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CPT code 21086: Auricular prosthesis, impression and preparation2026 Medicare rate & RVUs in Idaho

Report 21086 for the impression and preparation work involved in providing a custom external ear prosthesis after congenital absence, trauma, or surgical removal.

CMS RVU26DEffective Oct 1, 2026One payment locality15 Medicare services in 2024

In Idaho, Medicare pays $1,520.73 for 21086 in the office and $1,060.10 when it’s performed in a hospital or facility.

$1,520.73Office (non-facility)
$1,060.10Hospital or facility
−6.5%vs the national office rate ($1,627.29)

Check a contract rate as a % of Medicare · 21086 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 21086 for the payment locality that covers the ZIP.

On this page 11 sections
  1. Rate in Idaho
  2. What 21086 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 21086 covers

This service covers taking the impression and preparing a custom prosthesis to replace an external ear. It is used when an auricle is absent or has been removed, such as after cancer surgery or traumatic injury. A maxillofacial prosthodontist or another qualified clinician may perform the work, commonly in an office-based prosthetic practice. The service addresses the ear specifically, rather than an orbital, nasal, or broader facial defect.

Report 21086 for the auricular prosthesis impression and preparation service, supported by documentation of the affected site and the work performed. CMS assigns a 90-day global period: the day-before preoperative visit and 90 days of related postoperative care are included. When multiple procedures are performed in the same session, the highest-valued procedure is paid in full and the others at 50%. Modifier 50 identifies bilateral work and is paid at 150%. An assistant at surgery is paid only when medical necessity is documented; 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 Idaho compares for 21086

Across 109 of 109 payment localities, the office rate for 21086 runs from $1,480.38 in Arkansas to $2,038.17 in Alaska. Idaho pays $1,520.73. The RVUs are the same everywhere; the geographic indexes change the dollars.

21086 in Idaho vs other payment areas
  1. Idaho · this page$1,520.73
  2. Los Angeles, CA · California$1,762.18+$241.45
  3. Washington, DC area · District of Columbia$1,810.48+$289.75
  4. Miami, FL · Florida$1,797.96+$277.23
  5. Chicago, IL · Illinois$1,755.97+$235.24
  6. Manhattan, NY · New York$1,850.59+$329.86
  7. Alaska · Alaska$2,038.17+$517.44

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

Every other payment area

21086 in every other Medicare payment locality
Payment localityOfficeFacility
AlabamaAlabama$1,496.68$1,058.59
ArkansasArkansas$1,480.38$1,050.30
ArizonaArizona$1,591.55$1,106.39
Bakersfield, CACalifornia$1,676.22$1,127.48
Chico, CACalifornia$1,667.87$1,119.13
El Centro, CACalifornia$1,668.33$1,119.59
Fresno, CACalifornia$1,667.87$1,119.13
Hanford, CACalifornia$1,667.87$1,119.13

21086 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.

$1,480.38

$2,038.17

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

View every state and territory as a table
21086 office rate range by state
State / territoryOffice rate rangeLocalities
AK$2,038.171
AL$1,496.681
AR$1,480.381
AZ$1,591.551
CA$1,667.87–$1,994.0129
CO$1,663.211
CT$1,718.671
DC$1,810.481
DE$1,613.331
FL$1,641.77–$1,797.963
GA$1,566.71–$1,659.852
GU$1,687.781
HI$1,687.781
IA$1,510.101
ID$1,520.731
IL$1,616.14–$1,755.974
IN$1,527.001
KS$1,511.991
KY$1,539.001
LA$1,540.07–$1,597.072
MA$1,659.96–$1,790.982
MD$1,636.53–$1,810.483
ME$1,534.46–$1,586.752
MI$1,576.13–$1,665.162
MN$1,583.411
MO$1,524.87–$1,592.693
MS$1,502.481
MT$1,627.111
NC$1,545.451
ND$1,572.531
NE$1,514.141
NH$1,645.491
NJ$1,735.33–$1,800.582
NM$1,585.661
NV$1,612.621
NY$1,563.67–$1,895.145
OH$1,564.971
OK$1,529.181
OR$1,597.01–$1,697.112
PA$1,562.79–$1,689.392
PR$1,633.881
RI$1,656.651
SC$1,558.381
SD$1,566.081
TN$1,518.651
TX$1,555.51–$1,663.368
UT$1,574.401
VA$1,587.87–$1,810.482
VI$1,633.881
VT$1,574.501
WA$1,654.21–$1,815.472
WI$1,533.061
WV$1,572.081
WY$1,603.321

See 21086 in every payment locality

How the 21086 rate is calculated

Each of 21086’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 · 21086

RVUs × geographic indexes × conversion factor

Office or facility?

Work24.26

24.26 RVUs× 1.000 GPCI

Practice expense21.70

21.70 RVUs× 1.000 GPCI

Malpractice2.76

2.76 RVUs× 1.000 GPCI

Adjusted RVUs

48.7200

Conversion factor

$33.4009

Medicare rate

$1,627.29

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

The exact Idaho inputs and CMS source lines

PPRRVU2026_Oct_nonQPP.csv

1,870

Code
21086
Physician work
24.26
Practice expense
21.70
Malpractice
2.76

GPCI2026.csv

47

Locality
Idaho
Physician work
1.000
Practice expense
0.920
Malpractice
0.473
Office calculation for 21086 in Idaho
ComponentRVULocality factorAdjusted
Physician work24.26× 1.00024.2600
Practice expense21.70× 0.92019.9640
Malpractice2.76× 0.4731.3055
Total RVUs45.5295
Conversion factor× 33.4009

Office rate, Idaho$1520.73

Office: (24.26 × 1 + 21.7 × 0.92 + 2.76 × 0.473) × $33.4009 = $1520.73

Facility: (24.26 × 1 + 6.71 × 0.92 + 2.76 × 0.473) × $33.4009 = $1060.10

Open 21086 in the RVU calculator

Payment rules and modifiers for 21086

21086 has a 90-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 21086

Auricular prosthesis, impression and preparation

RuleCMS valueWhat it means
Global period090Major surgery: the day before, the day of, and 90 days after are included.
Multiple procedures2Standard reduction: highest-valued procedure at 100%, others at 50%.
Bilateral (modifier 50)1Bilateral with modifier 50 pays 150% of the fee schedule amount.
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)0.10/0.69/0.21Share of the payment for pre-op, the procedure itself, and post-op care.

Global surgery period · 21086

Auricular prosthesis, impression and preparation

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.

  • 24Unrelated E/M visit by the same physician
  • 79Unrelated procedure (starts its own global period)
  • 58Staged, more extensive, or therapy procedure that was planned
  • 78Unplanned return to the operating room for a related complication
SurgeryVisit
Sep 23, 2026Jan 10, 2027

Pre-op dayGlobal period

What modifiers do to the payment

Modifier 50 · payment effect

With and without the modifier

21086 without 50 · national office

$1,627.29

Auricular prosthesis, impression and preparation

21086-50 · Bilateral: 150%

$2,440.94

Both sides on one line with modifier 50 are paid at 150% of the fee schedule amount (subject to multiple-procedure rules with other procedures).

When to use modifier 50

Codes related to 21086

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

Codes related to 21086
CodeHow it relatesOffice range, Idaho
Used instead
21077Orbital prosthesis, impression and custom preparationImpression and preparation for an orbital prosthesis rather than an external ear prosthesis.$2,050.09
21087Nasal prosthesis, impression and custom preparationImpression and preparation for a nasal prosthesis rather than an auricular prosthesis.$1,520.73
21088Facial prosthesis, impression and preparationFor a facial prosthesis when the defect is not covered by a more specific site code.No office rate
21089Unlisted prosthesis, maxillofacial procedureUnlisted maxillofacial prosthetic procedure when no specific code describes the service.No office rate

How 21086 has changed in Idaho

21086 · Office / nonfacility

$1520.73

Effective 2026-10-01

The base rate is $68.96 higher than on 2025-10-01, moving from $1451.77 to $1520.73 (4.8%).

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

    $1451.77changed to$1520.73

    • Conversion factor 32.3465 changed to 33.4009
    • Work RVU 24.88 changed to 24.26
    • Practice expense RVU 20.82 changed to 21.70
    • Malpractice RVU 2.38 changed to 2.76
    • Practice expense GPCI 0.908 changed to 0.920
    • Malpractice GPCI 0.461 changed to 0.473

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    $1465.14changed to$1451.77

    • Conversion factor 33.2875 changed to 32.3465
    • Practice expense RVU 19.86 changed to 20.82
    • Malpractice RVU 2.39 changed to 2.38

    Held through RVU25B, RVU25C, RVU25D.

  3. March 9, 2024

    RVU24AR

    $1441.23changed to$1465.14

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $1470.89changed to$1441.23

    • Conversion factor 33.8872 changed to 32.7442
    • Practice expense RVU 19.59 changed to 19.86
    • Malpractice RVU 2.35 changed to 2.39
    • Practice expense GPCI 0.893 changed to 0.908
    • Malpractice GPCI 0.439 changed to 0.461

  5. January 1, 2023

    RVU23A

    $1472.96changed to$1470.89

    • Conversion factor 34.6062 changed to 33.8872
    • Practice expense RVU 19.12 changed to 19.59
    • Malpractice RVU 2.20 changed to 2.35
    • Practice expense GPCI 0.877 changed to 0.893
    • Malpractice GPCI 0.416 changed to 0.439

    Held through RVU23B, RVU23C, RVU23D.

  6. January 1, 2022

    RVU22A

    $1495.01changed to$1472.96

    • Conversion factor 34.8931 changed to 34.6062
    • Practice expense RVU 19.47 changed to 19.12
    • Malpractice RVU 2.14 changed to 2.20

    Held through RVU22B, RVU22C, RVU22D.

  7. January 1, 2021

    RVU21A

    $1596.53changed to$1495.01

    • Conversion factor 36.0896 changed to 34.8931
    • Practice expense RVU 20.64 changed to 19.47
    • Malpractice RVU 2.13 changed to 2.14
    • Practice expense GPCI 0.890 changed to 0.877
    • Malpractice GPCI 0.464 changed to 0.416

    Held through RVU21B, RVU21C, RVU21D.

  8. January 1, 2020

    RVU20A

    $1689.54changed to$1596.53

    • Conversion factor 36.0391 changed to 36.0896
    • Practice expense RVU 21.99 changed to 20.64
    • Malpractice RVU 4.23 changed to 2.13
    • Practice expense GPCI 0.902 changed to 0.890
    • Malpractice GPCI 0.512 changed to 0.464

    Held through RVU20B, RVU20C, RVU20D.

  9. January 1, 2019

    RVU19A

    $1742.20changed to$1689.54

    • Conversion factor 35.9996 changed to 36.0391
    • Practice expense RVU 23.68 changed to 21.99
    • Malpractice RVU 4.21 changed to 4.23

    Held through RVU19B, RVU19C, RVU19D.

  10. January 1, 2018

    RVU18AR1

    $1768.60changed to$1742.20

    • Conversion factor 35.8887 changed to 35.9996
    • Practice expense RVU 24.72 changed to 23.68
    • Malpractice RVU 4.22 changed to 4.21
    • Practice expense GPCI 0.900 changed to 0.902
    • Malpractice GPCI 0.510 changed to 0.512

    Held through RVU18B, RVU18C, RVU18D.

  11. January 1, 2017

    RVU17A

    $1777.06changed to$1768.60

    • Conversion factor 35.8043 changed to 35.8887
    • Practice expense RVU 25.16 changed to 24.72
    • Malpractice RVU 4.25 changed to 4.22
    • Practice expense GPCI 0.898 changed to 0.900
    • Malpractice GPCI 0.508 changed to 0.510

    Held through RVU17B, RVU17C, RVU17D.

  12. January 1, 2016

    RVU16A

    $1783.95changed to$1777.06

    • Conversion factor 35.9335 changed to 35.8043
    • Practice expense RVU 25.22 changed to 25.16
    • Malpractice RVU 4.17 changed to 4.25

    Held through RVU16B, RVU16C, RVU16D.

  13. July 1, 2015

    RVU15C

    $1775.07changed to$1783.95

    • Conversion factor 35.7547 changed to 35.9335

    Held through RVU15D.

  14. January 1, 2015

    RVU15A

    $1771.34changed to$1775.07

    • Conversion factor 35.8228 changed to 35.7547
    • Practice expense RVU 25.52 changed to 25.22
    • Malpractice RVU 3.06 changed to 4.17
    • Practice expense GPCI 0.896 changed to 0.898
    • Malpractice GPCI 0.556 changed to 0.508

    Held through RVU15B.

  15. January 1, 2014

    RVU14A

    $1734.30changed to$1771.34

    • Conversion factor 34.0230 changed to 35.8228
    • Practice expense RVU 27.03 changed to 25.52
    • Malpractice RVU 3.20 changed to 3.06
    • Practice expense GPCI 0.894 changed to 0.896
    • Malpractice GPCI 0.603 changed to 0.556

    Held through RVU14B, RVU14C, RVU14D.

  16. January 1, 2013

    RVU13AR

    Earliest loaded release: $1734.30

    Held through RVU13B, RVU13C, RVU13D.

Rates in every CMS release
Effective fromOfficeFacilityCMS release
2026-10-01$1,520.73$1,060.10RVU26D
2026-07-01$1,520.73$1,060.10RVU26C
2026-04-01$1,520.73$1,060.10RVU26B
2026-01-01$1,520.73$1,060.10RVU26A
2025-10-01$1,451.77$1,185.08RVU25D
2025-07-01$1,451.77$1,185.08RVU25C
2025-04-01$1,451.77$1,185.08RVU25B
2025-01-01$1,451.77$1,185.08RVU25A
2024-10-01$1,465.14$1,195.23RVU24D
2024-07-01$1,465.14$1,195.23RVU24C
2024-04-01$1,465.14$1,195.23RVU24B
2024-03-09$1,465.14$1,195.23RVU24AR
2024-01-01$1,441.23$1,175.72RVU24A
2023-10-01$1,470.89$1,206.11RVU23D
2023-07-01$1,470.89$1,206.11RVU23C
2023-04-01$1,470.89$1,206.11RVU23B
2023-01-01$1,470.89$1,206.11RVU23A
2022-10-01$1,472.96$1,212.56RVU22D
2022-07-01$1,472.96$1,212.56RVU22C
2022-04-01$1,472.96$1,212.56RVU22B
2022-01-01$1,472.96$1,212.56RVU22A
2021-10-01$1,495.01$1,235.21RVU21D
2021-07-01$1,495.01$1,235.21RVU21C
2021-04-01$1,495.01$1,235.21RVU21B
2021-01-01$1,495.01$1,235.21RVU21A
2020-10-01$1,596.53$1,332.18RVU20D
2020-07-01$1,596.53$1,332.18RVU20C
2020-04-01$1,596.53$1,332.18RVU20B
2020-01-01$1,596.53$1,332.18RVU20A
2019-10-01$1,689.54$1,418.75RVU19D
2019-07-01$1,689.54$1,418.75RVU19C
2019-04-01$1,689.54$1,418.75RVU19B
2019-01-01$1,689.54$1,418.75RVU19A
2018-10-01$1,742.20$1,466.51RVU18D
2018-07-01$1,742.20$1,466.51RVU18C
2018-04-01$1,742.20$1,466.51RVU18B
2018-01-01$1,742.20$1,466.51RVU18AR1
2017-10-01$1,768.60$1,489.21RVU17D
2017-07-01$1,768.60$1,489.21RVU17C
2017-04-01$1,768.60$1,489.21RVU17B
2017-01-01$1,768.60$1,489.21RVU17A
2016-10-01$1,777.06$1,495.09RVU16D
2016-07-01$1,777.06$1,495.09RVU16C
2016-04-01$1,777.06$1,495.09RVU16B
2016-01-01$1,777.06$1,495.09RVU16A
2015-10-01$1,783.95$1,499.35RVU15D
2015-07-01$1,783.95$1,499.35RVU15C
2015-04-01$1,775.07$1,491.88RVU15B
2015-01-01$1,775.07$1,491.88RVU15A
2014-10-01$1,771.34$1,490.81RVU14D
2014-07-01$1,771.34$1,490.81RVU14C
2014-04-01$1,771.34$1,490.81RVU14B
2014-01-01$1,771.34$1,490.81RVU14A
2013-10-01$1,734.30$1,442.61RVU13D
2013-07-01$1,734.30$1,442.61RVU13C
2013-04-01$1,734.30$1,442.61RVU13B
2013-01-01$1,734.30$1,442.61RVU13AR

Price 21086 for an earlier date of service

Where the Idaho rate applies

Idaho is a Medicare payment area, not a city. Our Census mapping connects it to 235 cities and communities in Idaho. Some span more than one payment area; confirm with the service ZIP.

  • Aberdeen
  • Acequia
  • Albion
  • American Falls
  • Ammon
  • Arbon Valley
  • Arco
  • Arimo

Browse all communities in Idaho

21086 billing questions

When should 21086 be chosen over 21088?

Use 21086 for an auricular, or external ear, prosthesis. Code 21088 addresses a facial prosthesis for a defect not described by a more specific site code.

Does 21086 cover the impression and preparation for an orbital or nasal prosthesis?

No. The site determines the code: 21077 is for an orbital prosthesis, and 21087 is for a nasal prosthesis.

What documentation supports reporting 21086?

Document the ear defect or absence and the impression and preparation work performed for the auricular prosthesis.

How does the 90-day global period affect reporting?

The day-before preoperative visit and 90 days of related postoperative care are included in the global period for 21086.

How is bilateral work handled?

CMS identifies 21086 as a bilateral procedure; modifier 50 is paid at 150%.

Can an assistant or co-surgeon be reported?

Assistant-at-surgery payment requires documentation of medical necessity. Co-surgeons and team surgery are not permitted under the CMS rules for this code.

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 21086PPRRVU2026_Oct_nonQPP.csv, line 1,870 (RVU26D)
Geographic factors for IdahoGPCI2026.csv, line 47 (RVU26D)

Open CMS sourceHow we calculate rates

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