Billing code 21086: Auricular prosthesisMedicare rate & RVUs
Report 21086 for the impression and preparation work involved in providing a custom external ear prosthesis after congenital absence, trauma, or surgical removal.
Medicare pays $1,627.29 for 21086 nationally in the office and $1,126.61 in a hospital or facility. Local office rates run $1,480.38–$2,038.17.
Medicare rate · 21086
Auricular prosthesis
Swap in your local Medicare rate.
- Work RVUs
- 24.26
- Total RVUs
- 48.72
- Global days
- 090
National rate · 2026
$1,627.29
Office setting, before claim adjustments.
See every locality for 21086 → · Billed by an NP, PA or therapist? →
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 10 sections
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.
Where 21086 pays more and less
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
109 payment localities
$1480.38 to $2038.17
109 of 109 payment localities
| Payment locality | Office | Facility |
|---|---|---|
| Alabama | $1,496.68 | $1,058.59 |
| Alaska* | $2,038.17 | $1,504.94 |
| Arizona | $1,591.55 | $1,106.39 |
| Arkansas | $1,480.38 | $1,050.30 |
| Atlanta | $1,659.85 | $1,151.16 |
| Austin | $1,660.44 | $1,130.72 |
| Bakersfield | $1,676.22 | $1,127.48 |
| Baltimore/Surr. Cntys | $1,715.02 | $1,177.79 |
| Beaumont | $1,555.51 | $1,099.90 |
| Brazoria | $1,606.97 | $1,110.80 |
| Chicago | $1,755.97 | $1,252.79 |
| Chico | $1,667.87 | $1,119.13 |
| Colorado | $1,663.21 | $1,130.49 |
| Connecticut | $1,718.67 | $1,179.43 |
| Dallas | $1,618.59 | $1,119.92 |
| Dc + Md/Va Suburbs | $1,810.48 | $1,220.68 |
| Delaware | $1,613.33 | $1,118.66 |
| Detroit | $1,665.16 | $1,182.01 |
| East St. Louis | $1,662.78 | $1,202.16 |
| El Centro | $1,668.33 | $1,119.59 |
| Fort Lauderdale | $1,711.20 | $1,204.01 |
| Fort Worth | $1,612.55 | $1,118.88 |
| Fresno | $1,667.87 | $1,119.13 |
| Galveston | $1,612.84 | $1,115.67 |
| Hanford-Corcoran | $1,667.87 | $1,119.13 |
| Hawaii, Guam | $1,687.78 | $1,118.51 |
| Houston | $1,663.36 | $1,166.19 |
| Idaho | $1,520.73 | $1,060.10 |
| Indiana | $1,527.00 | $1,062.87 |
| Iowa | $1,510.10 | $1,051.97 |
| Kansas | $1,511.99 | $1,059.37 |
| Kentucky | $1,539.00 | $1,093.90 |
| Los Angeles-Long Beach-Anaheim (Los Angeles/Orange Cnty) | $1,762.18 | $1,169.87 |
| Madera | $1,667.87 | $1,119.13 |
| Manhattan | $1,850.59 | $1,268.80 |
| Merced | $1,667.87 | $1,119.13 |
| Metropolitan Boston | $1,790.98 | $1,193.17 |
| Metropolitan Kansas City | $1,580.96 | $1,110.82 |
| Metropolitan Philadelphia | $1,689.39 | $1,168.18 |
| Metropolitan St. Louis | $1,592.69 | $1,116.04 |
| Miami | $1,797.96 | $1,276.75 |
| Minnesota | $1,583.41 | $1,068.21 |
| Mississippi | $1,502.48 | $1,071.40 |
| Modesto | $1,667.87 | $1,119.13 |
| Montana** | $1,627.11 | $1,126.43 |
| Napa | $1,863.47 | $1,203.58 |
| Nebraska | $1,514.14 | $1,052.02 |
| Nevada** | $1,612.62 | $1,111.44 |
| New Hampshire | $1,645.49 | $1,124.28 |
| New Mexico | $1,585.66 | $1,126.54 |
| New Orleans | $1,597.07 | $1,125.93 |
| North Carolina | $1,545.45 | $1,078.32 |
| North Dakota** | $1,572.53 | $1,071.85 |
| Northern Nj | $1,800.58 | $1,219.79 |
| Nyc Suburbs/Long Island | $1,895.14 | $1,299.83 |
| Ohio | $1,564.97 | $1,107.85 |
| Oklahoma | $1,529.18 | $1,082.07 |
| Oxnard-Thousand Oaks-Ventura | $1,747.14 | $1,155.34 |
| Portland | $1,697.11 | $1,140.85 |
| Poughkpsie/N Nyc Suburbs | $1,751.97 | $1,203.73 |
| Puerto Rico | $1,633.88 | $1,127.69 |
| Queens | $1,851.81 | $1,260.01 |
| Redding | $1,667.87 | $1,119.13 |
| Rest Of California | $1,667.87 | $1,119.13 |
| Rest Of Florida | $1,641.77 | $1,163.12 |
| Rest Of Georgia | $1,566.71 | $1,120.11 |
| Rest Of Illinois | $1,616.14 | $1,159.01 |
| Rest Of Louisiana | $1,540.07 | $1,096.97 |
| Rest Of Maine | $1,534.46 | $1,073.84 |
| Rest Of Maryland | $1,636.53 | $1,129.85 |
| Rest Of Massachusetts | $1,659.96 | $1,132.74 |
| Rest Of Michigan | $1,576.13 | $1,119.01 |
| Rest Of Missouri | $1,524.87 | $1,093.29 |
| Rest Of New Jersey | $1,735.33 | $1,188.59 |
| Rest Of New York | $1,563.67 | $1,088.03 |
| Rest Of Oregon | $1,597.01 | $1,098.34 |
| Rest Of Pennsylvania | $1,562.79 | $1,103.16 |
| Rest Of Texas | $1,581.38 | $1,106.24 |
| Rest Of Washington | $1,654.21 | $1,126.99 |
| Rhode Island | $1,656.65 | $1,139.45 |
| Riverside-San Bernardino-Ontario | $1,697.91 | $1,149.16 |
| Sacramento-Roseville-Folsom | $1,731.83 | $1,149.54 |
| Salinas | $1,724.88 | $1,144.59 |
| San Diego-Chula Vista-Carlsbad | $1,751.44 | $1,152.63 |
| San Francisco-Oakland-Berkeley (Marin Cnty) | $1,951.57 | $1,245.61 |
| San Francisco-Oakland-Berkeley (San Francisco/San Mateo/Alameda/Contra Costa Cnty) | $1,948.43 | $1,242.47 |
| San Jose-Sunnyvale-Santa Clara (San Benito Cnty) | $1,994.01 | $1,272.03 |
| San Jose-Sunnyvale-Santa Clara (Santa Clara Cnty) | $1,981.20 | $1,259.22 |
| San Luis Obispo-Paso Robles | $1,699.04 | $1,128.77 |
| Santa Cruz-Watsonville | $1,757.37 | $1,149.04 |
| Santa Maria-Santa Barbara | $1,727.52 | $1,143.73 |
| Santa Rosa-Petaluma | $1,774.08 | $1,159.25 |
| Seattle (King Cnty) | $1,815.47 | $1,201.13 |
| South Carolina | $1,558.38 | $1,095.75 |
| South Dakota** | $1,566.08 | $1,065.40 |
| Southern Maine | $1,586.75 | $1,090.58 |
| Stockton | $1,667.87 | $1,119.13 |
| Suburban Chicago | $1,723.70 | $1,209.50 |
| Tennessee | $1,518.65 | $1,063.54 |
| Utah | $1,574.40 | $1,103.76 |
| Vallejo | $1,858.95 | $1,199.06 |
| Vermont | $1,574.50 | $1,078.83 |
| Virgin Islands | $1,633.88 | $1,127.69 |
| Virginia | $1,587.87 | $1,095.70 |
| Visalia | $1,667.87 | $1,119.13 |
| West Virginia | $1,572.08 | $1,136.99 |
| Wisconsin | $1,533.06 | $1,053.41 |
| Wyoming** | $1,603.32 | $1,102.64 |
| Yuba City | $1,667.87 | $1,119.13 |
21086 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.
$1,480.38
$2,038.17
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 | $2,038.17 | 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 |
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
Swap in your local Medicare rate.
Work 24.26Practice expense 21.70Malpractice 2.76
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
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
| 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
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 50 · payment effect
With and without the modifier
21086 without 50 · national office
$1,627.29
Auricular prosthesis
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).
21086 compared with similar codes
Compare codes
21086 vs 21077 vs 21087 vs 21088 vs 21089: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 21077Orbital prosthesis
- 21086 is for an external ear prosthesis; 21077 is for an orbital prosthesis.
- 21087Nasal prosthesis
- Use 21086 for an auricular prosthesis and 21087 for a nasal prosthesis.
- 21088Impres&prep facial prosth
- 21086 identifies the ear site specifically. 21088 is for a facial prosthesis when a more specific site code does not describe the service.
- 21089Unlisted maxlfcl prosth px
- 21086 describes the auricular prosthesis service specifically; 21089 is the unlisted option when no specific maxillofacial prosthetic code fits.
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
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