Billing code 21356: Facial fracture repairMedicare rate & RVUs
Reports open reduction of a depressed zygomatic arch fracture to restore the arch’s position and facial contour, typically in an operative setting.
Medicare pays $593.20 for 21356 nationally in the office and $379.77 in a hospital or facility. Local office rates run $521.63–$776.53.
Medicare rate · 21356
Facial fracture repair
Swap in your local Medicare rate.
- Work RVUs
- 4.71
- Total RVUs
- 17.76
- Global days
- 010
National rate · 2026
$593.20
Office setting, before claim adjustments.
See every locality for 21356 → · 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 21356 covers
This service treats a depressed fracture of the zygomatic arch through an open approach, repositioning the displaced bone to restore the arch’s contour. It is distinct from repair of a broader malar fracture involving other parts of the cheekbone. Oral and maxillofacial surgeons, facial plastic surgeons, and otolaryngologists commonly perform the repair, usually in a facility setting.
Report the code when the operative note supports an open approach and a depressed fracture of the zygomatic arch; document the fracture site and reduction performed. Related postoperative visits for 10 days are included. For multiple procedures in the same session, the highest-valued procedure is paid in full and others at 50%. Modifier 50 identifies bilateral services, paid at 150%. Assistant-at-surgery payment requires documented medical necessity. CMS does not permit co-surgeons or team surgery for this code.
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 21356 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
$521.63 to $776.53
109 of 109 payment localities
| Payment locality | Office | Facility |
|---|---|---|
| Alabama | $529.63 | $342.88 |
| Alaska* | $685.08 | $457.78 |
| Arizona | $576.37 | $369.55 |
| Arkansas | $521.63 | $338.29 |
| Atlanta | $606.08 | $389.24 |
| Austin | $613.74 | $387.93 |
| Bakersfield | $623.72 | $389.80 |
| Baltimore/Surr. Cntys | $632.36 | $403.34 |
| Beaumont | $554.53 | $360.31 |
| Brazoria | $584.33 | $372.82 |
| Chicago | $634.40 | $419.90 |
| Chico | $621.26 | $387.34 |
| Colorado | $614.67 | $387.57 |
| Connecticut | $633.82 | $403.95 |
| Dallas | $588.82 | $376.24 |
| Dc + Md/Va Suburbs | $677.37 | $425.95 |
| Delaware | $586.14 | $375.27 |
| Detroit | $599.14 | $393.17 |
| East St. Louis | $590.49 | $394.13 |
| El Centro | $621.41 | $387.48 |
| Fort Lauderdale | $622.23 | $406.03 |
| Fort Worth | $585.13 | $374.69 |
| Fresno | $621.26 | $387.34 |
| Galveston | $586.56 | $374.62 |
| Hanford-Corcoran | $621.26 | $387.34 |
| Hawaii, Guam | $636.51 | $393.84 |
| Houston | $602.66 | $390.73 |
| Idaho | $545.19 | $348.83 |
| Indiana | $548.42 | $350.57 |
| Iowa | $540.92 | $345.63 |
| Kansas | $539.60 | $346.66 |
| Kentucky | $545.58 | $355.84 |
| Los Angeles-Long Beach-Anaheim (Los Angeles/Orange Cnty) | $664.16 | $411.67 |
| Madera | $621.26 | $387.34 |
| Manhattan | $686.34 | $438.34 |
| Merced | $621.26 | $387.34 |
| Metropolitan Boston | $675.28 | $420.44 |
| Metropolitan Kansas City | $567.73 | $367.32 |
| Metropolitan Philadelphia | $618.37 | $396.19 |
| Metropolitan St. Louis | $573.75 | $370.56 |
| Miami | $654.81 | $432.63 |
| Minnesota | $584.30 | $364.67 |
| Mississippi | $529.03 | $345.26 |
| Modesto | $621.26 | $387.34 |
| Montana** | $593.14 | $379.71 |
| Napa | $717.91 | $436.61 |
| Nebraska | $543.62 | $346.62 |
| Nevada** | $588.70 | $375.05 |
| New Hampshire | $606.19 | $384.01 |
| New Mexico | $565.37 | $369.65 |
| New Orleans | $573.21 | $372.38 |
| North Carolina | $555.35 | $356.22 |
| North Dakota** | $575.74 | $362.31 |
| Northern Nj | $670.15 | $422.57 |
| Nyc Suburbs/Long Island | $705.28 | $451.51 |
| Ohio | $558.07 | $363.21 |
| Oklahoma | $543.15 | $352.56 |
| Oxnard-Thousand Oaks-Ventura | $660.50 | $408.23 |
| Portland | $633.31 | $396.19 |
| Poughkpsie/N Nyc Suburbs | $645.07 | $411.36 |
| Puerto Rico | $597.23 | $381.45 |
| Queens | $690.24 | $437.96 |
| Redding | $621.26 | $387.34 |
| Rest Of California | $621.26 | $387.34 |
| Rest Of Florida | $590.10 | $386.06 |
| Rest Of Georgia | $554.94 | $364.56 |
| Rest Of Illinois | $574.38 | $379.52 |
| Rest Of Louisiana | $545.22 | $356.33 |
| Rest Of Maine | $549.57 | $353.21 |
| Rest Of Maryland | $597.24 | $381.25 |
| Rest Of Massachusetts | $611.29 | $386.55 |
| Rest Of Michigan | $561.63 | $366.76 |
| Rest Of Missouri | $536.34 | $352.36 |
| Rest Of New Jersey | $639.74 | $406.67 |
| Rest Of New York | $564.15 | $361.39 |
| Rest Of Oregon | $582.84 | $370.27 |
| Rest Of Pennsylvania | $558.25 | $362.32 |
| Rest Of Texas | $569.62 | $367.07 |
| Rest Of Washington | $609.76 | $385.02 |
| Rhode Island | $606.43 | $385.95 |
| Riverside-San Bernardino-Ontario | $630.73 | $396.81 |
| Sacramento-Roseville-Folsom | $651.48 | $403.26 |
| Salinas | $649.07 | $401.70 |
| San Diego-Chula Vista-Carlsbad | $664.13 | $408.87 |
| San Francisco-Oakland-Berkeley (Marin Cnty) | $758.90 | $457.97 |
| San Francisco-Oakland-Berkeley (San Francisco/San Mateo/Alameda/Contra Costa Cnty) | $757.90 | $456.97 |
| San Jose-Sunnyvale-Santa Clara (San Benito Cnty) | $776.53 | $468.77 |
| San Jose-Sunnyvale-Santa Clara (Santa Clara Cnty) | $772.45 | $464.68 |
| San Luis Obispo-Paso Robles | $638.74 | $395.64 |
| Santa Cruz-Watsonville | $670.26 | $410.94 |
| Santa Maria-Santa Barbara | $651.44 | $402.58 |
| Santa Rosa-Petaluma | $676.96 | $414.87 |
| Seattle (King Cnty) | $687.96 | $426.08 |
| South Carolina | $557.90 | $360.69 |
| South Dakota** | $573.68 | $360.25 |
| Southern Maine | $578.70 | $367.18 |
| Stockton | $621.26 | $387.34 |
| Suburban Chicago | $627.97 | $408.77 |
| Tennessee | $542.60 | $348.59 |
| Utah | $565.81 | $365.19 |
| Vallejo | $716.47 | $435.17 |
| Vermont | $574.62 | $363.32 |
| Virgin Islands | $597.23 | $381.45 |
| Virginia | $577.65 | $367.84 |
| Visalia | $621.26 | $387.34 |
| West Virginia | $552.62 | $367.15 |
| Wisconsin | $555.79 | $351.32 |
| Wyoming** | $585.56 | $372.13 |
| Yuba City | $621.26 | $387.34 |
21356 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.
$521.63
$698.90
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 | $685.08 | 1 |
| AL | $529.63 | 1 |
| AR | $521.63 | 1 |
| AZ | $576.37 | 1 |
| CA | $621.26–$776.53 | 29 |
| CO | $614.67 | 1 |
| CT | $633.82 | 1 |
| DC | $677.37 | 1 |
| DE | $586.14 | 1 |
| FL | $590.10–$654.81 | 3 |
| GA | $554.94–$606.08 | 2 |
| GU | $636.51 | 1 |
| HI | $636.51 | 1 |
| IA | $540.92 | 1 |
| ID | $545.19 | 1 |
| IL | $574.38–$634.40 | 4 |
| IN | $548.42 | 1 |
| KS | $539.60 | 1 |
| KY | $545.58 | 1 |
| LA | $545.22–$573.21 | 2 |
| MA | $611.29–$675.28 | 2 |
| MD | $597.24–$677.37 | 3 |
| ME | $549.57–$578.70 | 2 |
| MI | $561.63–$599.14 | 2 |
| MN | $584.30 | 1 |
| MO | $536.34–$573.75 | 3 |
| MS | $529.03 | 1 |
| MT | $593.14 | 1 |
| NC | $555.35 | 1 |
| ND | $575.74 | 1 |
| NE | $543.62 | 1 |
| NH | $606.19 | 1 |
| NJ | $639.74–$670.15 | 2 |
| NM | $565.37 | 1 |
| NV | $588.70 | 1 |
| NY | $564.15–$705.28 | 5 |
| OH | $558.07 | 1 |
| OK | $543.15 | 1 |
| OR | $582.84–$633.31 | 2 |
| PA | $558.25–$618.37 | 2 |
| PR | $597.23 | 1 |
| RI | $606.43 | 1 |
| SC | $557.90 | 1 |
| SD | $573.68 | 1 |
| TN | $542.60 | 1 |
| TX | $554.53–$613.74 | 8 |
| UT | $565.81 | 1 |
| VA | $577.65–$677.37 | 2 |
| VI | $597.23 | 1 |
| VT | $574.62 | 1 |
| WA | $609.76–$687.96 | 2 |
| WI | $555.79 | 1 |
| WV | $552.62 | 1 |
| WY | $585.56 | 1 |
How the 21356 rate is calculated
Each of 21356’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 · 21356
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 4.71Practice expense 12.17Malpractice 0.88
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 21356
21356 has a 10-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 21356
Facial fracture repair
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 010 | Minor procedure: the day of the procedure plus 10 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) | 0.10/0.80/0.10 | Share of the payment for pre-op, the procedure itself, and post-op care. |
Global surgery period · 21356
Facial fracture repair
10-day global period ends
Oct 11, 2026
Covers Oct 1, 2026 through Oct 11, 2026 (11 days).
Visit on Oct 31, 2026
After the global period ends: visits and procedures are billed normally.
What modifiers do to the payment
Modifier 50 · payment effect
With and without the modifier
21356 without 50 · national office
$593.20
Facial fracture repair
21356-50 · Bilateral: 150%
$889.80
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).
21356 compared with similar codes
Compare codes
21356 vs 21355 vs 21360 vs 21365: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 21355Cheekbone fracture
- Choose 21356 for open treatment of a depressed zygomatic arch fracture. Code 21355 is for percutaneous treatment of a malar fracture.
- 21360Malar fracture repair
- Code 21360 describes open treatment of a depressed malar fracture. Code 21356 is specific to a depressed fracture of the zygomatic arch.
- 21365Malar fracture repair
- Code 21365 is for open treatment of a complex malar fracture. Use 21356 when the treated injury is a depressed zygomatic arch fracture.
21356 billing questions
How does this differ from code 21355?
This code is for open treatment of a depressed zygomatic arch fracture. Code 21355 describes percutaneous treatment of a malar fracture.
When would code 21360 be more appropriate?
Use 21360 for open treatment of a depressed malar fracture when the fracture involves the malar region rather than an isolated depressed zygomatic arch.
Are routine postoperative visits separately reported?
Related postoperative visits during the 10-day global period are included in this service.
How is bilateral treatment reported?
Report modifier 50 for bilateral treatment; CMS pays the bilateral procedure at 150%.
Can an assistant surgeon or co-surgeon be billed?
Assistant-at-surgery payment is allowed only when medical necessity is documented. Co-surgeons and team surgery are not permitted for this code.
What happens when other procedures are performed in the same session?
Under the standard multiple-procedure reduction, the highest-valued procedure is paid in full and other procedures are paid at 50%.
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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