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

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 Chicago, IL, Medicare pays $1,755.97 for 21086 in the office and $1,252.79 when it’s performed in a hospital or facility.

$1,755.97Office (non-facility)

$1,252.79Hospital or facility

+7.9%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.

On this page 11 sections

Rate in Chicago, IL
What 21086 covers
Compared with other areas
Rate map
How it’s calculated
Payment rules
Related codes
Rate history
Where it applies
Billing questions
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 Chicago, IL 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. Chicago, IL pays $1,755.97. The RVUs are the same everywhere; the geographic indexes change the dollars.

21086 in Chicago, IL vs other payment areas

Chicago, IL · this page$1,755.97
East St. Louis, IL · Illinois$1,662.78−$93.19
Rest of Illinois · Illinois$1,616.14−$139.83
Suburban Chicago, IL · Illinois$1,723.70−$32.27
Los Angeles, CA · California$1,762.18+$6.21
Washington, DC area · District of Columbia$1,810.48+$54.51
Miami, FL · Florida$1,797.96+$41.99

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

Every other payment area

21086 in every other Medicare payment locality
Payment locality	Office	Facility
Manhattan, NYNew York	$1,850.59	$1,268.80
AlaskaAlaska	$2,038.17	$1,504.94
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
Madera, CACalifornia	$1,667.87	$1,119.13
Merced, CACalifornia	$1,667.87	$1,119.13
Modesto, CACalifornia	$1,667.87	$1,119.13
Napa, CACalifornia	$1,863.47	$1,203.58
Oxnard, CACalifornia	$1,747.14	$1,155.34
Redding, CACalifornia	$1,667.87	$1,119.13
Rest of CaliforniaCalifornia	$1,667.87	$1,119.13
Riverside, CACalifornia	$1,697.91	$1,149.16
Sacramento, CACalifornia	$1,731.83	$1,149.54
Salinas, CACalifornia	$1,724.88	$1,144.59
San Diego, CACalifornia	$1,751.44	$1,152.63
Marin County, CACalifornia	$1,951.57	$1,245.61
San Francisco, CACalifornia	$1,948.43	$1,242.47
San Benito County, CACalifornia	$1,994.01	$1,272.03
Santa Clara County, CACalifornia	$1,981.20	$1,259.22
San Luis Obispo, CACalifornia	$1,699.04	$1,128.77
Santa Cruz, CACalifornia	$1,757.37	$1,149.04
Santa Maria, CACalifornia	$1,727.52	$1,143.73
Santa Rosa, CACalifornia	$1,774.08	$1,159.25
Stockton, CACalifornia	$1,667.87	$1,119.13
Vallejo, CACalifornia	$1,858.95	$1,199.06
Visalia, CACalifornia	$1,667.87	$1,119.13
Yuba City, CACalifornia	$1,667.87	$1,119.13
ColoradoColorado	$1,663.21	$1,130.49
ConnecticutConnecticut	$1,718.67	$1,179.43
DelawareDelaware	$1,613.33	$1,118.66
Fort Lauderdale, FLFlorida	$1,711.20	$1,204.01
Rest of FloridaFlorida	$1,641.77	$1,163.12
Atlanta, GAGeorgia	$1,659.85	$1,151.16
Rest of GeorgiaGeorgia	$1,566.71	$1,120.11
Hawaii, Guam, HIHawaii	$1,687.78	$1,118.51
IowaIowa	$1,510.10	$1,051.97
IdahoIdaho	$1,520.73	$1,060.10
IndianaIndiana	$1,527.00	$1,062.87
KansasKansas	$1,511.99	$1,059.37
KentuckyKentucky	$1,539.00	$1,093.90
New Orleans, LALouisiana	$1,597.07	$1,125.93
Rest of LouisianaLouisiana	$1,540.07	$1,096.97
Metropolitan Boston, MAMassachusetts	$1,790.98	$1,193.17
Rest of MassachusettsMassachusetts	$1,659.96	$1,132.74
Baltimore area, MDMaryland	$1,715.02	$1,177.79
Rest of MarylandMaryland	$1,636.53	$1,129.85
Rest of MaineMaine	$1,534.46	$1,073.84
Southern Maine, MEMaine	$1,586.75	$1,090.58
Detroit, MIMichigan	$1,665.16	$1,182.01
Rest of MichiganMichigan	$1,576.13	$1,119.01
MinnesotaMinnesota	$1,583.41	$1,068.21
Metropolitan Kansas City, MOMissouri	$1,580.96	$1,110.82
Metropolitan St. Louis, MOMissouri	$1,592.69	$1,116.04
Rest of MissouriMissouri	$1,524.87	$1,093.29
MississippiMississippi	$1,502.48	$1,071.40
MontanaMontana	$1,627.11	$1,126.43
North CarolinaNorth Carolina	$1,545.45	$1,078.32
North DakotaNorth Dakota	$1,572.53	$1,071.85
NebraskaNebraska	$1,514.14	$1,052.02
New HampshireNew Hampshire	$1,645.49	$1,124.28
Northern New JerseyNew Jersey	$1,800.58	$1,219.79
Rest of New JerseyNew Jersey	$1,735.33	$1,188.59
New MexicoNew Mexico	$1,585.66	$1,126.54
NevadaNevada	$1,612.62	$1,111.44
NYC suburbs and Long Island, NYNew York	$1,895.14	$1,299.83
Poughkeepsie and northern NYC suburbs, NYNew York	$1,751.97	$1,203.73
Queens, NYNew York	$1,851.81	$1,260.01
Rest of New YorkNew York	$1,563.67	$1,088.03
OhioOhio	$1,564.97	$1,107.85
OklahomaOklahoma	$1,529.18	$1,082.07
Portland, OROregon	$1,697.11	$1,140.85
Rest of OregonOregon	$1,597.01	$1,098.34
Metropolitan Philadelphia, PAPennsylvania	$1,689.39	$1,168.18
Rest of PennsylvaniaPennsylvania	$1,562.79	$1,103.16
Puerto RicoPuerto Rico	$1,633.88	$1,127.69
Rhode IslandRhode Island	$1,656.65	$1,139.45
South CarolinaSouth Carolina	$1,558.38	$1,095.75
South DakotaSouth Dakota	$1,566.08	$1,065.40
TennesseeTennessee	$1,518.65	$1,063.54
Austin, TXTexas	$1,660.44	$1,130.72
Beaumont, TXTexas	$1,555.51	$1,099.90
Brazoria, TXTexas	$1,606.97	$1,110.80
Dallas, TXTexas	$1,618.59	$1,119.92
Fort Worth, TXTexas	$1,612.55	$1,118.88
Galveston, TXTexas	$1,612.84	$1,115.67
Houston, TXTexas	$1,663.36	$1,166.19
Rest of TexasTexas	$1,581.38	$1,106.24
UtahUtah	$1,574.40	$1,103.76
VirginiaVirginia	$1,587.87	$1,095.70
Virgin Islands, VIUnited States Virgin Islands	$1,633.88	$1,127.69
VermontVermont	$1,574.50	$1,078.83
Rest of WashingtonWashington	$1,654.21	$1,126.99
King County, WAWashington	$1,815.47	$1,201.13
WisconsinWisconsin	$1,533.06	$1,053.41
West VirginiaWest Virginia	$1,572.08	$1,136.99
WyomingWyoming	$1,603.32	$1,102.64

21086 rates by state

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

ME WI VT NH MT ND MN MI NY MA RI WA ID WY SD IA IL IN OH PA NJ CT OR NV UT CO NE MO KY WV VA MD DE CA AZ NM KS OK AR TN NC SC DC TX LA MS AL GA FL AK HI

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 / territory	Office rate range	Localities
AK	$2,038.17	1
AL	$1,496.68	1
AR	$1,480.38	1
AZ	$1,591.55	1
CA	$1,667.87–$1,994.01	29
CO	$1,663.21	1
CT	$1,718.67	1
DC	$1,810.48	1
DE	$1,613.33	1
FL	$1,641.77–$1,797.96	3
GA	$1,566.71–$1,659.85	2
GU	$1,687.78	1
HI	$1,687.78	1
IA	$1,510.10	1
ID	$1,520.73	1
IL	$1,616.14–$1,755.97	4
IN	$1,527.00	1
KS	$1,511.99	1
KY	$1,539.00	1
LA	$1,540.07–$1,597.07	2
MA	$1,659.96–$1,790.98	2
MD	$1,636.53–$1,810.48	3
ME	$1,534.46–$1,586.75	2
MI	$1,576.13–$1,665.16	2
MN	$1,583.41	1
MO	$1,524.87–$1,592.69	3
MS	$1,502.48	1
MT	$1,627.11	1
NC	$1,545.45	1
ND	$1,572.53	1
NE	$1,514.14	1
NH	$1,645.49	1
NJ	$1,735.33–$1,800.58	2
NM	$1,585.66	1
NV	$1,612.62	1
NY	$1,563.67–$1,895.14	5
OH	$1,564.97	1
OK	$1,529.18	1
OR	$1,597.01–$1,697.11	2
PA	$1,562.79–$1,689.39	2
PR	$1,633.88	1
RI	$1,656.65	1
SC	$1,558.38	1
SD	$1,566.08	1
TN	$1,518.65	1
TX	$1,555.51–$1,663.36	8
UT	$1,574.40	1
VA	$1,587.87–$1,810.48	2
VI	$1,633.88	1
VT	$1,574.50	1
WA	$1,654.21–$1,815.47	2
WI	$1,533.06	1
WV	$1,572.08	1
WY	$1,603.32	1

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?

Your ZIP

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 Chicago, IL 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

Locality: Chicago, IL
Physician work: 1.007
Practice expense: 1.005
Malpractice: 2.295

Office calculation for 21086 in Chicago, IL
Component	RVU	Locality factor	Adjusted
Physician work	24.26	× 1.007	24.4298
Practice expense	21.70	× 1.005	21.8085
Malpractice	2.76	× 2.295	6.3342
Total RVUs			52.5725
Conversion factor			× 33.4009

Office rate, Chicago, IL$1755.97

Office: (24.26 × 1.007 + 21.7 × 1.005 + 2.76 × 2.295) × $33.4009 = $1755.97

Facility: (24.26 × 1.007 + 6.71 × 1.005 + 2.76 × 2.295) × $33.4009 = $1252.79

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

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)	1	Bilateral with modifier 50 pays 150% of the fee schedule amount.
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)	0.10/0.69/0.21	Share of the payment for pre-op, the procedure itself, and post-op care.

Global surgery period · 21086

Auricular prosthesis, impression and preparation

Date of surgery

Date of a later visit

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
Code	How it relates	Office range, Chicago, IL
Used instead
21077	Orbital prosthesis, impression and custom preparationImpression and preparation for an orbital prosthesis rather than an external ear prosthesis.	$2,368.51
21087	Nasal prosthesis, impression and custom preparationImpression and preparation for a nasal prosthesis rather than an auricular prosthesis.	$1,755.97
21088	Facial prosthesis, impression and preparationFor a facial prosthesis when the defect is not covered by a more specific site code.	No office rate
21089	Unlisted prosthesis, maxillofacial procedureUnlisted maxillofacial prosthetic procedure when no specific code describes the service.	No office rate

How 21086 has changed in Chicago, IL

21086 · Office / nonfacility

$1755.97

Effective 2026-10-01

Compare with release effective

The base rate is $101.26 higher than on 2025-10-01, moving from $1654.71 to $1755.97 (6.1%).

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

January 1, 2026
RVU26A
$1654.71changed to$1755.97
- 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 1.023 changed to 1.005
- Malpractice GPCI 2.018 changed to 2.295
Held through RVU26B, RVU26C, RVU26D.
January 1, 2025
RVU25A
$1670.83changed to$1654.71
- 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.
March 9, 2024
RVU24AR
$1643.56changed to$1670.83
- Conversion factor 32.7442 changed to 33.2875
Held through RVU24B, RVU24C, RVU24D.
January 1, 2024
RVU24A
$1691.35changed to$1643.56
- 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
- Work GPCI 1.009 changed to 1.007
- Practice expense GPCI 1.033 changed to 1.023
- Malpractice GPCI 1.945 changed to 2.018
January 1, 2023
RVU23A
$1703.70changed to$1691.35
- 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
- Work GPCI 1.011 changed to 1.009
- Practice expense GPCI 1.044 changed to 1.033
- Malpractice GPCI 1.871 changed to 1.945
Held through RVU23B, RVU23C, RVU23D.
January 1, 2022
RVU22A
$1726.66changed to$1703.70
- 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.
January 1, 2021
RVU21A
$1825.83changed to$1726.66
- 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
- Work GPCI 1.009 changed to 1.011
- Practice expense GPCI 1.039 changed to 1.044
- Malpractice GPCI 1.898 changed to 1.871
Held through RVU21B, RVU21C, RVU21D.
January 1, 2020
RVU20A
$2016.73changed to$1825.83
- 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
- Work GPCI 1.008 changed to 1.009
- Practice expense GPCI 1.034 changed to 1.039
- Malpractice GPCI 1.925 changed to 1.898
Held through RVU20B, RVU20C, RVU20D.
January 1, 2019
RVU19A
$2076.04changed to$2016.73
- 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.
January 1, 2018
RVU18AR1
$2121.39changed to$2076.04
- 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
- Work GPCI 1.012 changed to 1.008
- Practice expense GPCI 1.036 changed to 1.034
- Malpractice GPCI 1.972 changed to 1.925
Held through RVU18B, RVU18C, RVU18D.
January 1, 2017
RVU17A
$2146.46changed to$2121.39
- 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
- Work GPCI 1.016 changed to 1.012
- Practice expense GPCI 1.037 changed to 1.036
- Malpractice GPCI 2.019 changed to 1.972
Held through RVU17B, RVU17C, RVU17D.
January 1, 2016
RVU16A
$2150.64changed to$2146.46
- 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.
July 1, 2015
RVU15C
$2139.93changed to$2150.64
- Conversion factor 35.7547 changed to 35.9335
Held through RVU15D.
January 1, 2015
RVU15A
$2090.69changed to$2139.93
- 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
- Work GPCI 1.023 changed to 1.016
- Practice expense GPCI 1.044 changed to 1.037
- Malpractice GPCI 2.048 changed to 2.019
Held through RVU15B.
January 1, 2014
RVU14A
$2064.56changed to$2090.69
- 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
- Work GPCI 1.030 changed to 1.023
- Practice expense GPCI 1.051 changed to 1.044
- Malpractice GPCI 2.077 changed to 2.048
Held through RVU14B, RVU14C, RVU14D.
October 1, 2013
RVU13D
No ratechanged to$2064.56
January 1, 2013
RVU13AR
Earliest loaded release: No rate
Held through RVU13B, RVU13C.

Rates in every CMS release
Effective from	Office	Facility	CMS release
2026-10-01	$1,755.97	$1,252.79	RVU26D
2026-07-01	$1,755.97	$1,252.79	RVU26C
2026-04-01	$1,755.97	$1,252.79	RVU26B
2026-01-01	$1,755.97	$1,252.79	RVU26A
2025-10-01	$1,654.71	$1,354.25	RVU25D
2025-07-01	$1,654.71	$1,354.25	RVU25C
2025-04-01	$1,654.71	$1,354.25	RVU25B
2025-01-01	$1,654.71	$1,354.25	RVU25A
2024-10-01	$1,670.83	$1,366.74	RVU24D
2024-07-01	$1,670.83	$1,366.74	RVU24C
2024-04-01	$1,670.83	$1,366.74	RVU24B
2024-03-09	$1,670.83	$1,366.74	RVU24AR
2024-01-01	$1,643.56	$1,344.43	RVU24A
2023-10-01	$1,691.35	$1,385.05	RVU23D
2023-07-01	$1,691.35	$1,385.05	RVU23C
2023-04-01	$1,691.35	$1,385.05	RVU23B
2023-01-01	$1,691.35	$1,385.05	RVU23A
2022-10-01	$1,703.70	$1,393.72	RVU22D
2022-07-01	$1,703.70	$1,393.72	RVU22C
2022-04-01	$1,703.70	$1,393.72	RVU22B
2022-01-01	$1,703.70	$1,393.72	RVU22A
2021-10-01	$1,726.66	$1,417.38	RVU21D
2021-07-01	$1,726.66	$1,417.38	RVU21C
2021-04-01	$1,726.66	$1,417.38	RVU21B
2021-01-01	$1,726.66	$1,417.38	RVU21A
2020-10-01	$1,825.83	$1,517.23	RVU20D
2020-07-01	$1,825.83	$1,517.23	RVU20C
2020-04-01	$1,825.83	$1,517.23	RVU20B
2020-01-01	$1,825.83	$1,517.23	RVU20A
2019-10-01	$2,016.73	$1,706.32	RVU19D
2019-07-01	$2,016.73	$1,706.32	RVU19C
2019-04-01	$2,016.73	$1,706.32	RVU19B
2019-01-01	$2,016.73	$1,706.32	RVU19A
2018-10-01	$2,076.04	$1,760.01	RVU18D
2018-07-01	$2,076.04	$1,760.01	RVU18C
2018-04-01	$2,076.04	$1,760.01	RVU18B
2018-01-01	$2,076.04	$1,760.01	RVU18AR1
2017-10-01	$2,121.39	$1,799.78	RVU17D
2017-07-01	$2,121.39	$1,799.78	RVU17C
2017-04-01	$2,121.39	$1,799.78	RVU17B
2017-01-01	$2,121.39	$1,799.78	RVU17A
2016-10-01	$2,146.46	$1,820.84	RVU16D
2016-07-01	$2,146.46	$1,820.84	RVU16C
2016-04-01	$2,146.46	$1,820.84	RVU16B
2016-01-01	$2,146.46	$1,820.84	RVU16A
2015-10-01	$2,150.64	$1,821.98	RVU15D
2015-07-01	$2,150.64	$1,821.98	RVU15C
2015-04-01	$2,139.93	$1,812.91	RVU15B
2015-01-01	$2,139.93	$1,812.91	RVU15A
2014-10-01	$2,090.69	$1,763.82	RVU14D
2014-07-01	$2,090.69	$1,763.82	RVU14C
2014-04-01	$2,090.69	$1,763.82	RVU14B
2014-01-01	$2,090.69	$1,763.82	RVU14A
2013-10-01	$2,064.56	$1,721.64	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

Price 21086 for an earlier date of service

Where the Chicago, IL rate applies

Chicago, IL is a Medicare payment area, not a city. Our Census mapping connects it to 137 cities and communities in Illinois. Some span more than one payment area; confirm with the service ZIP.

21086 in Chicago · multiple payment areas
Alsip
Arlington Heights
21086 in Barrington · multiple payment areas
21086 in Barrington Hills · multiple payment areas
21086 in Bartlett · multiple payment areas
Bedford Park
Bellwood

Browse all communities in Illinois

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)

1,86721083,,[CPT descriptor omitted],A,,18.79,21.33,,6.49,,2.14,42.26,27.42,0,090,0.10,0.69,0.21,2,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00

1,86821084,,[CPT descriptor omitted],A,,21.92,23.80,,7.22,,2.50,48.22,31.64,0,090,0.10,0.69,0.21,2,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00

1,86921085,,[CPT descriptor omitted],A,,8.77,11.42,,3.03,,1.07,21.26,12.87,0,010,0.10,0.80,0.10,2,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00

1,87021086,,[CPT descriptor omitted],A,,24.26,21.70,,6.71,,2.76,48.72,33.73,0,090,0.10,0.69,0.21,2,1,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00

1,87121087,,[CPT descriptor omitted],A,,24.26,21.70,,6.71,,2.76,48.72,33.73,0,090,0.10,0.69,0.21,2,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00

1,87221088,,[CPT descriptor omitted],C,,0.00,0.00,,0.00,,0.00,0.00,0.00,0,090,0.10,0.69,0.21,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00

1,87321089,,[CPT descriptor omitted],C,,0.00,0.00,,0.00,,0.00,0.00,0.00,0,YYY,0.00,0.00,0.00,0,0,1,1,1,9,,33.4009,09,0,99,0.00,0.00,0.00

Geographic factors for Chicago, ILGPCI2026.csv, line 48 (RVU26D)

4510212,GA,99,REST OF GEORGIA,1.000,0.892,1.192

4601212,HI,01,"HAWAII, GUAM",1.000,1.137,0.579

4702202,ID,00,IDAHO,1.000,0.920,0.473

4806102,IL,16,CHICAGO,1.007,1.005,2.295

4906102,IL,12,EAST ST. LOUIS,1.000,0.920,2.014

5006102,IL,15,SUBURBAN CHICAGO,1.007,1.027,1.772

5106102,IL,99,REST OF ILLINOIS,1.000,0.913,1.563

Open CMS source How we calculate rates

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What 21086 covers

How Chicago, IL compares for 21086

Every other payment area

21086 rates by state

How the 21086 rate is calculated

Payment rules and modifiers for 21086

What modifiers do to the payment

Codes related to 21086

How 21086 has changed in Chicago, IL

Where the Chicago, IL rate applies

21086 billing questions

When should 21086 be chosen over 21088?

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

What documentation supports reporting 21086?

How does the 90-day global period affect reporting?

How is bilateral work handled?

Can an assistant or co-surgeon be reported?

Where these rates come from

Did this answer your question about what 21086 pays in Chicago, IL?

Put 21086 and the rest of your codes on one sheet