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Billing code 21366: Malar fracture repairMedicare rate & RVUs

Open repair of a complex cheekbone fracture with bone grafting, reported when reconstruction requires graft support or replacement of missing bone.

CMS RVU26DEffective Oct 1, 2026109 payment localities

Medicare pays $1,138.64 for 21366 nationally in a facility.

Medicare rate · 21366

Malar fracture repair

Swap in your local Medicare rate.

Work RVUs
18.14
Total RVUs
34.09
Global days
090

National rate · 2026

$1,138.64

Facility setting, before claim adjustments.

See every locality for 21366 → · 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 21366 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 21366 covers

This service is an open reconstruction of a complex malar, or cheekbone, fracture using a bone graft. It is typically performed by an oral and maxillofacial surgeon, facial plastic surgeon, or other surgeon treating facial trauma, often in an operating room. The fracture may involve the malar bone and its connections to surrounding facial bones; the operative report must support a complex injury and graft-assisted repair, not simply an isolated depressed cheekbone fracture.

Report the code when the surgeon opens the fracture site and uses a graft as part of the complex malar repair. Documentation should identify the fracture pattern, open approach, graft placement, and treated side. CMS assigns a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. For multiple procedures in one session, the highest-valued procedure is paid in full and others at 50%. Bilateral reporting with modifier 50 is paid at 150%. Assistant-at-surgery and co-surgeon payment are permitted; team-surgery payment is not.

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 21366 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

21366 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$1,037.37
Alaska*Unavailable$1,418.53
ArizonaUnavailable$1,109.44
ArkansasUnavailable$1,024.91
AtlantaUnavailable$1,169.74
AustinUnavailable$1,151.44
BakersfieldUnavailable$1,146.64
Baltimore/Surr. CntysUnavailable$1,205.63
BeaumontUnavailable$1,092.82
BrazoriaUnavailable$1,115.01

21366 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
21366 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 21366 rate is calculated

Each of 21366’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 · 21366

RVUs × geographic indexes × conversion factor

Swap in your local Medicare rate.

Work 18.14Practice expense 12.59Malpractice 3.36

34.0900 adjusted RVUs×$33.4009 conversion factor=$1,138.64

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

Payment rules and modifiers for 21366

21366 has a 90-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 21366

Malar fracture repair

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)1Bilateral with modifier 50 pays 150% of the fee schedule amount.
Assistant at surgery (80/81/82/AS)2Paid.
Co-surgeons (62)2Permitted.
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 · 21366

Malar fracture repair

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 50 · payment effect

With and without the modifier

21366 without 50 · national facility

$1,138.64

Malar fracture repair

21366-50 · Bilateral: 150%

$1,707.96

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

21366 compared with similar codes

Compare codes

21366 vs 21365 vs 21360 vs 21355: national Medicare rates

Swap in your local Medicare rate.

  • 21366
    Malar fracture repair · 18.14 wRVU
    —
  • 21365
    Malar fracture repair · 16.35 wRVU
    —
  • 21360
    Malar fracture repair · 7.01 wRVU
    —
  • 21355
    Cheekbone fracture · 4.34 wRVU
    $445.57

How to choose

21365Malar fracture repair
Use 21366 when the complex malar fracture repair includes a bone graft. Use 21365 for complex open treatment without grafting.
21360Malar fracture repair
21360 describes open treatment of a depressed malar fracture. 21366 is for a complex malar fracture repaired with a graft.
21355Cheekbone fracture
21355 is for percutaneous malar fracture treatment; 21366 involves open repair of a complex fracture with grafting.

Codes related to 21366

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

Codes related to 21366
CodeHow it relatesNational office range
Same family
21365Malar fracture repairOpen treatment of a complex malar fracture without the graft distinction in 21366.No office rate
Used instead
21360Malar fracture repairOpen treatment for a depressed malar fracture rather than a complex graft-assisted repair.No office rate
21355Cheekbone fracturePercutaneous treatment of a malar fracture instead of open graft-assisted reconstruction.$396.06–$575.62
21356Facial fracture repairOpen treatment focused on a depressed zygomatic arch fracture.$521.63–$776.53

21366 billing questions

How does this differ from 21365?

Both describe open treatment of a complex malar fracture, but 21366 is the graft-assisted service. Use 21365 when the documented complex repair does not include a bone graft.

Is the bone graft part of this service?

Yes. The code identifies complex malar fracture repair with grafting; it is not the code for the same repair without a graft.

When is modifier 50 appropriate?

Use modifier 50 for bilateral treatment when both sides are treated. CMS payment for the bilateral procedure is 150%.

What should the operative note establish?

Document the complex malar fracture pattern, open repair, graft placement, and laterality. The record should distinguish this repair from treatment of an isolated depressed malar fracture or zygomatic arch fracture.

How are other procedures in the same session paid?

Under the standard multiple procedure reduction, the highest-valued procedure is paid in full and other procedures are paid at 50%. The code has a 90-day global period for related postoperative care.

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 21366PPRRVU2026_Oct_nonQPP.csv, line 1,963 (RVU26D)

Open CMS sourceHow we calculate rates

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