CPT code 21076: Obturator prosthesis, surgical obturator2026 Medicare rate & RVUs in Massachusetts
Reports impression and preparation of a surgical obturator to cover a maxillary surgical defect, commonly in connection with maxillectomy.
Medicare pays $938.18–$1,014.56 for 21076 in the office in Massachusetts, from Rest of Massachusetts to Metropolitan Boston, MA. Which amount applies depends on the service address.
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
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On this page 9 sections
What 21076 covers
This service covers taking an impression and preparing a surgical obturator for a maxillary defect, commonly when a patient is undergoing maxillectomy. The device is intended for the surgical phase, helping separate the oral and nasal cavities after resection. A maxillofacial prosthodontist or other qualified dental or surgical specialist may perform the prosthetic work, often coordinating with the team treating an oral or maxillary tumor.
Report 21076 for the surgical obturator, not an interim device used during healing or a definitive device made after healing; those have separate codes. Document the defect and planned surgery, the impression and prosthetic work performed, and the device’s surgical purpose. Related postoperative visits for 10 days are included in the global period. When multiple procedures are performed in one session, the highest-valued procedure is paid in full and others at 50%. Modifier 50 is inappropriate for this service. Assistant-at-surgery payment requires documented medical necessity; co-surgeons and team surgery are not permitted.
This summary was written with AI assistance from CMS physician fee schedule data and checked against the CMS billing rules shown here. Rates on this page come directly from CMS files.
Where 21076 pays more and less in Massachusetts
| Payment locality | Office | Facility |
|---|---|---|
| Metropolitan Boston, MA | $1,014.56 | $666.41 |
| Rest of Massachusetts | $938.18 | $631.14 |
How the 21076 rate is calculated
Each of 21076’s three RVUs is multiplied by a geographic index (GPCI) for the payment locality, added up, and multiplied by the conversion factor. Drag the indexes or enter a ZIP to see what moves the rate.
How the rate is built · 21076
RVUs × geographic indexes × conversion factor
Work13.07
13.07 RVUs× 1.000 GPCI
Practice expense12.80
12.80 RVUs× 1.000 GPCI
Malpractice1.67
1.67 RVUs× 1.000 GPCI
Adjusted RVUs
27.5400
Conversion factor
$33.4009
Medicare rate
$919.86
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 21076
21076 has a 10-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 21076
Obturator prosthesis, surgical obturator
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 010 | Minor procedure: the day of the procedure plus 10 days after are included. |
| Multiple procedures | 2 | Standard reduction: highest-valued procedure at 100%, others at 50%. |
| Bilateral (modifier 50) | 0 | The 150% bilateral adjustment doesn’t apply. |
| Assistant at surgery (80/81/82/AS) | 0 | Not paid without supporting documentation. |
| Co-surgeons (62) | 0 | Not permitted. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 0 | Physician service: no professional/technical split. |
| Split (54/55/56) | 0.10/0.80/0.10 | Share of the payment for pre-op, the procedure itself, and post-op care. |
Global surgery period · 21076
Obturator prosthesis, surgical obturator
10-day global period ends
Oct 11, 2026
Covers Oct 1, 2026 through Oct 11, 2026 (11 days).
Visit on Oct 31, 2026
After the global period ends: visits and procedures are billed normally.
What modifiers do to the payment
Modifier 51 · payment effect
With and without the modifier
21076 without 51 · national office
$919.86
Obturator prosthesis, surgical obturator
21076-51 · Second procedure: 50%
$459.93
When this isn’t the highest-valued procedure in the session, Medicare pays 50% of its fee schedule amount (the highest is paid at 100%).
21076 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 21079Obturator prosthesisInterim obturator
- Choose 21076 for the surgical obturator. Code 21079 is for an interim obturator used during healing.
- 21080Obturator prosthesisDefinitive obturator
- Code 21080 describes a definitive obturator; 21076 is for the device prepared for the surgical phase.
- 21085Oral splintSurgical use
- Code 21085 is for an oral surgical splint. Code 21076 is for an obturator intended to cover a maxillary surgical defect.
21076 billing questions
How is 21076 different from 21079?
21076 is for a surgical obturator intended for the surgical phase. Code 21079 describes an interim obturator used during healing.
When should 21080 be used instead?
Use 21080 for a definitive obturator, rather than the surgical-phase device reported with 21076.
Can the impression be billed separately from 21076?
The code covers the impression and preparation of the surgical obturator together. Document both parts of that prosthetic service.
What documentation supports 21076?
Record the maxillary defect and related surgery, the impression and preparation performed, and that the obturator is intended for the surgical phase.
Can modifier 50 be reported for bilateral work?
No. Modifier 50 is inappropriate for this service’s descriptor and anatomy.
What applies when other procedures are performed in the same session?
The highest-valued procedure is paid in full, with other procedures subject to the standard multiple-procedure reduction. Assistant-at-surgery payment requires documented medical necessity.
Where these rates come from
FeeBase calculates base physician payments from CMS work, practice-expense and malpractice RVUs, adjusted by each locality’s geographic indexes and the conversion factor. Services without a published rate are labeled, never given a made-up amount. Amounts are Medicare allowed amounts before claim adjustments: not a patient’s bill or a commercial rate.
CMS RVU26D · effective Oct 1, 2026 through the day before Jan 1, 2027
Show the CMS file lines behind this rate
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