CPT code 21088: Facial prosthesis, impression and preparation2026 Medicare rate & RVUs in Illinois
Reports impression-taking and custom preparation for a facial prosthesis replacing an external facial defect, such as one following surgery or trauma.
CMS doesn’t publish an office rate for 21088 in Illinois.
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 21088 covers
This service involves taking impressions and custom-preparing a prosthesis to replace missing external facial tissue. It is used for facial defects that are not the specific orbital, ear, or nasal prostheses described by separate codes. A maxillofacial prosthodontist or other clinician with maxillofacial prosthetic expertise typically performs the work, often after surgery or trauma has left a facial defect.
Medicare assigns CPT 21088 physician fee schedule status C: there is no national payment amount, and the Medicare Administrative Contractor sets payment for each claim. The service has a 90-day global period, which includes the day-before preoperative visit and 90 days of related postoperative care. Modifier 50 is inappropriate for this code. Assistant-at-surgery payment requires documentation of 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.
Where 21088 pays more and less in Illinois
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
| Payment locality | Office | Facility |
|---|---|---|
| Chicago, IL | Unavailable | Unavailable |
| East St. Louis, IL | Unavailable | Unavailable |
| Rest of Illinois | Unavailable | Unavailable |
| Suburban Chicago, IL | Unavailable | Unavailable |
How the 21088 rate is calculated
Each of 21088’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 · 21088
RVUs × geographic indexes × conversion factor
Work0.00
0.00 RVUs× 1.000 GPCI
Practice expense0.00
0.00 RVUs× 1.000 GPCI
Malpractice0.00
0.00 RVUs× 1.000 GPCI
Adjusted RVUs
0.0000
Conversion factor
$33.4009
Medicare rate
$0.00
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 21088
21088 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 21088
Facial 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 | 0 | No multiple-procedure reduction. |
| Bilateral (modifier 50) | 0 | The 150% bilateral adjustment doesn’t apply. |
| 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 · 21088
Facial 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.
Pre-op dayGlobal period
21088 compared with similar codes
Compare codes · National
5 codes, side by side
How to choose
- 21077Orbital prosthesisImpression and custom preparation
- 21077 applies to an orbital prosthesis. Use 21088 for a facial prosthesis outside that specific anatomic category.
- 21086Auricular prosthesisImpression and preparation
- 21086 is for an auricular prosthesis; 21088 describes a facial prosthesis rather than an ear prosthesis.
- 21087Nasal prosthesisImpression and custom preparation
- 21087 is for a nasal prosthesis. 21088 is for a facial prosthesis not specifically classified as nasal.
- 21089Unlisted prosthesisMaxillofacial procedure
- 21089 is the unlisted maxillofacial prosthetic procedure code. Use 21088 when the work is impression and custom preparation for a facial prosthesis.
21088 billing questions
When should 21088 be chosen over an orbital, nasal, or auricular prosthesis code?
Use 21088 for impression and custom preparation of a facial prosthesis that is not specifically orbital, nasal, or auricular. Those anatomic prostheses have separate codes.
Does 21088 include the impression and custom preparation?
Yes. The code describes both impression-taking and custom preparation for the facial prosthesis.
Does Medicare publish a national payment amount for 21088?
No. Its physician fee schedule status is C, so the Medicare Administrative Contractor sets payment for each claim.
What global period applies to 21088?
It has a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care.
Can modifier 50 or an assistant surgeon be reported?
Modifier 50 is inappropriate for this code. Assistant-at-surgery payment requires documentation of medical necessity; 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
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