CPT code 21080: Obturator prosthesis, definitive obturator2026 Medicare rate & RVUs in Tennessee
Impression and preparation of a definitive obturator prosthesis to restore an acquired maxillary defect, commonly after resection and healing.
In Tennessee, Medicare pays $1,610.52 for 21080 in the office and $1,095.28 when it’s performed in a hospital or facility.
Check a contract rate as a % of Medicare · 21080 nationwide
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
On this page 11 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.
How Tennessee compares for 21080
Across 109 of 109 payment localities, the office rate for 21080 runs from $1,567.54 in Arkansas to $2,147.27 in Alaska. Tennessee pays $1,610.52. The RVUs are the same everywhere; the geographic indexes change the dollars.
- Tennessee · this page$1,610.52
- Los Angeles, CA · California$1,880.08+$269.56
- Washington, DC area · District of Columbia$1,930.24+$319.72
- Miami, FL · Florida$1,911.93+$301.41
- Chicago, IL · Illinois$1,865.50+$254.98
- Manhattan, NY · New York$1,971.31+$360.79
- Alaska · Alaska$2,147.27+$536.75
Other areas in Tennessee first, then benchmark localities. Bars start at $0.
Every other payment area
| Payment locality | Office | Facility |
|---|---|---|
| AlabamaAlabama | $1,585.57 | $1,089.61 |
| ArkansasArkansas | $1,567.54 | $1,080.65 |
| ArizonaArizona | $1,690.52 | $1,141.28 |
| Bakersfield, CACalifornia | $1,785.73 | $1,164.50 |
| Chico, CACalifornia | $1,777.00 | $1,155.78 |
| El Centro, CACalifornia | $1,777.49 | $1,156.26 |
| Fresno, CACalifornia | $1,777.00 | $1,155.78 |
| Hanford, CACalifornia | $1,777.00 | $1,155.78 |
| Madera, CACalifornia | $1,777.00 | $1,155.78 |
| Merced, CACalifornia | $1,777.00 | $1,155.78 |
| Modesto, CACalifornia | $1,777.00 | $1,155.78 |
| Napa, CACalifornia | $1,993.11 | $1,246.05 |
| Oxnard, CACalifornia | $1,864.67 | $1,194.69 |
| Redding, CACalifornia | $1,777.00 | $1,155.78 |
| Rest of CaliforniaCalifornia | $1,777.00 | $1,155.78 |
| Riverside, CACalifornia | $1,808.63 | $1,187.40 |
| Sacramento, CACalifornia | $1,847.22 | $1,188.02 |
| Salinas, CACalifornia | $1,839.88 | $1,182.94 |
| San Diego, CACalifornia | $1,869.86 | $1,191.95 |
| Marin County, CACalifornia | $2,089.60 | $1,290.39 |
| San Francisco, CACalifornia | $2,086.29 | $1,287.08 |
| San Benito County, CACalifornia | $2,135.45 | $1,318.11 |
| Santa Clara County, CACalifornia | $2,121.94 | $1,304.60 |
| San Luis Obispo, CACalifornia | $1,812.12 | $1,166.52 |
| Santa Cruz, CACalifornia | $1,877.45 | $1,188.77 |
| Santa Maria, CACalifornia | $1,843.15 | $1,182.24 |
| Santa Rosa, CACalifornia | $1,895.41 | $1,199.36 |
| Stockton, CACalifornia | $1,777.00 | $1,155.78 |
| Vallejo, CACalifornia | $1,988.35 | $1,241.29 |
| Visalia, CACalifornia | $1,777.00 | $1,155.78 |
| Yuba City, CACalifornia | $1,777.00 | $1,155.78 |
| ColoradoColorado | $1,770.60 | $1,167.51 |
| ConnecticutConnecticut | $1,829.45 | $1,218.99 |
| DelawareDelaware | $1,714.30 | $1,154.28 |
| Fort Lauderdale, FLFlorida | $1,818.98 | $1,244.80 |
| Rest of FloridaFlorida | $1,742.79 | $1,200.92 |
| Atlanta, GAGeorgia | $1,764.88 | $1,189.00 |
| Rest of GeorgiaGeorgia | $1,660.30 | $1,154.70 |
| Hawaii, Guam, HIHawaii | $1,800.79 | $1,156.33 |
| IowaIowa | $1,601.81 | $1,083.17 |
| IdahoIdaho | $1,613.28 | $1,091.81 |
| East St. Louis, ILIllinois | $1,763.06 | $1,241.59 |
| Rest of IllinoisIllinois | $1,713.51 | $1,196.01 |
| Suburban Chicago, ILIllinois | $1,832.63 | $1,250.51 |
| IndianaIndiana | $1,620.26 | $1,094.82 |
| KansasKansas | $1,603.22 | $1,090.83 |
| KentuckyKentucky | $1,630.92 | $1,127.03 |
| New Orleans, LALouisiana | $1,694.87 | $1,161.50 |
| Rest of LouisianaLouisiana | $1,631.84 | $1,130.21 |
| Metropolitan Boston, MAMassachusetts | $1,911.03 | $1,234.25 |
| Rest of MassachusettsMassachusetts | $1,766.44 | $1,169.59 |
| Baltimore area, MDMaryland | $1,825.54 | $1,217.35 |
| Rest of MarylandMaryland | $1,739.82 | $1,166.21 |
| Rest of MaineMaine | $1,627.76 | $1,106.29 |
| Southern Maine, MEMaine | $1,686.62 | $1,124.91 |
| Detroit, MIMichigan | $1,767.93 | $1,220.95 |
| Rest of MichiganMichigan | $1,671.32 | $1,153.82 |
| MinnesotaMinnesota | $1,685.09 | $1,101.84 |
| Metropolitan Kansas City, MOMissouri | $1,677.78 | $1,145.54 |
| Metropolitan St. Louis, MOMissouri | $1,690.83 | $1,151.22 |
| Rest of MissouriMissouri | $1,614.61 | $1,126.01 |
| MississippiMississippi | $1,590.95 | $1,102.92 |
| MontanaMontana | $1,729.64 | $1,162.82 |
| North CarolinaNorth Carolina | $1,640.03 | $1,111.19 |
| North DakotaNorth Dakota | $1,672.10 | $1,105.28 |
| NebraskaNebraska | $1,606.49 | $1,083.33 |
| New HampshireNew Hampshire | $1,751.17 | $1,161.11 |
| Northern New JerseyNew Jersey | $1,918.51 | $1,261.01 |
| Rest of New JerseyNew Jersey | $1,847.03 | $1,228.07 |
| New MexicoNew Mexico | $1,681.59 | $1,161.82 |
| NevadaNevada | $1,714.42 | $1,147.04 |
| NYC suburbs and Long Island, NYNew York | $2,019.70 | $1,345.76 |
| Poughkeepsie and northern NYC suburbs, NYNew York | $1,864.55 | $1,243.88 |
| Queens, NYNew York | $1,973.65 | $1,303.67 |
| Rest of New YorkNew York | $1,660.13 | $1,121.66 |
| OhioOhio | $1,659.56 | $1,142.06 |
| OklahomaOklahoma | $1,620.78 | $1,114.61 |
| Portland, OROregon | $1,808.65 | $1,178.92 |
| Rest of OregonOregon | $1,697.70 | $1,133.15 |
| Metropolitan Philadelphia, PAPennsylvania | $1,796.76 | $1,206.71 |
| Rest of PennsylvaniaPennsylvania | $1,657.52 | $1,137.19 |
| Puerto RicoPuerto Rico | $1,737.36 | $1,164.31 |
| Rhode IslandRhode Island | $1,761.79 | $1,176.27 |
| South CarolinaSouth Carolina | $1,653.19 | $1,129.45 |
| South DakotaSouth Dakota | $1,665.29 | $1,098.48 |
| Austin, TXTexas | $1,767.75 | $1,168.06 |
| Beaumont, TXTexas | $1,649.43 | $1,133.63 |
| Brazoria, TXTexas | $1,707.63 | $1,145.92 |
| Dallas, TXTexas | $1,720.11 | $1,155.56 |
| Fort Worth, TXTexas | $1,713.20 | $1,154.33 |
| Galveston, TXTexas | $1,713.93 | $1,151.08 |
| Houston, TXTexas | $1,767.19 | $1,204.34 |
| Rest of TexasTexas | $1,678.76 | $1,140.85 |
| UtahUtah | $1,670.92 | $1,138.11 |
| VirginiaVirginia | $1,687.37 | $1,130.20 |
| Virgin Islands, VIUnited States Virgin Islands | $1,737.36 | $1,164.31 |
| VermontVermont | $1,673.65 | $1,112.51 |
| Rest of WashingtonWashington | $1,760.49 | $1,163.64 |
| King County, WAWashington | $1,938.22 | $1,242.74 |
| WisconsinWisconsin | $1,628.27 | $1,085.27 |
| West VirginiaWest Virginia | $1,664.74 | $1,172.18 |
| WyomingWyoming | $1,704.56 | $1,137.75 |
21080 rates by state
Office rate range in each state. Select a state to see its payment localities.
Explore a state
Local rates. Clear comparisons.
Hover or focus a tile to see its rate range. Select it to open the state’s fee schedule.
$1,567.54
$2,147.27
Color shows the midpoint of each state’s locality range.
View every state and territory as a table
| State / territory | Office rate range | Localities |
|---|---|---|
| AK | $2,147.27 | 1 |
| AL | $1,585.57 | 1 |
| AR | $1,567.54 | 1 |
| AZ | $1,690.52 | 1 |
| CA | $1,777.00–$2,135.45 | 29 |
| CO | $1,770.60 | 1 |
| CT | $1,829.45 | 1 |
| DC | $1,930.24 | 1 |
| DE | $1,714.30 | 1 |
| FL | $1,742.79–$1,911.93 | 3 |
| GA | $1,660.30–$1,764.88 | 2 |
| GU | $1,800.79 | 1 |
| HI | $1,800.79 | 1 |
| IA | $1,601.81 | 1 |
| ID | $1,613.28 | 1 |
| IL | $1,713.51–$1,865.50 | 4 |
| IN | $1,620.26 | 1 |
| KS | $1,603.22 | 1 |
| KY | $1,630.92 | 1 |
| LA | $1,631.84–$1,694.87 | 2 |
| MA | $1,766.44–$1,911.03 | 2 |
| MD | $1,739.82–$1,930.24 | 3 |
| ME | $1,627.76–$1,686.62 | 2 |
| MI | $1,671.32–$1,767.93 | 2 |
| MN | $1,685.09 | 1 |
| MO | $1,614.61–$1,690.83 | 3 |
| MS | $1,590.95 | 1 |
| MT | $1,729.64 | 1 |
| NC | $1,640.03 | 1 |
| ND | $1,672.10 | 1 |
| NE | $1,606.49 | 1 |
| NH | $1,751.17 | 1 |
| NJ | $1,847.03–$1,918.51 | 2 |
| NM | $1,681.59 | 1 |
| NV | $1,714.42 | 1 |
| NY | $1,660.13–$2,019.70 | 5 |
| OH | $1,659.56 | 1 |
| OK | $1,620.78 | 1 |
| OR | $1,697.70–$1,808.65 | 2 |
| PA | $1,657.52–$1,796.76 | 2 |
| PR | $1,737.36 | 1 |
| RI | $1,761.79 | 1 |
| SC | $1,653.19 | 1 |
| SD | $1,665.29 | 1 |
| TN | $1,610.52 | 1 |
| TX | $1,649.43–$1,767.75 | 8 |
| UT | $1,670.92 | 1 |
| VA | $1,687.37–$1,930.24 | 2 |
| VI | $1,737.36 | 1 |
| VT | $1,673.65 | 1 |
| WA | $1,760.49–$1,938.22 | 2 |
| WI | $1,628.27 | 1 |
| WV | $1,664.74 | 1 |
| WY | $1,704.56 | 1 |
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.
The exact Tennessee inputs and CMS source lines
PPRRVU2026_Oct_nonQPP.csv
1,864
- Code
- 21080
- Physician work
- 24.43
- Practice expense
- 24.45
- Malpractice
- 2.91
GPCI2026.csv
95
- Locality
- Tennessee
- Physician work
- 1.000
- Practice expense
- 0.909
- Malpractice
- 0.537
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 24.43 | × 1.000 | 24.4300 |
| Practice expense | 24.45 | × 0.909 | 22.2250 |
| Malpractice | 2.91 | × 0.537 | 1.5627 |
| Total RVUs | 48.2177 | ||
| Conversion factor | × 33.4009 | ||
Office rate, Tennessee$1610.52
Office: (24.43 × 1 + 24.45 × 0.909 + 2.91 × 0.537) × $33.4009 = $1610.52
Facility: (24.43 × 1 + 7.48 × 0.909 + 2.91 × 0.537) × $33.4009 = $1095.28
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%).
How 21080 has changed in Tennessee
21080 · Office / nonfacility
$1610.52
Effective 2026-10-01
The base rate is $80.48 higher than on 2025-10-01, moving from $1530.04 to $1610.52 (5.3%).
It is unchanged from the immediately preceding available release, effective 2026-07-01.
One bar per available release, ordered by effective date. Missing rates remain gaps. These comparisons hold the code, setting and locality identifiers constant; they do not isolate which policy or input caused a change.
What changed, release by release
January 1, 2026
RVU26A
$1530.04changed to$1610.52
- Conversion factor 32.3465 changed to 33.4009
- Work RVU 25.06 changed to 24.43
- Practice expense RVU 23.36 changed to 24.45
- Malpractice RVU 2.41 changed to 2.91
- Practice expense GPCI 0.896 changed to 0.909
- Malpractice GPCI 0.544 changed to 0.537
Held through RVU26B, RVU26C, RVU26D.
January 1, 2025
RVU25A
$1539.84changed to$1530.04
- Conversion factor 33.2875 changed to 32.3465
- Practice expense RVU 22.19 changed to 23.36
- Malpractice RVU 2.42 changed to 2.41
Held through RVU25B, RVU25C, RVU25D.
March 9, 2024
RVU24AR
$1514.70changed to$1539.84
- Conversion factor 32.7442 changed to 33.2875
Held through RVU24B, RVU24C, RVU24D.
January 1, 2024
RVU24A
$1560.86changed to$1514.70
- Conversion factor 33.8872 changed to 32.7442
- Practice expense RVU 22.10 changed to 22.19
- Malpractice RVU 2.40 changed to 2.42
- Practice expense GPCI 0.894 changed to 0.896
- Malpractice GPCI 0.518 changed to 0.544
January 1, 2023
RVU23A
$1581.87changed to$1560.86
- Conversion factor 34.6062 changed to 33.8872
- Practice expense RVU 21.91 changed to 22.10
- Malpractice RVU 2.25 changed to 2.40
- Practice expense GPCI 0.892 changed to 0.894
- Malpractice GPCI 0.492 changed to 0.518
Held through RVU23B, RVU23C, RVU23D.
January 1, 2022
RVU22A
$1597.59changed to$1581.87
- Conversion factor 34.8931 changed to 34.6062
- Practice expense RVU 22.01 changed to 21.91
- Malpractice RVU 2.22 changed to 2.25
Held through RVU22B, RVU22C, RVU22D.
January 1, 2021
RVU21A
$1676.21changed to$1597.59
- Conversion factor 36.0896 changed to 34.8931
- Practice expense RVU 22.61 changed to 22.01
- Malpractice RVU 2.17 changed to 2.22
- Practice expense GPCI 0.897 changed to 0.892
- Malpractice GPCI 0.509 changed to 0.492
Held through RVU21B, RVU21C, RVU21D.
January 1, 2020
RVU20A
$1745.26changed to$1676.21
- Conversion factor 36.0391 changed to 36.0896
- Practice expense RVU 23.50 changed to 22.61
- Malpractice RVU 4.17 changed to 2.17
- Practice expense GPCI 0.901 changed to 0.897
- Malpractice GPCI 0.526 changed to 0.509
Held through RVU20B, RVU20C, RVU20D.
January 1, 2019
RVU19A
$1785.62changed to$1745.26
- Conversion factor 35.9996 changed to 36.0391
- Practice expense RVU 24.78 changed to 23.50
- Malpractice RVU 4.21 changed to 4.17
Held through RVU19B, RVU19C, RVU19D.
April 1, 2018
RVU18B
No ratechanged to$1785.62
Held through RVU18C, RVU18D.
January 1, 2013
RVU13AR
Earliest loaded release: No rate
Held through RVU13B, RVU13C, RVU13D, RVU14A, RVU14B, RVU14C, RVU14D, RVU15A, RVU15B, RVU15C, RVU15D, RVU16A, RVU16B, RVU16C, RVU16D, RVU17A, RVU17B, RVU17C, RVU17D, RVU18AR1.
| Effective from | Office | Facility | CMS release |
|---|---|---|---|
| 2026-10-01 | $1,610.52 | $1,095.28 | RVU26D |
| 2026-07-01 | $1,610.52 | $1,095.28 | RVU26C |
| 2026-04-01 | $1,610.52 | $1,095.28 | RVU26B |
| 2026-01-01 | $1,610.52 | $1,095.28 | RVU26A |
| 2025-10-01 | $1,530.04 | $1,219.06 | RVU25D |
| 2025-07-01 | $1,530.04 | $1,219.06 | RVU25C |
| 2025-04-01 | $1,530.04 | $1,219.06 | RVU25B |
| 2025-01-01 | $1,530.04 | $1,219.06 | RVU25A |
| 2024-10-01 | $1,539.84 | $1,231.14 | RVU24D |
| 2024-07-01 | $1,539.84 | $1,231.14 | RVU24C |
| 2024-04-01 | $1,539.84 | $1,231.14 | RVU24B |
| 2024-03-09 | $1,539.84 | $1,231.14 | RVU24AR |
| 2024-01-01 | $1,514.70 | $1,211.05 | RVU24A |
| 2023-10-01 | $1,560.86 | $1,252.76 | RVU23D |
| 2023-07-01 | $1,560.86 | $1,252.76 | RVU23C |
| 2023-04-01 | $1,560.86 | $1,252.76 | RVU23B |
| 2023-01-01 | $1,560.86 | $1,252.76 | RVU23A |
| 2022-10-01 | $1,581.87 | $1,270.72 | RVU22D |
| 2022-07-01 | $1,581.87 | $1,270.72 | RVU22C |
| 2022-04-01 | $1,581.87 | $1,270.72 | RVU22B |
| 2022-01-01 | $1,581.87 | $1,270.72 | RVU22A |
| 2021-10-01 | $1,597.59 | $1,292.25 | RVU21D |
| 2021-07-01 | $1,597.59 | $1,292.25 | RVU21C |
| 2021-04-01 | $1,597.59 | $1,292.25 | RVU21B |
| 2021-01-01 | $1,597.59 | $1,292.25 | RVU21A |
| 2020-10-01 | $1,676.21 | $1,373.20 | RVU20D |
| 2020-07-01 | $1,676.21 | $1,373.20 | RVU20C |
| 2020-04-01 | $1,676.21 | $1,373.20 | RVU20B |
| 2020-01-01 | $1,676.21 | $1,373.20 | RVU20A |
| 2019-10-01 | $1,745.26 | $1,441.66 | RVU19D |
| 2019-07-01 | $1,745.26 | $1,441.66 | RVU19C |
| 2019-04-01 | $1,745.26 | $1,441.66 | RVU19B |
| 2019-01-01 | $1,745.26 | $1,441.66 | RVU19A |
| 2018-10-01 | $1,785.62 | $1,481.38 | RVU18D |
| 2018-07-01 | $1,785.62 | $1,481.38 | RVU18C |
| 2018-04-01 | $1,785.62 | $1,481.38 | RVU18B |
| 2018-01-01 | Rate data unavailable | Rate data unavailable | RVU18AR1 |
| 2017-10-01 | Rate data unavailable | Rate data unavailable | RVU17D |
| 2017-07-01 | Rate data unavailable | Rate data unavailable | RVU17C |
| 2017-04-01 | Rate data unavailable | Rate data unavailable | RVU17B |
| 2017-01-01 | Rate data unavailable | Rate data unavailable | RVU17A |
| 2016-10-01 | Rate data unavailable | Rate data unavailable | RVU16D |
| 2016-07-01 | Rate data unavailable | Rate data unavailable | RVU16C |
| 2016-04-01 | Rate data unavailable | Rate data unavailable | RVU16B |
| 2016-01-01 | Rate data unavailable | Rate data unavailable | RVU16A |
| 2015-10-01 | Rate data unavailable | Rate data unavailable | RVU15D |
| 2015-07-01 | Rate data unavailable | Rate data unavailable | RVU15C |
| 2015-04-01 | Rate data unavailable | Rate data unavailable | RVU15B |
| 2015-01-01 | Rate data unavailable | Rate data unavailable | RVU15A |
| 2014-10-01 | Rate data unavailable | Rate data unavailable | RVU14D |
| 2014-07-01 | Rate data unavailable | Rate data unavailable | RVU14C |
| 2014-04-01 | Rate data unavailable | Rate data unavailable | RVU14B |
| 2014-01-01 | Rate data unavailable | Rate data unavailable | RVU14A |
| 2013-10-01 | Rate data unavailable | Rate data unavailable | RVU13D |
| 2013-07-01 | Rate data unavailable | Rate data unavailable | RVU13C |
| 2013-04-01 | Rate data unavailable | Rate data unavailable | RVU13B |
| 2013-01-01 | Rate data unavailable | Rate data unavailable | RVU13AR |
Where the Tennessee rate applies
Tennessee is a Medicare payment area, not a city. Our Census mapping connects it to 504 cities and communities in Tennessee. Some span more than one payment area; confirm with the service ZIP.
- Adams
- Adamsville
- Alamo
- Alcoa
- Alexandria
- Algood
- Allardt
- Altamont
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
Fee sheets · Coming soon
Put 21080 and the rest of your codes on one sheet
Your codes at your locality, with payer contracts beside Medicare.
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