooperative children.
`92550`	Tympanometry and acoustic reflex testing	Preoperative diagnostic test to document middle ear effusion and guide indication for `69433`.
`92551`	Pure tone audiometry (threshold evaluation)	Hearing assessment performed pre- or post-procedure to quantify conductive hearing loss.
`69210`	Removal of impacted cerumen (if performed prior to visualization)	May be performed immediately prior to myringotomy to allow ear canal access.
`69200`	Removal of foreign body from external ear canal	Performed when an obstructing object must be removed to permit tube placement.
`99024`	Postoperative follow-up visit global period waived	Used by some payers for significant, separately billable postoperative care; documentation must support.

CPT 69420: Myringotomy with Aspiration and Eustachian Tube Inflation

CPT-69421-MYRINGOTOMY-MIDDLE-EAR-ASPIRATION-ET-INFLATION

CPT 69421: Myringotomy with Middle Ear Aspiration and Eustachian Tube Inflation

CPT-69424-VENTILATING-TUBE-REMOVAL-UNDER-GENERAL-ANESTHESIA

CPT 69424: Removal of Ventilating Tube From Ear Under General Anesthesia

CPT-69436-TYMPANOSTOMY-WITH-VENTILATION-TUBE-GENERAL-ANESTHESIA

CPT 69436: Tympanostomy with Ventilation Tube, General Anesthesia

CPT-69440-MIDDLE-EAR-EXPLORATION-POSTAURICULAR-TRANSCANAL-APPROACH

CPT 69440: Exploration of Middle Ear via Postauricular or Canal Incision

CPT-69450-TYMPANIC-MEMBRANE-ADHESION-DESTRUCTION

CPT 69450: Destruction of Tympanic Membrane Adhesions

Frequently Asked Questions

References

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.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.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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CPT 69433: Myringotomy with Ventilating Tube, Local/Topical Anesthesia

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Billing Code Overview

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CPT 69433: Myringotomy with Ventilating Tube, Local/Topical Anesthesia

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Billing Code Overview

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Related Diagnoses

Related CPT Codes

Related Codes

References

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Related Diagnoses

Related CPT Codes

Related Codes

References

CPT 69433: Myringotomy with Ventilating Tube, Local/Topical Anesthesia

Sign up for cpt 69433 policy alerts

Billing Code Overview

CPT 69433: Myringotomy with Ventilating Tube, Local/Topical Anesthesia

Sign up for cpt 69433 policy alerts

Billing Code Overview

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Related Diagnoses

Related CPT Codes

Related Codes

What procedure does CPT 69433 represent and where is it typically performed?

Which modifiers are commonly used with 69433 and when should they be applied?

What related CPT codes should be considered with 69433 for preoperative testing or concurrent procedures?

Which ICD-10 diagnosis codes commonly support medical necessity for 69433?

What documentation elements are important to support billing of 69433 and associated modifier use?

References

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Related Diagnoses

Related CPT Codes

Related Codes

What procedure does CPT 69433 represent and where is it typically performed?

Which modifiers are commonly used with 69433 and when should they be applied?

What related CPT codes should be considered with 69433 for preoperative testing or concurrent procedures?

Which ICD-10 diagnosis codes commonly support medical necessity for 69433?

What documentation elements are important to support billing of 69433 and associated modifier use?

References