CPT 69646 Radical Tympanoplasty Reimbursement | OpenPayer

Summary & Overview

CPT 69646: Radical Tympanoplasty with Mastoidectomy and Ossicular Reconstruction

CPT code 69646 represents a complex otologic surgery — a radical or complete tympanoplasty with mastoidectomy and ossicular chain reconstruction. This code is used when surgeons repair a perforated tympanic membrane, remove all or part of the mastoid, and reconstruct or repair the ossicular chain to restore conductive hearing. It captures a comprehensive middle ear procedure that typically involves the ear canal and tympanic membrane and is clinically significant for patients with chronic ear disease or extensive tympanic membrane damage. Nationally, the procedure matters because it involves specialized surgical resources, potential inpatient or outpatient operating room utilization, and coordination across surgical and audiologic services.

Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical context, where the service is typically delivered, and the types of surgical components included under this code. The publication provides benchmarks and policy-relevant details such as how the procedure is classified for facility and professional billing, common payment considerations, and guidance on documentation elements that support medical necessity. Data not available in the input will be noted where applicable; the focus remains on national applicability and implications for billing, coding, and clinical documentation for complex tympanoplasty with mastoid surgery.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicare69646CPTtympanoplastymastoidectomyossicular-reconstructionotolaryngologysurgical-proceduresmiddle-ear

Billing Code Overview

CPT code 69646 describes a radical or complete tympanoplasty with mastoidectomy and ossicular chain reconstruction. The procedure addresses a perforated tympanic membrane and chronic middle ear disease by repairing or reconstructing the eardrum, removing all or part of the mastoid, and reconstructing the ossicular chain to improve conductive hearing. The description may also include reconstruction of the ear canal and other middle ear procedures as part of the same operative session.

Service type: Complex otologic surgical procedure involving middle ear and mastoid reconstruction
Typical site of service: Hospital operating room or ambulatory surgical center, performed by an otolaryngologist (ENT surgeon)

Clinical & Coding Specifications

Clinical Context

A 45-year-old patient presents with chronic conductive hearing loss and recurrent otorrhea after tympanic membrane perforation and longstanding cholesteatoma. Otologic examination and CT of the temporal bones demonstrate a large central tympanic membrane perforation, retraction pockets with cholesteatoma, and opacification of the mastoid air cells. Audiometry shows a conductive hearing loss with an air-bone gap of 30 dB. The surgical plan is a single-stage mastoidectomy with tympanoplasty and ossicular chain reconstruction (mastoidectomy with tympanic membrane reconstruction and ossiculoplasty) to remove disease, reconstruct the ear canal and tympanic membrane, and restore ossicular continuity.

Typical clinical workflow:

Preoperative: history, physical exam, audiometry, temporal bone CT, informed consent, anesthesia evaluation, and preop documentation of laterality and baseline hearing.
Intraoperative: general anesthesia, cortical/mastoidectomy (as indicated), removal of cholesteatoma or diseased mastoid air cells, tympanic membrane radical/complete reconstruction (tympanoplasty), ossicular chain reconstruction (ossiculoplasty) using prosthesis or autograft, reconstruction of the ear canal or canalplasty as needed, hemostasis, and placement of packing/drains.
Postoperative: PACU recovery, short inpatient observation or same-day discharge depending on complexity and comorbidities, postoperative instructions, otic precautions, analgesia, antibiotic management if indicated, and scheduled audiometric follow-up and wound/endoscopic ear checks at 2–6 weeks and later for hearing assessment.

Typical site of service: Hospital operating room or ambulatory surgery center (depending on complexity and patient comorbidities).

Coding Specifications

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

CPT-69620-MYRINGOPLASTY-TYMPANIC-MEMBRANE-REPAIR

CPT 69620: Myringoplasty (Tympanic Membrane Repair)

CPT-69642-TYMPANOPLASTY-MASTOIDECTOMY-OSSICULAR-RECONSTRUCTION

CPT 69642: Tympanic Membrane Repair with Mastoidectomy and Ossicular Reconstruction

CPT-69666-OVAL-WINDOW-FISTULA-REPAIR

CPT 69666: Oval Window Fistula Repair, Inner Ear

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

CPT 69660: Stapedectomy or Stapedotomy, Middle Ear Surgery

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

CPT 69645: Radical Tympanic Membrane Reconstruction with Mastoidectomy

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

CPT 69633: Tympanic Membrane and Ossicular Reconstruction with Prosthesis

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

CPT 69667: Exploratory Tympanotomy for Round Window Fistula

CPT-69602-MODIFIED-RADICAL-MASTOIDECTOMY-REVISION

CPT 69602: Revision to Modified Radical Mastoidectomy

CPT-69604-REVISION-MASTOIDECTOMY-WITH-TYMPANOPLASTY

CPT 69604: Revision Mastoidectomy with Tympanoplasty

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Taxonomy Code	Specialty	Notes
`207L00000X`	Otolaryngology (ENT)	Primary specialty performing mastoidectomy/tympanoplasty/ossiculoplasty.
`207LP2900X`	Pediatric Otolaryngology	Performs similar procedures in pediatric patients; technique and postoperative care may differ.
`2080P0206X`	Neurotology	Subspecialty focusing on complex ear surgery, cholesteatoma, skull base and ossicular reconstruction.
`207R00000X`	Head and Neck Surgery	May perform related procedures when broader head and neck pathology is present.
`2084P0802X`	Otology	Focused on middle ear surgery and hearing restoration procedures.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`H72.0`	Chronic suppurative otitis media, without cholesteatoma	Chronic perforation and infection leading to tympanic membrane reconstruction and possible mastoid surgery.
`H72.1`	Chronic suppurative otitis media, with cholesteatoma	Cholesteatoma frequently requires mastoidectomy and tympanoplasty with ossicular reconstruction.
`H72.89`	Other chronic middle ear diseases	Includes other chronic middle ear pathologies that may necessitate mastoidectomy and tympanic reconstruction.
`H71.3`	Cholesteatoma of middle ear and mastoid, unspecified	Directly associated with disease processes requiring removal and reconstruction.
`H90.3`	Conductive hearing loss, bilateral	Conductive hearing loss is the functional indication for ossicular chain reconstruction.
`H90.2`	Conductive hearing loss, unilateral	Unilateral conductive deficit indicating ossiculoplasty on the affected side.
`H72.9`	Unspecified chronic otitis media	Used when chronic middle ear disease is documented without further specificity and surgical repair is performed.
`H60.3`	Chronic mastoiditis	Mastoid involvement that may mandate mastoidectomy with tympanic reconstruction.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`69620`	Mastoidectomy, radical, with or without tympanoplasty; without ossicular chain reconstruction	May be performed when mastoid disease requires radical removal; `69646` includes ossicular reconstruction, so `69620` represents a similar mastoid/tympanic procedure without ossiculoplasty.
`69630`	Mastoidectomy, modified radical; with tympanoplasty	Alternative mastoid procedure; may be performed depending on disease extent and surgeon approach.
`69633`	Mastoidectomy, radical, with tympanoplasty and ossicular reconstruction	Closely related code for radical mastoidectomy with tympanoplasty and ossicular reconstruction; used based on surgical extent and documentation.
`69644`	Tympanoplasty, obliteration or reconstruction of middle ear and mastoid (complete)	Performed for extensive middle ear and mastoid reconstruction; may be used in similar clinical contexts.
`69990`	Microsurgical techniques, requiring use of an operating microscope (unlisted in some sets)	Technique often used during tympanoplasty and ossiculoplasty for precision; billed when a specific microscope code is applicable.
`69100`	Myringotomy with insertion of tympanostomy tube(s) (requiring general anesthesia in children)	Performed for middle ear ventilation as a less invasive or adjunct procedure in other clinical settings; may precede or follow more definitive reconstruction.

`22`	Increased procedural services	Use when the procedure required substantially greater work than typical (document justification in operative note).
`23`	Unusual anesthesia	Use when a procedure is performed under general anesthesia because of unusual circumstances where local/regional would normally be used.
`26`	Professional component	Use when billing only the physician professional component separate from technical facility services.
`50`	Bilateral procedure	Use when the same procedure is performed on both ears during the same operative session.
`51`	Multiple procedures	Use when multiple distinct procedures are performed during the same operative session (may affect payment bundling).
`52`	Reduced services	Use when the procedure is partially reduced or not completed as originally planned.
`53`	Discontinued procedure	Use when the procedure is terminated due to extenuating circumstances after anesthesia induction.
`59`	Distinct procedural service	Use to indicate a separate, distinct procedure not normally reported together with another code (ensure documentation supports distinctness).
`62`	Two surgeons	Use when two surgeons work together as primary surgeons performing distinct parts of the procedure.
`76`	Repeat procedure by same physician	Use when an identical procedure is repeated subsequent to the original during the postoperative period (note: `76` is not in the provided list; not included).
`78`	Unplanned return to OR by same physician following initial procedure for a related procedure during the global period	Use for reoperation related to complications of the original procedure.

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