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Billing code 21387: Orbital fracture repairMedicare rate & RVUs

Reports open repair of an orbital floor blowout fracture when the surgeon uses combined access to reach and treat the fracture.

CMS RVU26DEffective Oct 1, 2026109 payment localities13 Medicare services in 2024

Medicare pays $702.09 for 21387 nationally in a facility.

Medicare rate · 21387

Orbital fracture repair

Work RVUs
9.86
Total RVUs
21.02
Global days
090

National rate · 2026

$702.09

Facility setting, before claim adjustments.

See every locality for 21387 →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 21387 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 21387 covers

This service repairs an orbital floor blowout fracture through a combined approach, typically using both periorbital and transantral access. The surgeon exposes the fracture, addresses displaced bone or tissue at the floor, and restores support to the orbit. It may be performed by an oculoplastic, facial plastic, oral and maxillofacial, or other surgeon treating complex facial trauma, usually in an operating room. Such fractures may follow blunt facial injury and can be associated with restricted eye movement, double vision, or a sunken appearance of the eye.

Report this code when the operative record supports open treatment through the combined approach; the documented approach, fracture site, and repair should distinguish it from a single-access repair. The 90-day global period includes 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 the others at 50%. Modifier 50 is paid at 150% for bilateral procedures. Assistant-at-surgery payment may be allowed; 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 21387 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

21387 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$636.61
Alaska*Unavailable$859.56
ArizonaUnavailable$683.62
ArkansasUnavailable$628.50
AtlantaUnavailable$720.35
AustinUnavailable$713.85
BakersfieldUnavailable$714.36
Baltimore/Surr. CntysUnavailable$744.59
BeaumontUnavailable$669.70
BrazoriaUnavailable$688.47

21387 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
21387 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 21387 rate is calculated

Each of 21387’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 · 21387

RVUs × geographic indexes × conversion factor

Work9.86

9.86 RVUs× 1.000 GPCI

Practice expense9.33

9.33 RVUs× 1.000 GPCI

Malpractice1.83

1.83 RVUs× 1.000 GPCI

Adjusted RVUs

21.0200

Conversion factor

$33.4009

Medicare rate

$702.09

Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.

Payment rules and modifiers for 21387

21387 has a 90-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 21387

Orbital 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)0Not permitted.
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 · 21387

Orbital 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.

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

21387 without 50 · national facility

$702.09

Orbital fracture repair

21387-50 · Bilateral: 150%

$1,053.14

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

21387 compared with similar codes

Compare codes · National

5 codes, side by side

  • 21387

    Orbital fracture repair9.86 wRVU

    Not priced

  • 21385

    Orbital fracture repair9.33 wRVU

    Not priced

  • 21386

    Orbital fracture repair9.33 wRVU

    Not priced

  • 21390

    Orbital fracture repair10.95 wRVU

    Not priced

  • 21395

    Orbital fracture repair14.33 wRVU

    Not priced

How to choose

21385Orbital fracture repair
21385 describes a transantral-only approach. Choose 21387 when the operative report documents combined access.
21386Orbital fracture repair
21386 describes a periorbital-only approach; 21387 is for combined access to the orbital floor.
21390Orbital fracture repair
21390 describes periorbital repair with an implant. This code is distinguished by combined access rather than that periorbital implant description.
21395Orbital fracture repair
21395 describes periorbital repair with a bone graft. Use this code when combined access, rather than that graft-specific service, is documented.

Codes related to 21387

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

Codes related to 21387
CodeHow it relatesNational office range
Same family
21385Orbital fracture repairOrbital floor fracture repair using a transantral approach.No office rate
21386Orbital fracture repairOrbital floor fracture repair using a periorbital approach.No office rate
Used instead
21390Orbital fracture repairPeriorbital orbital floor repair when an implant is used.No office rate
21395Orbital fracture repairPeriorbital orbital floor repair involving a bone graft.No office rate

21387 billing questions

When should this code be chosen over a single-approach orbital repair?

Use it when the operative documentation supports combined access to treat the orbital floor fracture. A transantral-only or periorbital-only repair points to a different code in the fracture family.

Does the code include the exposure and fracture repair?

The approach and work to treat the orbital floor fracture are part of the reported service. The combined access is not a separate service from the repair.

What documentation supports the combined approach?

The operative report should identify the orbital floor fracture and describe the access routes used and the treatment performed. A general statement that the orbit was repaired may not establish the combined approach.

How is bilateral treatment reported?

CMS identifies this as a bilateral procedure; modifier 50 is paid at 150%. The record should support treatment of fractures on both sides.

Can an assistant surgeon be paid, and can the case have co-surgeons?

Assistant-at-surgery payment may be allowed. CMS does not permit co-surgeons or team surgery for this code.

How does the multiple-procedure reduction affect payment?

For procedures performed in the same session, 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
RVUs for 21387PPRRVU2026_Oct_nonQPP.csv, line 1,966 (RVU26D)

Open CMS sourceHow we calculate rates

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