CPT 69644 Mastoidectomy & Tympanoplasty Reimbursement | OpenPayer

Summary & Overview

CPT 69644: Mastoidectomy with Tympanic Membrane and Ossicular Reconstruction

CPT code 69644 covers combined mastoidectomy and tympanoplasty procedures that reconstruct the tympanic membrane and address mastoid disease, often with posterior canal wall and ossicular chain reconstruction. This code represents complex otologic surgery central to restoring middle ear structure and hearing function and is a key procedural code in otolaryngology practice nationwide. It matters nationally because it is used in management of chronic ear disease, cholesteatoma, and traumatic tympanic membrane perforations requiring surgical repair.

Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of the clinical scope of the procedure, typical sites of service, and payer coverage context. The publication provides benchmarks and payment context for negotiators and administrators, summarizes common billing modifiers and coding considerations, and situates the procedure within clinical pathways for middle ear reconstruction. The content is intended to help coding staff, billing managers, and policy analysts understand where CPT code 69644 fits in surgical practice, what services it commonly encompasses, and what to expect when preparing claims and reviewing reimbursement policies.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareCPT 69644mastoidectomytympanoplastyossicular reconstructionotologysurgical procedureambulatory surgeryhospital outpatientmiddle ear surgery

Billing Code Overview

CPT code 69644 describes a surgical procedure that reconstructs the tympanic membrane (eardrum), addresses mastoid disease by removing all or part of the mastoid, and may include reconstruction of the posterior ear canal wall and ossicular chain reconstruction. The procedure can involve reconstruction of the ear canal, tympanic membrane repair, and other middle ear surgeries as part of a combined mastoidectomy and tympanoplasty approach.

Service type: Complex otologic surgery combining mastoidectomy and tympanoplasty with possible ossicular reconstruction
Typical site of service: Hospital operating room or ambulatory surgery center

Clinical & Coding Specifications

Clinical Context

A 45-year-old patient with chronic otorrhea and a persistent central tympanic membrane perforation presents after recurrent infections and progressive conductive hearing loss. Otoscopic exam shows a large perforation with possible middle ear mucosal disease and CT temporal bones demonstrates mastoid air cell opacification consistent with chronic mastoiditis. The otologic surgeon schedules a combined tympanoplasty with mastoidectomy and ossicular chain reconstruction under general anesthesia. The surgical workflow includes preoperative evaluation and consent, operative ear preparation and microscopic inspection, cortical or canal wall-up mastoidectomy to remove infected mastoid air cells, tympanic membrane reconstruction using graft material (temporalis fascia or cartilage), possible reconstruction of the posterior ear canal wall with cartilage or bone grafts or synthetic material, and ossiculoplasty if ossicular discontinuity is present. Intraoperative findings determine the extent of ossicular reconstruction (partial or total prosthesis) and whether staged procedures are required. Postoperative care includes recovery from anesthesia, ear packing and dressing, short course antibiotics if indicated, follow-up otoscopy for graft take, and audiometric testing to document hearing improvement.

Coding Specifications

Modifier	Description	When to Use
`22`	Increased procedural services	Use when the procedure required substantially greater work, time, or technical difficulty than typical for (document specifics).

CPT 69636: Tympanic Membrane Repair with Ossicular Reconstruction and Mastoidectomy

CPT-69637-TYMPANIC-MEMBRANE-OSSICULAR-RECONSTRUCTION-MASTOIDECTOMY

CPT 69637: Tympanic Membrane Repair with Ossicular Reconstruction and Mastoidectomy

CPT-69643-MASTOIDECTOMY-TYMPANIC-MEMBRANE-RECONSTRUCTION

CPT 69643: Tympanic Membrane Repair with Mastoidectomy

CPT-69660-STAPEDECTOMY-STAPEDOTOMY-MIDDLE-EAR-SURGERY

CPT 69660: Stapedectomy or Stapedotomy, Middle Ear Surgery

CPT-69667-EXPLORATORY-TYMPANOTOMY-ROUND-WINDOW-FISTULA

CPT 69667: Exploratory Tympanotomy for Round Window Fistula

CPT-69676-TYMPANIC-NERVE-SEVERING-JACOBSONS-NERVE

CPT 69676: Severing of Tympanic (Jacobson's) Nerve

CPT-69645-RADICAL-TYMPANIC-MEMBRANE-RECONSTRUCTION-MASTOIDECTOMY

CPT 69645: Radical Tympanic Membrane Reconstruction with Mastoidectomy

CPT-69603-REVISION-RADICAL-MASTOIDECTOMY

CPT 69603: Revision Radical Mastoidectomy, Ossicle and Middle Ear Excision

CPT-69661-STAPEDECTOMY-STAPEDOTOMY-OSSICULAR-RECONSTRUCTION

CPT 69661: Stapedectomy/Stapedotomy with Prosthesis Insertion

CPT-69610-TYMPANIC-MEMBRANE-REPAIR-PERFORATION

CPT 69610: Repair of Perforated Tympanic Membrane

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69644

Taxonomy Code	Specialty	Notes
`207XX0000X`	Otolaryngology (ENT)	Primary specialty performing tympanoplasty with mastoidectomy and ossicular reconstruction.
`208ZP0800X`	Otology/Neurotology	Subspecialists managing complex chronic ear disease, ossiculoplasty, and canal wall reconstruction.
`207Q00000X`	Head and Neck Surgery	Surgeons who may participate in complex reconstructions involving ear canal or adjacent structures.
`163W00000X`	Audiologist	Provides pre- and postoperative audiometric assessment (not a billing surgeon taxonomy but commonly involved).

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`H72.0`	Chronic tympanic membrane perforation, central	Indicates a persistent perforation requiring tympanoplasty and possible mastoid intervention.
`H70.9`	Unspecified suppurative and necrotic conditions of the ear (chronic mastoiditis)	Reflects chronic mastoid infection often necessitating mastoidectomy with tympanic reconstruction.
`H90.3`	Sensorineural hearing loss, bilateral	Included when mixed hearing loss is present; may be evaluated pre/postoperatively though not always an indication for this surgery.
`H90.2`	Conductive hearing loss, bilateral	Common clinical manifestation prompting tympanoplasty and ossicular reconstruction.
`H71.3`	Cholesteatoma of middle ear and mastoid	Cholesteatoma commonly requires mastoidectomy and tympanic membrane reconstruction; ossicular reconstruction frequently performed.
`H81.1`	Benign paroxysmal vertigo	Vestibular symptoms may be present with middle ear disease; not a direct indication but relevant to preoperative assessment.
`J01.90`	Acute sinusitis, unspecified	Included only when concurrent upper respiratory infection impacts timing of ear surgery (preoperative consideration).
`H69.9`	Eustachian tube dysfunction, unspecified	Chronic Eustachian tube dysfunction contributes to retraction, perforation, and middle ear disease influencing surgical planning.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`69436`	Tympanoplasty without mastoidectomy (repair of perforation)	May be performed when mastoid involvement is absent; represents a less extensive tympanic membrane repair option compared with `69644`.
`69620`	Mastoidectomy, radical (with removal of posterior canal wall)	Represents a more extensive mastoid procedure sometimes required for severe disease; may be an alternative or staged procedure relative to `69644`.
`69631`	Tympanoplasty with ossicular chain reconstruction	Overlaps with the ossiculoplasty component of `69644`; may be reported when tympanoplasty with ossicular reconstruction is performed without mastoidectomy.
`69714`	Stapedectomy or stapedotomy, including prosthesis	Performed for ossicular chain pathology involving the stapes; may be performed concurrently if stapes involvement is identified.
`69210`	Removal of impacted cerumen (for cerumen removal prior to otologic procedures)	Often performed preoperatively in clinic or as part of preparation for operative microscopy and assessment.
`92550`	Tympanometry	Pre- and postoperative diagnostic test to assess middle ear function; supports documentation of conductive hearing loss and postoperative outcomes.

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