CPT code 21080: Obturator prosthesis, definitive obturator2026 Medicare rate & RVUs in Maryland
Impression and preparation of a definitive obturator prosthesis to restore an acquired maxillary defect, commonly after resection and healing.
Medicare pays $1,739.82–$1,930.24 for 21080 in the office in Maryland, from Rest of Maryland to Washington, DC area. 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 21080 covers
This service covers taking an impression and preparing a definitive obturator prosthesis for a patient with an acquired maxillary or palatal defect, often following maxillectomy. The custom appliance closes the opening between the oral and nasal cavities and can support speech and swallowing. A maxillofacial prosthodontist or dentist with maxillofacial prosthetic expertise typically performs the work in a dental prosthetics clinic or hospital outpatient setting. The definitive stage is generally selected after the surgical defect has healed or stabilized, rather than for an appliance used immediately after surgery or during interim healing.
Report this code for the definitive obturator service, not the surgical or interim obturator stage. Documentation should identify the defect and clinical stage and describe the impression and preparation performed. CMS assigns a 90-day major-surgery global period, including the day-before preoperative visit and related postoperative care through day 90. When multiple procedures occur in the same session, the highest-valued procedure is paid in full and others at 50%. Bilateral adjustment is inappropriate; assistant-at-surgery payment is restricted, and 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 21080 pays more and less in Maryland
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
3 payment localities
$1739.82 to $1930.24
| Payment locality | Office | Facility |
|---|---|---|
| Baltimore area, MD | $1,825.54 | $1,217.35 |
| Rest of Maryland | $1,739.82 | $1,166.21 |
| Washington, DC area | $1,930.24 | $1,262.54 |
How the 21080 rate is calculated
Each of 21080’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 · 21080
RVUs × geographic indexes × conversion factor
Work24.43
24.43 RVUs× 1.000 GPCI
Practice expense24.45
24.45 RVUs× 1.000 GPCI
Malpractice2.91
2.91 RVUs× 1.000 GPCI
Adjusted RVUs
51.7900
Conversion factor
$33.4009
Medicare rate
$1,729.83
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 21080
21080 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 21080
Obturator prosthesis, definitive obturator
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 090 | Major surgery: the day before, the day of, and 90 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) | 1 | Not paid (statutory restriction). |
| 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) | 0.10/0.69/0.21 | Share of the payment for pre-op, the procedure itself, and post-op care. |
Global surgery period · 21080
Obturator prosthesis, definitive obturator
90-day global period ends
Dec 30, 2026
Covers Sep 30, 2026 through Dec 30, 2026 (92 days, including the day before surgery).
Visit on Oct 31, 2026
Day 30 of the 90-day post-op period: related follow-up care is included in the surgical payment.
Pre-op dayGlobal period
What modifiers do to the payment
Modifier 51 · payment effect
With and without the modifier
21080 without 51 · national office
$1,729.83
Obturator prosthesis, definitive obturator
21080-51 · Second procedure: 50%
$864.92
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%).
21080 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 21076Obturator prosthesisSurgical obturator
- Choose 21076 for the surgical obturator stage. Choose 21080 for the definitive obturator service.
- 21079Obturator prosthesisInterim obturator
- 21079 describes an interim obturator during healing; 21080 describes the definitive obturator stage.
- 21081Mandibular prosthesisImpression and custom preparation
- 21081 concerns a prosthesis for a mandibular resection defect. This code is for a definitive obturator associated with a maxillary or palatal defect.
21080 billing questions
When should this code be chosen over 21079?
Use 21080 for the definitive obturator stage. Code 21079 describes an interim obturator used during the healing period.
How does 21080 differ from 21076?
21080 is for a definitive obturator; 21076 is for a surgical obturator used in the surgical stage.
What documentation supports reporting 21080?
Document the acquired maxillary or palatal defect, its clinical stage, and the impression and preparation work for the definitive appliance.
Can modifier 50 be used for bilateral obturator work?
No. CMS identifies bilateral adjustment as inappropriate for this code.
How does the global period affect related care?
The 90-day major-surgery global includes the day-before preoperative visit and related postoperative care through day 90.
What happens when another procedure is performed in the same session?
Under the standard multiple procedure reduction, the highest-valued procedure is paid in full and the other procedure is paid at 50%.
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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