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Billing code 21395: Orbital fracture repairMedicare rate & RVUs

Open repair of an orbital floor fracture through a periorbital approach with bone grafting to reconstruct the floor and support orbital contents.

CMS RVU26DEffective Oct 1, 2026109 payment localities

Medicare pays $896.81 for 21395 nationally in a facility.

Medicare rate · 21395

Orbital fracture repair

Swap in your local Medicare rate.

Work RVUs
14.33
Total RVUs
26.85
Global days
090

National rate · 2026

$896.81

Facility setting, before claim adjustments.

See every locality for 21395 → · 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 21395 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 21395 covers

This service treats an orbital floor blowout fracture through a periorbital surgical approach, with bone graft used to rebuild the injured floor. The surgeon exposes the fracture, addresses displaced orbital tissues as part of the repair, and places graft to restore support. It is typically performed by a surgeon experienced in facial or orbital trauma, such as an oculoplastic, facial plastic, otolaryngology, or oral and maxillofacial surgeon, in an operating room.

Report this code when the operative repair uses the periorbital approach and includes bone grafting. The operative report should identify the fracture, approach, graft use, and treated side. Medicare assigns a 90-day global period, including 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. Bilateral reporting with modifier 50 is paid at 150%. Assistant-at-surgery payment may be available; co-surgeon payment requires supporting documentation, and team-surgery payment 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 21395 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

21395 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$817.19
Alaska*Unavailable$1,117.82
ArizonaUnavailable$873.85
ArkansasUnavailable$807.40
AtlantaUnavailable$921.32
AustinUnavailable$906.80
BakersfieldUnavailable$902.95
Baltimore/Surr. CntysUnavailable$949.52
BeaumontUnavailable$860.86
BrazoriaUnavailable$878.20

21395 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
21395 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 21395 rate is calculated

Each of 21395’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 · 21395

RVUs × geographic indexes × conversion factor

Swap in your local Medicare rate.

Work 14.33Practice expense 9.87Malpractice 2.65

26.8500 adjusted RVUs×$33.4009 conversion factor=$896.81

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

Payment rules and modifiers for 21395

21395 has a 90-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 21395

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 · 21395

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.

  • 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

21395 without 50 · national facility

$896.81

Orbital fracture repair

21395-50 · Bilateral: 150%

$1,345.22

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

21395 compared with similar codes

Compare codes

21395 vs 21386 vs 21390 vs 21387 vs 21385: national Medicare rates

Swap in your local Medicare rate.

  • 21395
    Orbital fracture repair · 14.33 wRVU
    —
  • 21386
    Orbital fracture repair · 9.33 wRVU
    —
  • 21390
    Orbital fracture repair · 10.95 wRVU
    —
  • 21387
    Orbital fracture repair · 9.86 wRVU
    —
  • 21385
    Orbital fracture repair · 9.33 wRVU
    —

How to choose

21386Orbital fracture repair
Choose 21395 when the periorbital repair includes bone grafting; 21386 represents the periorbital repair without that graft distinction.
21390Orbital fracture repair
21390 identifies periorbital repair with an implant. This code is for repair with bone graft.
21387Orbital fracture repair
21387 is for a combined approach. This code describes a periorbital approach with bone grafting.
21385Orbital fracture repair
21385 uses a transantral approach, while this code identifies a periorbital approach with bone grafting.

Codes related to 21395

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

Codes related to 21395
CodeHow it relatesNational office range
Same family
21386Orbital fracture repairPeriorbital orbital fracture repair without the bone-graft distinction.No office rate
Used instead
21390Orbital fracture repairPeriorbital orbital fracture repair distinguished by use of an implant.No office rate
21387Orbital fracture repairOrbital fracture repair using a combined approach rather than the periorbital approach alone.No office rate
21385Orbital fracture repairOrbital fracture repair performed through a transantral approach.No office rate

21395 billing questions

How is this code distinguished from 21386?

Both describe orbital fracture repair through a periorbital approach, but this code includes bone grafting. Use 21386 when the repair does not include a graft.

Does an orbital implant qualify as the graft in this code?

No. A repair using an implant rather than bone grafting is distinguished by 21390. The operative report should make the reconstruction material clear.

What documentation supports reporting this code?

Document the orbital floor fracture, periorbital approach, bone graft placement, and side treated. The operative report should describe the repair sufficiently to establish those elements.

How is bilateral repair reported under the CMS fee schedule?

For bilateral procedures reported with modifier 50, CMS pays this code at 150%. Document the repair performed on each side.

Are related postoperative visits separately included?

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

Can an assistant or co-surgeon be reported?

Assistant-at-surgery payment may be available. Co-surgeon payment requires supporting documentation; CMS does not permit team-surgery payment for this service.

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 21395PPRRVU2026_Oct_nonQPP.csv, line 1,968 (RVU26D)

Open CMS sourceHow we calculate rates

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