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CPT code 21085: Oral splint, surgical use2026 Medicare rate & RVUs in West Virginia

Reports impression-taking and preparation of an oral surgical splint used to support planned oral or maxillofacial surgery.

CMS RVU26DEffective Oct 1, 2026One payment locality2K Medicare services in 2024

In West Virginia, Medicare pays $675.54 for 21085 in the office and $432.02 when it’s performed in a hospital or facility.

$675.54Office (non-facility)
$432.02Hospital or facility
−4.9%vs the national office rate ($710.10)

Check a contract rate as a % of Medicare · 21085 nationwide

Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.

We’ll open 21085 for the payment locality that covers the ZIP.

On this page 11 sections
  1. Rate in West Virginia
  2. What 21085 covers
  3. Compared with other areas
  4. Rate map
  5. How it’s calculated
  6. Payment rules
  7. Related codes
  8. Rate history
  9. Where it applies
  10. Billing questions
  11. Sources

What 21085 covers

This service covers taking the impression and preparing an oral surgical splint for a patient undergoing oral or maxillofacial surgery. Oral and maxillofacial surgeons and prosthodontists may provide it in an office or facility setting. A common clinical context is orthognathic surgery, where a custom splint helps transfer or maintain a planned relationship between the jaws during treatment.

Report 21085 when the documented service is for an oral surgical splint, rather than an obturator, speech aid, or other maxillofacial prosthesis. The record should identify the surgical purpose and support the impression and preparation performed. The code has a 10-day global period, which includes related postoperative visits during that period. When multiple procedures are performed in the same session, the highest-valued procedure is paid in full and the others at 50%. Modifier 50 is inappropriate. 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.

How West Virginia compares for 21085

Across 109 of 109 payment localities, the office rate for 21085 runs from $638.99 in Arkansas to $894.34 in San Benito County, CA. West Virginia pays $675.54. The RVUs are the same everywhere; the geographic indexes change the dollars.

21085 in West Virginia vs other payment areas
  1. West Virginia · this page$675.54
  2. Los Angeles, CA · California$779.91+$104.37
  3. Washington, DC area · District of Columbia$797.86+$122.32
  4. Miami, FL · Florida$780.39+$104.85
  5. Chicago, IL · Illinois$760.34+$84.80
  6. Manhattan, NY · New York$811.59+$136.05
  7. Alaska · Alaska$865.31+$189.77

Other areas in West Virginia first, then benchmark localities. Bars start at $0.

Every other payment area

21085 in every other Medicare payment locality
Payment localityOfficeFacility
AlabamaAlabama$646.91$401.71
ArkansasArkansas$638.99$398.27
ArizonaArizona$693.13$421.59
Bakersfield, CACalifornia$738.31$431.18
Chico, CACalifornia$735.12$427.98
El Centro, CACalifornia$735.30$428.16
Fresno, CACalifornia$735.12$427.98
Hanford, CACalifornia$735.12$427.98

21085 rates by state

Office rate range in each state. Select a state to see its payment localities.

MEWIVTNHMTNDMNMINYMARIWAIDWYSDIAILINOHPANJCTORNVUTCONEMOKYWVVAMDDECAAZNMKSOKARTNNCSCDCTXLAMSALGAFLAKHI

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.

$638.99

$865.31

Color shows the midpoint of each state’s locality range.

View every state and territory as a table
21085 office rate range by state
State / territoryOffice rate rangeLocalities
AK$865.311
AL$646.911
AR$638.991
AZ$693.131
CA$735.12–$894.3429
CO$730.201
CT$752.841
DC$797.861
DE$703.381
FL$711.30–$780.393
GA$675.77–$724.272
GU$747.311
HI$747.311
IA$656.131
ID$660.751
IL$697.04–$760.344
IN$663.891
KS$655.761
KY$664.731
LA$664.74–$692.462
MA$727.75–$792.182
MD$714.68–$797.863
ME$666.08–$693.482
MI$681.53–$721.272
MN$696.001
MO$656.54–$691.873
MS$647.761
MT$710.031
NC$671.651
ND$688.871
NE$658.501
NH$721.271
NJ$760.38–$792.022
NM$685.631
NV$704.521
NY$680.42–$831.575
OH$677.201
OK$661.321
OR$697.96–$747.982
PA$676.86–$737.912
PR$713.761
RI$724.401
SC$675.751
SD$686.371
TN$658.851
TX$673.24–$728.748
UT$683.571
VA$693.11–$797.862
VI$713.761
VT$688.631
WA$725.59–$804.802
WI$669.351
WV$675.541
WY$700.811

See 21085 in every payment locality

How the 21085 rate is calculated

Each of 21085’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 · 21085

RVUs × geographic indexes × conversion factor

Office or facility?

Work8.77

8.77 RVUs× 1.000 GPCI

Practice expense11.42

11.42 RVUs× 1.000 GPCI

Malpractice1.07

1.07 RVUs× 1.000 GPCI

Adjusted RVUs

21.2600

Conversion factor

$33.4009

Medicare rate

$710.10

Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.

The exact West Virginia inputs and CMS source lines

PPRRVU2026_Oct_nonQPP.csv

1,869

Code
21085
Physician work
8.77
Practice expense
11.42
Malpractice
1.07

GPCI2026.csv

110

Locality
West Virginia
Physician work
1.000
Practice expense
0.869
Malpractice
1.431
Office calculation for 21085 in West Virginia
ComponentRVULocality factorAdjusted
Physician work8.77× 1.0008.7700
Practice expense11.42× 0.8699.9240
Malpractice1.07× 1.4311.5312
Total RVUs20.2251
Conversion factor× 33.4009

Office rate, West Virginia$675.54

Office: (8.77 × 1 + 11.42 × 0.869 + 1.07 × 1.431) × $33.4009 = $675.54

Facility: (8.77 × 1 + 3.03 × 0.869 + 1.07 × 1.431) × $33.4009 = $432.02

Open 21085 in the RVU calculator

Payment rules and modifiers for 21085

21085 has a 10-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 21085

Oral splint, surgical use

RuleCMS valueWhat it means
Global period010Minor procedure: the day of the procedure plus 10 days after are included.
Multiple procedures2Standard reduction: highest-valued procedure at 100%, others at 50%.
Bilateral (modifier 50)0The 150% bilateral adjustment doesn’t apply.
Assistant at surgery (80/81/82/AS)0Not paid without supporting documentation.
Co-surgeons (62)0Not permitted.
Team surgery (66)0Not permitted.
Professional/technical0Physician service: no professional/technical split.
Split (54/55/56)0.10/0.80/0.10Share of the payment for pre-op, the procedure itself, and post-op care.

Global surgery period · 21085

Oral splint, surgical use

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.

SurgeryVisit
Sep 28, 2026Oct 14, 2026

What modifiers do to the payment

Modifier 51 · payment effect

With and without the modifier

21085 without 51 · national office

$710.10

Oral splint, surgical use

21085-51 · Second procedure: 50%

$355.05

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%).

When to use modifier 51

Codes related to 21085

Related codes aren’t interchangeable: bill the code that matches the service performed.

Codes related to 21085
CodeHow it relatesOffice range, West Virginia
Same family
21076Obturator prosthesis, surgical obturatorImpression and preparation for a surgical obturator rather than an oral surgical splint.$887.90
21081Mandibular prosthesis, impression and custom preparationImpression and preparation for a mandibular resection prosthesis.$1,531.43
21082Palatal prosthesis, augmentation for tongue contactImpression and preparation for a palatal augmentation prosthesis.$1,436.04
21083Palatal lift prosthesis, impression and custom preparationImpression and preparation for a palatal lift prosthesis.$1,349.00
21084Speech aid prosthesis, impression and custom preparationImpression and preparation for a speech-aid prosthesis.$1,542.44

How 21085 has changed in West Virginia

21085 · Office / nonfacility

$675.54

Effective 2026-10-01

The base rate is $43.44 higher than on 2025-10-01, moving from $632.10 to $675.54 (6.9%).

It is unchanged from the immediately preceding available release, effective 2026-07-01.

Base rate by release · bars start at $0 · select a bar to compare

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

  1. January 1, 2026

    RVU26A

    $632.10changed to$675.54

    • Conversion factor 32.3465 changed to 33.4009
    • Work RVU 8.99 changed to 8.77
    • Practice expense RVU 10.88 changed to 11.42
    • Malpractice RVU 0.88 changed to 1.07
    • Practice expense GPCI 0.862 changed to 0.869
    • Malpractice GPCI 1.333 changed to 1.431

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    $641.34changed to$632.10

    • Conversion factor 33.2875 changed to 32.3465
    • Practice expense RVU 10.53 changed to 10.88
    • Malpractice RVU 0.90 changed to 0.88

    Held through RVU25B, RVU25C, RVU25D.

  3. March 9, 2024

    RVU24AR

    $630.87changed to$641.34

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $641.70changed to$630.87

    • Conversion factor 33.8872 changed to 32.7442
    • Practice expense RVU 10.27 changed to 10.53
    • Malpractice RVU 0.88 changed to 0.90
    • Practice expense GPCI 0.860 changed to 0.862
    • Malpractice GPCI 1.266 changed to 1.333

  5. January 1, 2023

    RVU23A

    $642.97changed to$641.70

    • Conversion factor 34.6062 changed to 33.8872
    • Practice expense RVU 9.99 changed to 10.27
    • Malpractice RVU 0.85 changed to 0.88
    • Practice expense GPCI 0.858 changed to 0.860
    • Malpractice GPCI 1.198 changed to 1.266

    Held through RVU23B, RVU23C, RVU23D.

  6. January 1, 2022

    RVU22A

    $648.13changed to$642.97

    • Conversion factor 34.8931 changed to 34.6062
    • Practice expense RVU 10.04 changed to 9.99
    • Malpractice RVU 0.81 changed to 0.85

    Held through RVU22B, RVU22C, RVU22D.

  7. January 1, 2021

    RVU21A

    $679.10changed to$648.13

    • Conversion factor 36.0896 changed to 34.8931
    • Practice expense RVU 10.23 changed to 10.04
    • Malpractice RVU 0.85 changed to 0.81
    • Practice expense GPCI 0.857 changed to 0.858
    • Malpractice GPCI 1.247 changed to 1.198

    Held through RVU21B, RVU21C, RVU21D.

  8. January 1, 2020

    RVU20A

    $720.04changed to$679.10

    • Conversion factor 36.0391 changed to 36.0896
    • Practice expense RVU 10.57 changed to 10.23
    • Malpractice RVU 1.49 changed to 0.85
    • Malpractice GPCI 1.296 changed to 1.247

    Held through RVU20B, RVU20C, RVU20D.

  9. January 1, 2019

    RVU19A

    $733.14changed to$720.04

    • Conversion factor 35.9996 changed to 36.0391
    • Practice expense RVU 11.02 changed to 10.57

    Held through RVU19B, RVU19C, RVU19D.

  10. January 1, 2018

    RVU18AR1

    $738.11changed to$733.14

    • Conversion factor 35.8887 changed to 35.9996
    • Practice expense RVU 11.37 changed to 11.02
    • Malpractice RVU 1.51 changed to 1.49
    • Practice expense GPCI 0.847 changed to 0.857
    • Malpractice GPCI 1.289 changed to 1.296

    Held through RVU18B, RVU18C, RVU18D.

  11. January 1, 2017

    RVU17A

    $737.07changed to$738.11

    • Conversion factor 35.8043 changed to 35.8887
    • Practice expense RVU 11.54 changed to 11.37
    • Malpractice RVU 1.52 changed to 1.51
    • Practice expense GPCI 0.836 changed to 0.847
    • Malpractice GPCI 1.282 changed to 1.289

    Held through RVU17B, RVU17C, RVU17D.

  12. January 1, 2016

    RVU16A

    $740.63changed to$737.07

    • Conversion factor 35.9335 changed to 35.8043
    • Practice expense RVU 11.57 changed to 11.54

    Held through RVU16B, RVU16C, RVU16D.

  13. July 1, 2015

    RVU15C

    $736.95changed to$740.63

    • Conversion factor 35.7547 changed to 35.9335

    Held through RVU15D.

  14. January 1, 2015

    RVU15A

    $813.85changed to$736.95

    • Conversion factor 35.8228 changed to 35.7547
    • Practice expense RVU 11.67 changed to 11.57
    • Malpractice RVU 3.20 changed to 1.52
    • Practice expense GPCI 0.832 changed to 0.836
    • Malpractice GPCI 1.256 changed to 1.282

    Held through RVU15B.

  15. January 1, 2014

    RVU14A

    $798.65changed to$813.85

    • Conversion factor 34.0230 changed to 35.8228
    • Practice expense RVU 12.52 changed to 11.67
    • Malpractice RVU 3.35 changed to 3.20
    • Practice expense GPCI 0.828 changed to 0.832
    • Malpractice GPCI 1.229 changed to 1.256

    Held through RVU14B, RVU14C, RVU14D.

  16. January 1, 2013

    RVU13AR

    Earliest loaded release: $798.65

    Held through RVU13B, RVU13C, RVU13D.

Rates in every CMS release
Effective fromOfficeFacilityCMS release
2026-10-01$675.54$432.02RVU26D
2026-07-01$675.54$432.02RVU26C
2026-04-01$675.54$432.02RVU26B
2026-01-01$675.54$432.02RVU26A
2025-10-01$632.10$463.69RVU25D
2025-07-01$632.10$463.69RVU25C
2025-04-01$632.10$463.69RVU25B
2025-01-01$632.10$463.69RVU25A
2024-10-01$641.34$470.32RVU24D
2024-07-01$641.34$470.32RVU24C
2024-04-01$641.34$470.32RVU24B
2024-03-09$641.34$470.32RVU24AR
2024-01-01$630.87$462.64RVU24A
2023-10-01$641.70$473.25RVU23D
2023-07-01$641.70$473.25RVU23C
2023-04-01$641.70$473.25RVU23B
2023-01-01$641.70$473.25RVU23A
2022-10-01$642.97$474.92RVU22D
2022-07-01$642.97$474.92RVU22C
2022-04-01$642.97$474.92RVU22B
2022-01-01$642.97$474.92RVU22A
2021-10-01$648.13$481.07RVU21D
2021-07-01$648.13$481.07RVU21C
2021-04-01$648.13$481.07RVU21B
2021-01-01$648.13$481.07RVU21A
2020-10-01$679.10$513.63RVU20D
2020-07-01$679.10$513.63RVU20C
2020-04-01$679.10$513.63RVU20B
2020-01-01$679.10$513.63RVU20A
2019-10-01$720.04$555.12RVU19D
2019-07-01$720.04$555.12RVU19C
2019-04-01$720.04$555.12RVU19B
2019-01-01$720.04$555.12RVU19A
2018-10-01$733.14$568.39RVU18D
2018-07-01$733.14$568.39RVU18C
2018-04-01$733.14$568.39RVU18B
2018-01-01$733.14$568.39RVU18AR1
2017-10-01$738.11$573.06RVU17D
2017-07-01$738.11$573.06RVU17C
2017-04-01$738.11$573.06RVU17B
2017-01-01$738.11$573.06RVU17A
2016-10-01$737.07$573.04RVU16D
2016-07-01$737.07$573.04RVU16C
2016-04-01$737.07$573.04RVU16B
2016-01-01$737.07$573.04RVU16A
2015-10-01$740.63$575.11RVU15D
2015-07-01$740.63$575.11RVU15C
2015-04-01$736.95$572.25RVU15B
2015-01-01$736.95$572.25RVU15A
2014-10-01$813.85$651.41RVU14D
2014-07-01$813.85$651.41RVU14C
2014-04-01$813.85$651.41RVU14B
2014-01-01$813.85$651.41RVU14A
2013-10-01$798.65$630.18RVU13D
2013-07-01$798.65$630.18RVU13C
2013-04-01$798.65$630.18RVU13B
2013-01-01$798.65$630.18RVU13AR

Price 21085 for an earlier date of service

Where the West Virginia rate applies

West Virginia is a Medicare payment area, not a city. Our Census mapping connects it to 439 cities and communities in West Virginia. Some span more than one payment area; confirm with the service ZIP.

  • Accoville
  • Addison (Webster Springs)
  • Adrian
  • Albright
  • Alderson
  • Alum Creek
  • Amherstdale
  • Anawalt

Browse all communities in West Virginia

21085 billing questions

How is 21085 different from 21076?

Use 21085 for an oral surgical splint. Code 21076 describes impression and preparation for a surgical obturator, a different type of maxillofacial prosthesis.

Does 21085 cover both the impression and splint preparation?

Yes. The service combines impression-taking and preparation of the oral surgical splint; document the work performed and its surgical purpose.

Can modifier 50 be used for a splint involving both sides?

No. The CMS bilateral adjustment does not apply, and modifier 50 is inappropriate for this code.

What postoperative care is included?

Related postoperative visits during the 10-day global period are included.

When can an assistant-at-surgery be paid?

Only when medical necessity for the assistant is documented. Co-surgeons and team surgery are not permitted.

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
RVUs for 21085PPRRVU2026_Oct_nonQPP.csv, line 1,869 (RVU26D)
Geographic factors for West VirginiaGPCI2026.csv, line 110 (RVU26D)

Open CMS sourceHow we calculate rates

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