Finally, growth goals of 6% to 8% ex-COVID represent comparisons between time periods in which results are not materially impacted by the COVID-19 pandemic.
Total company third quarter operational sales grew 10% versus 2020, while organic sales grew 11% versus '20 and 4% versus 2019, just below our guidance of 12% to 14% versus 2020 as Delta impacted procedure volume globally.
Q3 adjusted earnings per share of $0.41 grew 10.5% versus 2020 and 4% versus 2019, reaching the high end of our third quarter guidance range of $0.39 to $0.41.
Adjusted operating margin at 25.6% continues to improve and was in line with our third quarter expectations.
We continue to be pleased with our cash flow with third quarter free cash flow generation of $360 million and adjusted free cash flow of $525 million.
Compared to 2020, we target fourth quarter '21 organic revenue growth of 12% to 16% and full year growth of 18% to 19%.
Compared to 2019, we target fourth quarter '21 organic revenue growth of 4% to 8% and for full year organic revenue growth of 5% to 6% versus 2019.
Our fourth quarter adjusted earnings per share estimate is $0.43 to $0.45, and we're updating full year adjusted earnings per share to a revised range of $1.60 to $1.62.
Within the regions on an operational basis Q3 2020, the US grew 15%; Europe, Mid-East Africa grew 8%, Asia Pac grew 8% and the emerging market sales grew 18%.
Although Japan was in a state of emergency throughout third quarter, we were able to advance new product launches, achieving Number 1 share position with our Ranger Drug-Coated Balloon as well as launching POLARx in October.
China continues to deliver excellent results and sales grew 14% versus 2020.
Urology and Pelvic Health sales grew 7% organically versus 2020.
In Endoscopy, sales grew 11% organically versus 2020.
We continue to make progress with EXALT-D and are launching the 1.5 enhanced EXALT-D design, which features improved physician ergonomics.
Additionally, we're pleased to now have approximately 40% of ERCP procedures qualify for additional reimbursement with NTAP approval as of October 1.
Our Preventice business remains on track to deliver plus 20% growth for the full year versus 2020 on a pro forma basis, fueled by the broad and differentiated ambulatory ECG portfolio.
Electrophysiology organic sales were up 10% versus 2020, driven by strong international sales in both Europe and Japan.
Within the US, the Baylis platform is used in close to 40% of EP ablation procedures on the left side of the heart.
In neuromodulation, organic revenue grew 2% versus 2020 as underlying procedure volumes was impacted by the Delta surge throughout much of the quarter.
And last week, we received approval for our Essential Tremor indication and are excited to begin our limited launch in fourth quarter 2021, which expand our addressable market by $2 billion.
In Interventional Cardiology, organic sales grew 26% versus 2020, which includes a 1,200 basis point tailwind related to the WATCHMAN consignment sales return reserve taken in third quarter '20.
In TAVR, ACURATE neo2 continues to do well with physicians pleased with its clinical performance and ease of use, backed by strong real-world clinical data, resulting in approximately 20% market share in open accounts.
Momentum continues with SENTINEL, our cerebral embolic protection device, which is exceeding 20% share in the US, where it's utilized.
Coronary Therapies grew 8% versus 2020 as the China DES tender impact begins to annualize and our portfolio mix shift into higher growth markets continues to strengthen.
Peripheral Interventions consistently delivers with organic sales up 8% versus Q3 2020.
Eluvia, our drug-eluting stent exhibited superiority in the EMINENT trial compared to bare metal stents and 2-year data from the RANGER 2 trial demonstrated continued high rates, primary patency and significant reduction in reinterventions with our Ranger DCB.
And since 2017, we've reduced the BSC carbon footprint by 50% and are on track to meet our goal to be carbon neutral in all manufacturing and key distribution sites by 2030.
At our recent Investor Day, we detailed our LRP plans for growth of 6% to 8% growth, operating margin expansion of 50 basis points or more each year and double-digit adjusted earnings per share growth.
Third quarter consolidated revenue of $2.932 billion represents 10.3% reported revenue growth versus the third quarter of 2020 and reflects a $17 million tailwind from foreign exchange.
On an operational basis, revenue growth was 9.7% in the quarter.
Sales from the acquisitions of Preventice, Farapulse and Lumenis contributed 220 basis points more than offset by the divestiture of Specialty Pharmaceuticals, resulting in 10.6% organic revenue growth, slightly below our guidance range of 12% to 14% growth versus 2020.
Compared to the third quarter 2019, organic growth was 4.1%, below our guidance range of 5% to 7%.
This 4.1% growth excludes $35 million in 2019 sales of divested intrauterine health, embolic beads and BTG Specialty Pharmaceuticals businesses as well as $117 million in 2021 sales of acquired businesses, which consists of half a quarter of BTG Interventional Medicines, a full quarter of Preventice and post-close revenue from Farapulse and Lumenis.
Spend controls and a favorable tax rate drove Q3 adjusted earnings per share of $0.41, representing 10.5% growth versus 2020, 4% growth versus 2019 and achieving the high end of our guidance range of $0.39 to $0.41.
Adjusted gross margin for the third quarter was 70.6%, in line with our expectations.
Third quarter adjusted operating margin was 25.6%, again, in line with our expectations, driven by spend control and lower travel offsetting the revenue headwinds.
We're pleased with our trajectory and continue to target adjusted operating margin to average 26% for the second half of this year.
On a GAAP basis, operating margin was 13.2% and includes a $128 million intangible asset impairment primarily related to VENITI, as we've made the decision to retire the VICI VENOUS STENT venous stent following our voluntary recall earlier this year.
Moving to below the line.
Adjusted interest and other expense totaled $104 million, again, in line with expectations.
Our tax rate for the third quarter was 7.8% on an adjusted basis, favorable to our expectations, driven by the geographic mix of earnings.
We ended Q3 with 1,436 million fully diluted weighted average shares outstanding.
Adjusted free cash flow for the quarter was $525 million, and free cash flow was $359 million with $465 million from operating activities, less $106 million net capital expenditures.
Our goal remains to deliver adjusted free cash flow in line with 2020 approximately $2 billion as we continue to expect increased working capital investments in inventory and accounts receivable during the remainder of 2021.
As of September 30, 2021, we had cash on hand of $1.9 billion.
For the full year, we expect 2021 operational revenue growth to be in a range of 18% to 19% versus 2020, which includes an approximate net 30 basis point headwind from the divestiture of our intrauterine health franchise and Specialty Pharmaceuticals, partially offset by the acquisitions of Preventice, Farapulse and Lumenis.
Excluding the impact of closed acquisitions and divestitures, we expect full year organic revenue growth to be in a range of 18% to 19% versus 2020 and 5% to 6% versus 2019.
For the organic comparison to 2019, full year 2019 sales exclude $50 million in sales of our embolic beads portfolio and intrauterine health franchise as well as $81 million in Specialty Pharmaceutical sales and at the midpoint of guidance, 2021 sales exclude approximately $530 million in sales from recent acquisitions, including [Technical Issues] BTG Interventional Medicines through mid-August, Preventice, Farapulse and Lumenis as well as $13 million of Specialty Pharmaceutical sales prior to divestiture.
For the fourth quarter 2021, we expect operational revenue growth to be in a range of 14% to 18% versus 2020, which includes an approximate net 180 basis point tailwind from the acquisitions of Preventice, Farapulse and Lumenis, partially offset by the divestiture of Specialty Pharmaceutical.
Excluding the impact of acquisitions and divestitures, we expect Q4 organic revenue growth to be in a range of 12% to 16% versus 2020 and 4% to 8% growth versus 2019.
For the Q4 organic comparison to 2019, 2019 sales exclude $67 million in sales of our divested intrauterine health and Specialty Pharmaceuticals businesses.
And at the midpoint of guidance, 2021 sales exclude $90 million -- approximately $90 million in sales from the acquisition of Preventice, Farapulse and Lumenis.
We continue to expect adjusted below-the-line expenses, which include interest payments, dilution from our VC portfolio and costs associated with our hedging program to be approximately $400 million to $425 million for the year.
Based on year-to-date favorability, we now forecast our full year 2021 operational tax rate to be approximately 10% and our adjusted tax rate to be approximately 9%.
We expect fully diluted weighted average share count of approximately 1,439 million shares for Q4 2021 and 1,434 million shares for the full year 2021.
We are narrowing the range for full year 2021 adjusted earnings per share guidance to $1.60 to $1.62, which includes our update to sales guidance and considers Q3 performing at the high end of our guidance range.
For the fourth quarter, adjusted earnings per share is expected to be in a range of $0.43 to $0.45.
Andrew, let's open it up to questions for the next 35 minutes or so.

Summary:
Q3 adjusted earnings per share of $0.41 grew 10.5% versus 2020 and 4% versus 2019, reaching the high end of our third quarter guidance range of $0.39 to $0.41.
Our fourth quarter adjusted earnings per share estimate is $0.43 to $0.45, and we're updating full year adjusted earnings per share to a revised range of $1.60 to $1.62.
Third quarter consolidated revenue of $2.932 billion represents 10.3% reported revenue growth versus the third quarter of 2020 and reflects a $17 million tailwind from foreign exchange.
Spend controls and a favorable tax rate drove Q3 adjusted earnings per share of $0.41, representing 10.5% growth versus 2020, 4% growth versus 2019 and achieving the high end of our guidance range of $0.39 to $0.41.
Moving to below the line.
For the fourth quarter, adjusted earnings per share is expected to be in a range of $0.43 to $0.45.