2025 CPT code 69645
(Active) Effective Date: N/A Revision Date: N/A Surgery - Surgical Procedures on the Auditory System Surgery Feed
Tympanoplasty with mastoidectomy (including canalplasty, middle ear surgery, and tympanic membrane repair); radical or complete, without ossicular chain reconstruction.
Modifiers may be applicable depending on the circumstances. For example, modifier 51 may be used if multiple procedures are performed during the same session.Refer to the CPT® manual and payer-specific guidelines.
Medical necessity is established by the presence of a perforated eardrum, chronic infection, cholesteatoma, or other conditions requiring surgical intervention. The procedure should be deemed medically necessary based on the patient's history, physical examination, and imaging findings.
The otolaryngologist performs the surgery, including creating a postauricular incision, removing mastoid cortex and air cells, entering the mastoid antrum, preparing the tympanic membrane, creating and reflecting a posterior canal flap, removing adhesions/debris/cholesteatoma, removing portions of the canal wall, removing parts of the ossicles and middle ear mucosa (without reconstruction), optionally reconstructing the ear canal, harvesting a fascial graft or other tissue for eardrum repair, packing the middle ear to support the graft, placing silicone material (if needed), repositioning ear canal skin, packing the canal, suturing incisions, and applying a dressing.
In simple words: This surgery repairs a hole in the eardrum and removes infected or damaged bone behind the ear. It may also involve rebuilding parts of the ear canal.It does not include repairing the tiny bones of the middle ear.
This procedure involves a radical or complete reconstruction of the tympanic membrane (eardrum) to repair a perforation, along with the removal of all or part of the mastoid bone.It may include ear canal reconstruction, tympanic membrane repair, and other middle ear surgeries.Reconstruction of the ossicular chain is explicitly excluded.
Example 1: A patient presents with a chronic middle ear infection and a perforated eardrum.A 69645 is performed to remove the infected tissue and reconstruct the eardrum., A patient with cholesteatoma (a cyst behind the eardrum) undergoes a 69645 to remove the cholesteatoma and repair the damaged eardrum and mastoid bone., A patient with significant damage to the middle ear and mastoid following trauma requires a 69645 for extensive repair and reconstruction, excluding ossicular chain repair.
Pre-operative imaging (CT scan), operative report detailing the procedure performed (including removal of the mastoid cortex and any other involved structures), histological reports if any tissues are removed for examination, and post-operative notes outlining the patient's progress.
** The specific surgical approach (canal wall up or canal wall down) should be documented in the operative report and may influence the choice of code.This code does not include ossicular chain reconstruction; code 69646 should be used if ossicular chain reconstruction is performed.
- Revenue Code: P5E (Ambulatory Procedures - Other)
- RVU: This information is not available in provided sources. Refer to the AMA CPT®or other relevant payer-specific resources for current RVU values and reimbursement information.
- Global Days : This information is not available in provided sources. The global period will depend on payer policies and may vary.
- Payment Status: Active
- Modifier TC rule: This information is not available in the provided sources.Consult the CPT® manual for guidance on the application of technical component (TC) modifiers.
- Fee Schedule : This information is not available in the provided sources. Fee schedules vary by payer and location. Consult relevant fee schedules for the specific time period.
- Specialties:Otolaryngology
- Place of Service:Inpatient Hospital, Ambulatory Surgical Center, Outpatient Hospital