Summary & Overview
CPT 69645: Radical Tympanic Membrane Reconstruction with Mastoidectomy
CPT code 69645 denotes a radical or complete reconstruction of the tympanic membrane with removal of all or part of the mastoid. This otologic surgical code covers comprehensive middle-ear and ear-canal reconstruction aimed at repairing perforations and addressing chronic disease involving the mastoid. It is clinically significant because it represents a more extensive intervention than simple tympanoplasty and is relevant to care pathways for chronic ear disease, recurrent infections, and hearing preservation.
Key national payers discussed include Aetna, Blue Cross Blue Shield, Cigna, UnitedHealthcare and Medicare. Readers will find a concise overview of clinical scope and sites of service, plus the payer coverage landscape and common billing considerations for this service. The publication provides benchmarks for utilization and reimbursement where available, notes policy or coverage updates that affect claim adjudication, and outlines coding specifics that distinguish this service from related ear surgeries.
This summary is intended for revenue cycle leaders, surgical specialists in otolaryngology, and policy analysts seeking a national view of how CPT code 69645 is defined, where it is typically performed, and which payers commonly manage claims for this level of middle-ear reconstruction.
Billing Code Overview
CPT code 69645 describes a surgical procedure that performs a radical or complete reconstruction of the tympanic membrane (eardrum) to repair a perforation and includes removal of all or part of the mastoid. The procedure may include reconstruction of the ear canal and other middle ear surgeries. Reconstruction of the ossicular chain is explicitly not included in this procedure.
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Service type: Surgical repair/reconstruction of the tympanic membrane with mastoidectomy (radical/complete reconstruction)
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Typical site of service: Operating room or ambulatory surgical center, performed by an otolaryngologist (ENT) under general or regional anesthesia
Data not available in the input for associated taxonomies, ICD-10 diagnoses, and related codes.
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.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | No modifier | Standard reporting when no modifier applies |
22 | Increased Procedural Services |