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    v1.0.28
    OpenPayerBilling CodesRepair Procedures on the Middle EarCPT cpt-69646-radical-tympanoplasty-mastoidectomy-ossicular-reconstruction
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    CPT 69646: Radical Tympanic Membrane and Mastoid Reconstruction

    Medicare pays $1470 on average nationally for this procedure.

    CPT code 69646 describes a radical or complete tympanic membrane reconstruction with mastoidectomy and ossicular chain reconstruction to repair a perforated eardrum and improve conductive hearing; service type: comprehensive middle ear and mastoid surgical reconstruction; typical site of service: hospital operating room or ambulatory surgical center under general anesthesia 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 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).

    Related CPT Codes

    CPT CodeDescriptionRelationship to This Procedure
    69620Mastoidectomy, radical, with or without tympanoplasty; without ossicular chain reconstructionMay be performed when mastoid disease requires radical removal; 69646 includes ossicular reconstruction, so 69620 represents a similar mastoid/tympanic procedure without ossiculoplasty.
    69630Mastoidectomy, modified radical; with tympanoplastyAlternative mastoid procedure; may be performed depending on disease extent and surgeon approach.
    69633Mastoidectomy, radical, with tympanoplasty and ossicular reconstructionClosely related code for radical mastoidectomy with tympanoplasty and ossicular reconstruction; used based on surgical extent and documentation.
    69644Tympanoplasty, obliteration or reconstruction of middle ear and mastoid (complete)Performed for extensive middle ear and mastoid reconstruction; may be used in similar clinical contexts.
    69990Microsurgical 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.

    Related Modifiers

    11 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…
    59Modifier 59 indicates a distinct procedural service when two procedures that are not normally billed together are clinically and procedurally separate. The CPT definition (as reiterated by CMS)…- Use modifier -59 to report a distinct procedural service when documentation supports that the procedure reported is not normally billed together with another service on the same day because of a…
    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…
    76Modifier -76, Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional, is appended when the same provider performs an identical, medically necessary procedure or…- Use modifier -76 when the same physician or other qualified health care professional performs an identical procedure or service a second (or subsequent) time on the same date of service and the…

    Showing 1–10 of 11

    Related Provider Taxonomies

    8 rows

    Taxonomy CodeSpecialtyNotes
    207L00000XAnesthesiology PhysicianAn anesthesiologist is trained to provide pain relief and maintenance, or restoration, of a stable condition during and immediately following an opera…
    207LP2900XPain Medicine (Anesthesiology) PhysicianAn anesthesiologist who provides a high level of care, either as a primary physician or consultant, for patients experiencing problems with acute, chr…
    2080P0206XPediatric Gastroenterology PhysicianA pediatrician who specializes in the diagnosis and treatment of diseases of the digestive systems of infants, children and adolescents. This speciali…
    207R00000XInternal Medicine PhysicianA physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults…
    2084P0802XAddiction Psychiatry PhysicianAddiction Psychiatry is a subspecialty of psychiatry that focuses on evaluation and treatment of individuals with alcohol, drug, or other substance-re…
    374J00000XDoulaDoulas work in a variety of settings and have been trained to provide physical, emotional, and informational support to a mother before, during, and j…
    111NP0017XPediatric ChiropractorThe Pediatric Chiropractor is a chiropractor with specialized, advanced training and certification in the evaluation, care and management of health an…
    207RI0001XClinical & Laboratory Immunology (Internal Medicine) PhysicianAn internal medicine physician who specializes in clinical and laboratory immunology disease management.

    Related ICD-10-CM Codes

    15 rows

    ICD-10-CM CodeDescription
    B95.0Streptococcus, group A, as the cause of diseases classified elsewhere
    B96.0Mycoplasma pneumoniae [M. pneumoniae] as the cause of diseases classified elsewhere
    H65.21Chronic serous otitis media, right ear
    H65.22Chronic serous otitis media, left ear
    H65.23Chronic serous otitis media, bilateral
    H66.91Otitis media, unspecified, right ear
    H66.92Otitis media, unspecified, left ear
    H66.93Otitis media, unspecified, bilateral
    H81.09Meniere's disease, unspecified ear
    H90.2Conductive hearing loss, unspecified

    Showing 1–10 of 15

    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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    69100Myringotomy 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.