What is the average cost for atresia repair surgery?
Costs for atresia repair surgery are highly variable and depends on the complexity of the surgery and the patient's insurer. There are three sources of billing for atresia repair surgery, they are:
- The facility, which bills based on the amount of time the surgery takes. The facility will also bill for prosthetics, should titanium replacements for the ossicles be required
- The anesthesiologist, who bills based on the length of the surgery
- The surgeon's fee, which depends on the procedures performed and the complexity of the procedures
In the United States, insurers will inform you what they will pay for surgery based on CPT codes. The CPT codes most commonly used in conjunction with atresia repair are:
CPT Code Description
69320 Reconstruction external auditory canal for congenital atresia, single stage
15120 Split Thickness Skin Graft
69631* Tympanoplasty without mastoidectomy (including canalplasty, atticotomy and/or middle ear surgery), initial or revision; without ossicular chain reconstruction
69633* Tympanoplasty without mastoidectomy (including canalplasty, atticotomy and/or middle ear surgery), initial or revision; with ossicular chain reconstruction and synthetic prosthesis (eg, partial ossicular replacement prosthesis (PORP), total ossicular replacement prosthesis (TORP)
95867 Needle electromyography, cranial nerve supplied muscles, unilateral
95920 Intraoperative neurophysiology testing, per hour
69990 Microsurgical techniques, requiring use of operating microscope
00210 Anesthesia for intracranial procedures; not otherwise specified
* The 69631/69633 is an OR situation, not an AND. If prosthetic ossicles are not required, the procedure billed is 69631. If prosthetic ossicles are required, the correct code is 69633.
