Billing code 21386: Orbital fracture repairMedicare rate & RVUs

Medicare pays $630.94 for 21386 nationally in a facility.

Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.

What 21386 covers

Code 21386 describes open repair of an orbital floor blowout fracture reached through a periorbital route, typically through an incision in the eyelid area. The surgeon exposes the fractured floor, addresses displaced bone and any orbital tissue caught at the defect, and restores support as needed. Ophthalmic or oculoplastic, facial plastic, otolaryngology, and oral and maxillofacial surgeons may perform this repair in an operating room, often for traumatic fractures associated with double vision, restricted eye movement, or a change in globe position.

Choose this code based on the documented periorbital approach, not merely the presence of an orbital fracture; transantral and combined approaches have different codes, as do repairs involving an implant or bone graft. The operative report should identify the fracture location, surgical route, findings such as tissue entrapment, and reconstruction performed. CMS assigns a 90-day global period, including the day-before preoperative visit and related postoperative care through day 90. In a session with multiple procedures, the highest-valued procedure is paid in full and others at 50%. Bilateral reporting with modifier 50 is paid at 150%. Assistant-at-surgery payment may be made; 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 21386 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

21386 rates by state

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

How the 21386 rate is calculated

Each of 21386’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.

Payment rules and modifiers for 21386

21386 has a 90-day global period: related visits in that window are included in the surgery payment.

What modifiers do to the payment

When to use modifier 50

21386 compared with similar codes

How to choose

21385Orbital fracture repair

Use 21385 when the documented open repair uses a transantral approach; 21386 identifies a periorbital approach.

21387Orbital fracture repair

Code 21387 represents a combined approach. Code 21386 is for repair through the periorbital route.

21390Orbital fracture repair

Code 21390 includes implant placement in the orbital floor repair. Code 21386 identifies the periorbital approach.

21395Orbital fracture repair

Code 21395 is for orbital floor repair with a bone graft; 21386 identifies repair through a periorbital approach.

Codes related to 21386

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

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

Open CMS sourceHow we calculate rates