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Billing code 21275: Orbitofacial revisionMedicare rate & RVUs

Reports corrective surgery revising the bony framework around the orbits and adjacent face, rather than a separately defined orbital reconstruction.

CMS RVU26DEffective Oct 1, 2026109 payment localities

Medicare pays $764.21 for 21275 nationally in a facility.

Medicare rate · 21275

Orbitofacial revision

Swap in your local Medicare rate.

Work RVUs
11.47
Total RVUs
22.88
Global days
090

National rate · 2026

$764.21

Facility setting, before claim adjustments.

See every locality for 21275 → · 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
  1. Medicare rate
  2. What 21275 covers
  3. By payment locality
  4. Rate map
  5. How it’s calculated
  6. Payment rules
  7. Similar codes
  8. Related codes
  9. Billing questions
  10. Sources

What 21275 covers

This code describes operative revision of orbitofacial bones, the skeletal structures surrounding the eye sockets and adjoining face. It may be used when a surgeon corrects residual or recurrent bony deformity after prior craniofacial surgery, trauma, or congenital reconstruction. Craniofacial, plastic, or oral and maxillofacial surgeons may perform this work in a hospital or other surgical setting. The operative report should identify the bones revised and explain the deformity and corrective work performed.

Report the code when the documented operation is a revision of the orbitofacial bony framework, not simply a separately defined orbital reconstruction or soft-tissue procedure. It has a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. When multiple procedures occur in the same session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% multiple-procedure reduction. Modifier 50 is inappropriate under the CMS bilateral rule. Assistant-at-surgery payment may be made; co-surgeon payment requires supporting documentation, and team surgery is 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 21275 pays more and less

The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.

109 of 109 payment localities

21275 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$694.59
Alaska*Unavailable$943.97
ArizonaUnavailable$744.36
ArkansasUnavailable$686.00
AtlantaUnavailable$784.62
AustinUnavailable$774.85
BakersfieldUnavailable$773.43
Baltimore/Surr. CntysUnavailable$809.83
BeaumontUnavailable$731.26
BrazoriaUnavailable$748.84

21275 rates by state

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

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Local rates. Clear comparisons.

Hover or focus a tile to see its rate range. Select it to open the state’s fee schedule.

View every state and territory as a table
21275 office rate range by state
State / territoryOffice rate rangeLocalities
AKNo published base rate1
ALNo published base rate1
ARNo published base rate1
AZNo published base rate1
CANo published base rate29
CONo published base rate1
CTNo published base rate1
DCNo published base rate1
DENo published base rate1
FLNo published base rate3
GANo published base rate2
GUNo published base rate1
HINo published base rate1
IANo published base rate1
IDNo published base rate1
ILNo published base rate4
INNo published base rate1
KSNo published base rate1
KYNo published base rate1
LANo published base rate2
MANo published base rate2
MDNo published base rate3
MENo published base rate2
MINo published base rate2
MNNo published base rate1
MONo published base rate3
MSNo published base rate1
MTNo published base rate1
NCNo published base rate1
NDNo published base rate1
NENo published base rate1
NHNo published base rate1
NJNo published base rate2
NMNo published base rate1
NVNo published base rate1
NYNo published base rate5
OHNo published base rate1
OKNo published base rate1
ORNo published base rate2
PANo published base rate2
PRNo published base rate1
RINo published base rate1
SCNo published base rate1
SDNo published base rate1
TNNo published base rate1
TXNo published base rate8
UTNo published base rate1
VANo published base rate2
VINo published base rate1
VTNo published base rate1
WANo published base rate2
WINo published base rate1
WVNo published base rate1
WYNo published base rate1

How the 21275 rate is calculated

Each of 21275’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 · 21275

RVUs × geographic indexes × conversion factor

Swap in your local Medicare rate.

Work 11.47Practice expense 9.28Malpractice 2.13

22.8800 adjusted RVUs×$33.4009 conversion factor=$764.21

All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.

Payment rules and modifiers for 21275

21275 has a 90-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 21275

Orbitofacial revision

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)0The 150% bilateral adjustment doesn’t apply.
Assistant at surgery (80/81/82/AS)2Paid.
Co-surgeons (62)1Permitted with supporting documentation.
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 · 21275

Orbitofacial revision

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.

  • 24 Unrelated E/M visit by the same physician
  • 79 Unrelated procedure (starts its own global period)
  • 58 Staged, more extensive, or therapy procedure that was planned
  • 78 Unplanned 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 51 · payment effect

With and without the modifier

21275 without 51 · national facility

$764.21

Orbitofacial revision

21275-51 · Second procedure: 50%

$382.11

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

21275 compared with similar codes

Compare codes

21275 vs 21256 vs 21260 vs 21268: national Medicare rates

Swap in your local Medicare rate.

  • 21275
    Orbitofacial revision · 11.47 wRVU
    —
  • 21256
    Orbital reconstruction · 17.22 wRVU
    —
  • 21260
    Orbital reconstruction · 17.45 wRVU
    —
  • 21268
    Orbital reconstruction · 26.39 wRVU
    —

How to choose

21256Orbital reconstruction
21256 describes reconstruction of the orbit. Report 21275 when the documented service is revision of orbitofacial bones instead.
21260Orbital reconstruction
21260 is a separately defined eye-socket revision code. Choose between it and 21275 based on which code describes the actual operative scope.
21268Orbital reconstruction
21268 is another specific eye-socket revision option; 21275 describes revision of orbitofacial bones. Match the code to the documented procedure.

Codes related to 21275

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

Codes related to 21275
CodeHow it relatesNational office range
Used instead
21256Orbital reconstructionDescribes reconstruction of the orbit rather than revision of orbitofacial bones.No office rate
21260Orbital reconstructionConsider when the documented service matches this separately defined eye-socket revision code.No office rate
21261Orbital reconstructionA separately defined eye-socket revision option when its operative scope matches.No office rate
21263Orbital osteotomyConsider for the specific eye-socket revision service represented by that code.No office rate
21267Orbital repositioningA specific eye-socket revision option; select by the documented operation.No office rate
21268Orbital reconstructionA specific eye-socket revision option when that code describes the performed work.No office rate
21299Unlisted cranfcl&maxlfcl pxUnlisted craniofacial procedure option when no listed code describes the operation.No office rate

21275 billing questions

When should this code be chosen over an orbital reconstruction code?

Use this code for revision of orbitofacial bones. A code for reconstruction of the orbit, such as 21256, describes that separately defined service rather than the broader revision work.

Can modifier 50 be used when both sides are treated?

No. CMS identifies bilateral adjustment as inapplicable and modifier 50 as inappropriate for this code.

What documentation supports reporting this revision?

Document the bony deformity, the orbitofacial bones revised, the corrective work performed, and the relationship to any prior surgery or injury.

How does the 90-day global period affect follow-up visits?

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

Can an assistant or co-surgeon be reported?

Assistant-at-surgery payment may be made. Co-surgeon payment requires supporting documentation; team surgery is not permitted.

What happens when this is performed with another procedure in the same session?

The highest-valued procedure is paid in full, and other procedures are subject to the standard multiple-procedure reduction.

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 21275PPRRVU2026_Oct_nonQPP.csv, line 1,937 (RVU26D)

Open CMS sourceHow we calculate rates

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