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    v1.0.28
    OpenPayerBilling CodesRepair Procedures on the Middle EarCPT cpt-69645-radical-tympanic-membrane-reconstruction-mastoidectomy
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    CPT 69645: Radical Tympanic Membrane Reconstruction with Mastoidectomy

    Medicare pays $1389 on average nationally for this procedure.

    CPT code 69645 describes a radical or complete tympanic membrane reconstruction with partial or total mastoidectomy, typically performed as an operative reconstructive middle ear surgery to repair large eardrum perforations and address chronic mastoid disease; the service is surgical reconstruction of the tympanic membrane and mastoid with possible external auditory canal repair, and the typical site of service is an inpatient or outpatient surgical facility (hospital operating room or ambulatory surgery center) for otologic surgery.

    For related coverage guidance, see recent payer policy updates: Artificial Cervical Intervertebral Disc, Lumbar Microdiscectomy, Lumbar Decompression.

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    Table of contents

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    Clinical & Coding Specifications

    Clinical Context

    A 46-year-old patient presents with chronic otorrhea, persistent conductive hearing loss, and a large central tympanic membrane perforation after recurrent otitis media and prior failed tympanoplasty. The otolaryngologist evaluates audiometry showing a conductive hearing loss and CT temporal bones demonstrating coalescent mastoid disease with mastoid air cell sclerosis. The surgeon schedules a combined tympanoplasty with mastoidectomy under general anesthesia to perform a radical/complete reconstruction of the tympanic membrane and remove diseased mastoid air cells. The perioperative workflow includes pre-operative history and physical, informed consent documenting goals (closure of perforation, eradication of disease), anesthesia evaluation, intraoperative microscopic dissection of the mastoid and tympanic membrane reconstruction (without ossicular chain reconstruction), immediate postoperative recovery with wound and drain assessment, and follow-up visits for audiometric testing and otologic exam to confirm healing and hearing outcomes.

    Related CPT Codes

    CPT CodeDescriptionRelationship to This Procedure
    69436Tympanoplasty, any type; with ossicular chain reconstructionMay be performed when ossicular reconstruction is required in addition to tympanic membrane repair; not included in 69645
    69620Mastoidectomy, radical; without modification of ear canal (open procedure)Related mastoid procedure; 69645 describes radical/complete tympanic membrane reconstruction with mastoid removal—this code describes similar radical mastoid work
    69990Microsurgical techniques, requiring use of operating microscope (list separately in addition to code for primary procedure)Often reported in conjunction when an operating microscope is used during middle ear/mastoid surgery
    69210Removal impacted cerumen (for pre-op ear canal clearance)May be performed in preoperative clinic or immediately before surgery to clear the canal for examination or micro-suction
    92567TympanometryDiagnostic test often performed pre- and post-operatively to assess middle ear function

    Related Modifiers

    13 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…
    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…
    63Modifier‑63 is appended to surgical CPT codes (20000–69990) when a procedure is performed on a neonate or infant weighing ≤ 4 kg (about 8.8 lbs). The AMA/AAPC definition specifies this use and notes…- Use modifier -63 only for surgical procedures in the CPT 20000–69990 series performed on a neonate or infant who weighs ≤ 4 kg at the time of the procedure; it indicates increased complexity due to…
    66Modifier 66 (Surgical Team) is used when three or more surgeons act as primary surgeons on a single, highly complex procedure. The AMA defines it for use when a surgical team — often composed of…- Use modifier 66 when three or more surgeons act as primary surgeons working collaboratively as a surgical team on a single, highly complex or difficult procedure (for example organ…

    Showing 1–10 of 13

    Related Provider Taxonomies

    8 rows

    Taxonomy CodeSpecialtyNotes
    207Y00000XOtolaryngology PhysicianAn otolaryngologist-head and neck surgeon provides comprehensive medical and surgical care for patients with diseases and disorders that affect the ea…
    2084P0800XPsychiatry PhysicianA Psychiatrist specializes in the prevention, diagnosis, and treatment of mental disorders, emotional disorders, psychotic disorders, mood disorders, …
    207L00000XAnesthesiology PhysicianAn anesthesiologist is trained to provide pain relief and maintenance, or restoration, of a stable condition during and immediately following an opera…
    207UN0903XIn Vivo & In Vitro Nuclear Medicine PhysicianA nuclear medicine physician who specializes in in vivo and in vitro nuclear medicine.
    261QR0208XMobile Radiology Clinic/CenterAmbulatory Health Care Facilities · Clinic/Center
    133VN1301XOncology Nutrition Registered DietitianAn individual who is a Board Certified Specialist in Oncology Nutrition and provides direct nutrition care for individuals at risk for or diagnosed wi…
    335V00000XPortable X-ray and/or Other Portable Diagnostic Imaging SupplierA supplier that provides one or more of the following portable services, including but not limited to, x-ray, electrocardiogram (EKG), long-term EKG (…
    322D00000XEmotionally Disturbed Childrens' Residential Treatment FacilityA residential facility that provides habilitation services and other care and treatment to children diagnosed with mental health illness, behavioral i…

    Related ICD-10-CM Codes

    17 rows

    ICD-10-CM CodeDescription
    B96.3Hemophilus influenzae [H. influenzae] as the cause of diseases classified elsewhere
    H71.11Cholesteatoma of tympanum, right ear
    H71.12Cholesteatoma of tympanum, left ear
    H72.01Central perforation of tympanic membrane, right ear
    H72.02Central perforation of tympanic membrane, left ear
    H72.11Attic perforation of tympanic membrane, right ear
    H72.12Attic perforation of tympanic membrane, left ear
    H90.3Sensorineural hearing loss, bilateral
    H90.41Sensorineural hearing loss, unilateral, right ear, with unrestricted hearing on the contralateral side
    H90.42Sensorineural hearing loss, unilateral, left ear, with unrestricted hearing on the contralateral side

    Showing 1–10 of 17

    Related Payer Policy Updates

    Specialty: Neurology/Neurosurgery1 / 3

    7 rows

    PolicyPayerEffective Date
    Artificial Cervical Intervertebral Discuniverahealthcare2026-10-15
    Lumbar Microdiscectomyuniverahealthcare2026-10-15
    Lumbar Decompressionuniverahealthcare2026-10-15
    Nerve Fiber Density Testing (IENFD/ENFD) Coverage CriteriaOscar Health2026-10-01
    Biomarker Testing for Multiple Sclerosis and Related Neurologic DiseasesOscar Health2026-10-01
    Biochemical Markers of Alzheimer Disease and DementiaOscar Health2026-10-01
    Serum Testing For Evidence of Mild Traumatic Brain InjuryOscar Health2026-10-01

    Related Codes

    CPT-69601-REVISION-SIMPLE-TO-TOTAL-MASTOIDECTOMY

    CPT 69601: Revision to Total Mastoidectomy

    CPT-69602-MODIFIED-RADICAL-MASTOIDECTOMY-REVISION

    CPT 69602: Revision to Modified Radical Mastoidectomy

    CPT-69603-REVISION-RADICAL-MASTOIDECTOMY

    CPT 69603: Revision to Radical Mastoidectomy

    CPT-69604-REVISION-MASTOIDECTOMY-WITH-TYMPANOPLASTY

    CPT 69604: Revision Mastoidectomy with Tympanoplasty

    CPT-69610-TYMPANIC-MEMBRANE-REPAIR-PERFORATION

    CPT 69610: Repair of Perforated Tympanic Membrane

    CPT-69620-MYRINGOPLASTY-TYMPANIC-MEMBRANE-REPAIR

    CPT 69620: Myringoplasty (Tympanic Membrane Repair)

    CPT-69631-TYMPANIC-MEMBRANE-RECONSTRUCTION

    CPT 69631: Tympanic Membrane Reconstruction for Perforation

    CPT-69632-TYMPANOPLASTY-OSSICULOPLASTY-RECONSTRUCTION

    CPT 69632: Tympanoplasty with Ossicular Chain Reconstruction

    CPT-69633-TYMPANIC-MEMBRANE-AND-OSSICULAR-RECONSTRUCTION-WITH-PROSTHESIS

    CPT 69633: Tympanoplasty with Ossicular Chain Reconstruction and Prosthesis

    CPT-69635-TYMPANOPLASTY-WITH-MASTOIDECTOMY-INITIAL-OR-REVISION

    CPT 69635: Tympanic Membrane Reconstruction with Mastoidectomy

    Showing 1–10 of 25

    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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