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Billing code 21390: Orbital fracture repairMedicare rate & RVUs

Reports operative reconstruction of an orbital floor blowout fracture through a periorbital approach when the surgeon places an implant to support the repaired floor.

CMS RVU26DEffective Oct 1, 2026109 payment localities615 Medicare services in 2024

Medicare pays $708.43 for 21390 nationally in a facility.

Medicare rate · 21390

Orbital fracture repair

Work RVUs
10.95
Total RVUs
21.21
Global days
090

National rate · 2026

$708.43

Facility setting, before claim adjustments.

See every locality for 21390 →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 21390 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 21390 covers

Code 21390 covers operative repair of an orbital floor blowout fracture through an incision around the orbit, with an implant used to support the reconstructed floor. The surgeon exposes the fracture, addresses displaced orbital tissue as needed, and places the implant across the defect. This repair is typically performed by an oculoplastic, oral and maxillofacial, plastic, or facial trauma surgeon in an operating room after facial trauma has caused a floor defect or orbital tissue displacement.

Choose this code when the documented repair uses the periorbital approach and includes an implant. The operative report should identify the fracture and side, describe the approach and repair, and document implant placement. The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care. When multiple procedures are performed in the same session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% reduction. For bilateral repair, modifier 50 is paid at 150%. An assistant at surgery may be paid; 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 21390 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

21390 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$650.42
Alaska*Unavailable$888.34
ArizonaUnavailable$692.26
ArkansasUnavailable$643.22
AtlantaUnavailable$724.10
AustinUnavailable$720.60
BakersfieldUnavailable$724.37
Baltimore/Surr. CntysUnavailable$747.35
BeaumontUnavailable$678.52
BrazoriaUnavailable$697.91

21390 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
21390 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 21390 rate is calculated

Each of 21390’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 · 21390

RVUs × geographic indexes × conversion factor

Work10.95

10.95 RVUs× 1.000 GPCI

Practice expense8.79

8.79 RVUs× 1.000 GPCI

Malpractice1.47

1.47 RVUs× 1.000 GPCI

Adjusted RVUs

21.2100

Conversion factor

$33.4009

Medicare rate

$708.43

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

Payment rules and modifiers for 21390

21390 has a 90-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 21390

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)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 · 21390

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

21390 without 50 · national facility

$708.43

Orbital fracture repair

21390-50 · Bilateral: 150%

$1,062.64

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

21390 compared with similar codes

Compare codes · National

5 codes, side by side

  • 21390

    Orbital fracture repair10.95 wRVU

    Not priced

  • 21386

    Orbital fracture repair9.33 wRVU

    Not priced

  • 21395

    Orbital fracture repair14.33 wRVU

    Not priced

  • 21385

    Orbital fracture repair9.33 wRVU

    Not priced

  • 21387

    Orbital fracture repair9.86 wRVU

    Not priced

How to choose

21386Orbital fracture repair
Use 21390 when the periorbital fracture repair includes an implant. 21386 describes periorbital repair without that implant distinction.
21395Orbital fracture repair
Both describe periorbital orbital floor fracture repair, but 21395 specifies bone graft reconstruction rather than implant placement.
21385Orbital fracture repair
21385 uses a transantral route to repair the orbital floor; 21390 uses a periorbital route and includes an implant.
21387Orbital fracture repair
21387 is for a repair using both periorbital and transantral approaches, rather than the periorbital approach represented by 21390.

Codes related to 21390

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

Codes related to 21390
CodeHow it relatesNational office range
Same family
21386Orbital fracture repairPeriorbital orbital floor repair without the implant distinction.No office rate
21395Orbital fracture repairPeriorbital orbital floor repair using a bone graft.No office rate
Used instead
21385Orbital fracture repairOrbital floor fracture repair using a transantral approach.No office rate
21387Orbital fracture repairOrbital floor fracture repair using combined periorbital and transantral approaches.No office rate

21390 billing questions

How does 21390 differ from 21386?

Both involve a periorbital approach to orbital floor fracture repair. Report 21390 when an implant is placed; 21386 describes the periorbital repair without that implant distinction.

When would 21395 be considered instead?

21395 is the related periorbital repair code when bone graft is used. The operative report should support whether the reconstruction used an implant or bone graft.

Can the implant placement be reported as a separate fracture repair?

The implant is part of the repair represented by 21390. Do not report another orbital floor fracture repair code for the same repair.

How is bilateral repair reported?

When the service is performed on both sides, report modifier 50. CMS pays bilateral procedures at 150% under the stated rule.

What postoperative care is included?

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

What documentation supports co-surgeon payment?

Co-surgeon payment requires supporting documentation. The operative record should substantiate the surgeons' distinct roles in the repair.

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 21390PPRRVU2026_Oct_nonQPP.csv, line 1,967 (RVU26D)

Open CMS sourceHow we calculate rates

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