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Billing code 21406: Orbital fracture repairMedicare rate & RVUs

Reports open surgical treatment of an orbital fracture when the fractured bone is treated without an implant or bone graft.

CMS RVU26DEffective Oct 1, 2026109 payment localities30 Medicare services in 2024

Medicare pays $542.43 for 21406 nationally in a facility.

Medicare rate · 21406

Orbital fracture repair

Swap in your local Medicare rate.

Work RVUs
7.23
Total RVUs
16.24
Global days
090

National rate · 2026

$542.43

Facility setting, before claim adjustments.

See every locality for 21406 → · 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 21406 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 21406 covers

This service involves surgically exposing an orbital fracture and treating the displaced bone without placing an implant or bone graft. It may be performed for an orbital floor or rim fracture that requires open access and reduction. Facial trauma surgeons, including oral and maxillofacial, plastic, and otolaryngology surgeons, commonly perform the repair in a hospital operating room.

Select this code when the operative report supports open treatment and documents the fracture site, exposure and reduction, and that no implant or bone graft was used. A repair using an implant or bone graft falls under a different orbital-fracture code. The code has a 90-day global period, including the day-before preoperative visit and related postoperative care through day 90. 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 allowed; co-surgeons require 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 21406 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

21406 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$491.09
Alaska*Unavailable$659.90
ArizonaUnavailable$528.08
ArkansasUnavailable$484.72
AtlantaUnavailable$556.19
AustinUnavailable$552.73
BakersfieldUnavailable$554.28
Baltimore/Surr. CntysUnavailable$575.55
BeaumontUnavailable$516.19
BrazoriaUnavailable$532.28

21406 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
21406 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 21406 rate is calculated

Each of 21406’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 · 21406

RVUs × geographic indexes × conversion factor

Swap in your local Medicare rate.

Work 7.23Practice expense 7.68Malpractice 1.33

16.2400 adjusted RVUs×$33.4009 conversion factor=$542.43

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

Payment rules and modifiers for 21406

21406 has a 90-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 21406

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 · 21406

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

21406 without 50 · national facility

$542.43

Orbital fracture repair

21406-50 · Bilateral: 150%

$813.64

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

21406 compared with similar codes

Compare codes

21406 vs 21407 vs 21408 vs 21400 vs 21401: national Medicare rates

Swap in your local Medicare rate.

  • 21406
    Orbital fracture repair · 7.23 wRVU
    —
  • 21407
    Orbital repair · 8.79 wRVU
    —
  • 21408
    Orbital fracture repair · 12.46 wRVU
    —
  • 21400
    Orbital fracture treatment · 1.46 wRVU
    $238.48
  • 21401
    Orbital fracture treatment · 3.59 wRVU
    $552.12

How to choose

21407Orbital repair
Both describe open treatment of an orbital fracture; 21407 is the related option when an implant is used, while 21406 is for treatment without one.
21408Orbital fracture repair
Use 21408 when bone graft is part of the open orbital-fracture treatment. This code is for treatment without a bone graft.
21400Orbital fracture treatment
21400 describes closed treatment without manipulation. This code is for a fracture treated through open surgical exposure.
21401Orbital fracture treatment
21401 describes closed treatment with manipulation. This code applies when open surgical treatment is performed.

Codes related to 21406

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

Codes related to 21406
CodeHow it relatesNational office range
Same family
21407Orbital repairRelated open orbital-fracture treatment when an implant is used.No office rate
21408Orbital fracture repairRelated open orbital-fracture treatment involving bone graft.No office rate
Used instead
21400Orbital fracture treatmentClosed treatment without manipulation rather than open surgical treatment.$208.86–$320.14
21401Orbital fracture treatmentClosed treatment with manipulation rather than open surgical treatment.$483.59–$736.37

21406 billing questions

How does this differ from 21407?

Use 21406 for open treatment without an implant. When the orbital fracture repair includes an implant, consider 21407.

When would 21408 be a better fit?

21408 is the related code for open orbital fracture treatment with bone graft. This code describes treatment without an implant or bone graft.

How does open treatment differ from 21400 or 21401?

This code is for open surgical treatment. Codes 21400 and 21401 describe closed treatment, with 21401 involving manipulation.

What documentation supports reporting this code?

Document the orbital fracture site, the open surgical approach, how the fracture was treated, and whether an implant or bone graft was placed.

What postoperative care is included?

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

Can this be reported bilaterally?

For bilateral treatment, modifier 50 is paid at 150% under the CMS rule for this code.

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 21406PPRRVU2026_Oct_nonQPP.csv, line 1,971 (RVU26D)

Open CMS sourceHow we calculate rates

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