No office rate
Choose 21395 when the periorbital repair includes bone grafting; 21386 represents the periorbital repair without that graft distinction.
On this page
CMS RVU26D · Effective 2026-10-01
21395 in Austin
Office / nonfacility
Not available in this setting
Base rate per service
Facility setting
$906.80
Base rate per service
Amounts below use the non-QP conversion factor for participating physicians. These are base physician payments before claim-level adjustments, not patient costs or total hospital charges.
Facial trauma surgery
About 21395: Orbital floor fracture repair with bone graft
Open repair of an orbital floor fracture through a periorbital approach with bone grafting to reconstruct the floor and support orbital contents.
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.
CMS billing rules for 21395
- Global period
- Major surgery with a 90-day global period: the day-before preoperative visit and 90 days of related postoperative care are included.
- Multiple procedures
- Standard multiple procedure reduction: the highest-valued procedure is paid in full and others at 50% when performed in the same session.
- Bilateral procedures
- Bilateral procedure with modifier 50 is paid at 150%.
- Assistant at surgery
- Assistant at surgery may be paid.
- Co-surgeons
- Co-surgeons paid only with supporting documentation.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU14.33 · 53%
- Practice expense (office) RVU9.87 · 37%
- Malpractice RVU2.65 · 10%
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.
21395 compared with similar codes
Office rates for Austin, from the same CMS release.
No office rate
21390 identifies periorbital repair with an implant. This code is for repair with bone graft.
No office rate
21387 is for a combined approach. This code describes a periorbital approach with bone grafting.
No office rate
21385 uses a transantral approach, while this code identifies a periorbital approach with bone grafting.
The same code, a different location
How does Austin compare?
21395 across payment areas
Same release and payment basis · bars start at $0
Austin · This locality
Unavailable
Unavailable
No comparable rate is available in this setting.
Unavailable
No comparable rate is available in this setting.
Unavailable
No comparable rate is available in this setting.
Unavailable
No comparable rate is available in this setting.
Unavailable
No comparable rate is available in this setting.
Unavailable
No comparable rate is available in this setting.
Other payment areas listed in Texas appear first, followed by selected cross-country examples. The chart compares amounts, not distance.
The code’s RVUs stay the same in these comparisons. Geographic adjustments to work, practice expense and malpractice change the dollar amount. A city name alone may not identify the payment area for a service address.
Compare all 108 other payment areas
Rest Of Texas
Texas · 21395
Office
Unavailable
Facility
$871.42
No comparable office rate is available.
Los Angeles-Long Beach-Anaheim (Los Angeles/Orange Cnty)
California · 21395
Office
Unavailable
Facility
$947.03
No comparable office rate is available.
Dc + Md/Va Suburbs
District of Columbia · 21395
Office
Unavailable
Facility
$991.34
No comparable office rate is available.
Miami
Florida · 21395
Office
Unavailable
Facility
$1045.67
No comparable office rate is available.
Chicago
Illinois · 21395
Office
Unavailable
Facility
$1016.44
No comparable office rate is available.
Manhattan
New York · 21395
Office
Unavailable
Facility
$1032.72
No comparable office rate is available.
Alaska*
Alaska · 21395
Office
Unavailable
Facility
$1117.82
No comparable office rate is available.
Alabama
Alabama · 21395
Office
Unavailable
Facility
$817.19
No comparable office rate is available.
Arkansas
Arkansas · 21395
Office
Unavailable
Facility
$807.40
No comparable office rate is available.
Arizona
Arizona · 21395
Office
Unavailable
Facility
$873.85
No comparable office rate is available.
Bakersfield
California · 21395
Office
Unavailable
Facility
$902.95
No comparable office rate is available.
Chico
California · 21395
Office
Unavailable
Facility
$895.53
No comparable office rate is available.
El Centro
California · 21395
Office
Unavailable
Facility
$895.97
No comparable office rate is available.
Fresno
California · 21395
Office
Unavailable
Facility
$895.53
No comparable office rate is available.
Hanford-Corcoran
California · 21395
Office
Unavailable
Facility
$895.53
No comparable office rate is available.
Madera
California · 21395
Office
Unavailable
Facility
$895.53
No comparable office rate is available.
Merced
California · 21395
Office
Unavailable
Facility
$895.53
No comparable office rate is available.
Modesto
California · 21395
Office
Unavailable
Facility
$895.53
No comparable office rate is available.
Napa
California · 21395
Office
Unavailable
Facility
$988.25
No comparable office rate is available.
Oxnard-Thousand Oaks-Ventura
California · 21395
Office
Unavailable
Facility
$936.85
No comparable office rate is available.
Redding
California · 21395
Office
Unavailable
Facility
$895.53
No comparable office rate is available.
Rest Of California
California · 21395
Office
Unavailable
Facility
$895.53
No comparable office rate is available.
Riverside-San Bernardino-Ontario
California · 21395
Office
Unavailable
Facility
$924.07
No comparable office rate is available.
Sacramento-Roseville-Folsom
California · 21395
Office
Unavailable
Facility
$926.71
No comparable office rate is available.
Salinas
California · 21395
Office
Unavailable
Facility
$923.00
No comparable office rate is available.
San Diego-Chula Vista-Carlsbad
California · 21395
Office
Unavailable
Facility
$935.25
No comparable office rate is available.
San Francisco-Oakland-Berkeley (Marin Cnty)
California · 21395
Office
Unavailable
Facility
$1029.56
No comparable office rate is available.
San Francisco-Oakland-Berkeley (San Francisco/San Mateo/Alameda/Contra Costa Cnty)
California · 21395
Office
Unavailable
Facility
$1026.55
No comparable office rate is available.
San Jose-Sunnyvale-Santa Clara (San Benito Cnty)
California · 21395
Office
Unavailable
Facility
$1054.11
No comparable office rate is available.
San Jose-Sunnyvale-Santa Clara (Santa Clara Cnty)
California · 21395
Office
Unavailable
Facility
$1041.80
No comparable office rate is available.
San Luis Obispo-Paso Robles
California · 21395
Office
Unavailable
Facility
$909.70
No comparable office rate is available.
Santa Cruz-Watsonville
California · 21395
Office
Unavailable
Facility
$936.67
No comparable office rate is available.
Santa Maria-Santa Barbara
California · 21395
Office
Unavailable
Facility
$923.87
No comparable office rate is available.
Santa Rosa-Petaluma
California · 21395
Office
Unavailable
Facility
$945.27
No comparable office rate is available.
Stockton
California · 21395
Office
Unavailable
Facility
$895.53
No comparable office rate is available.
Vallejo
California · 21395
Office
Unavailable
Facility
$983.92
No comparable office rate is available.
Visalia
California · 21395
Office
Unavailable
Facility
$895.53
No comparable office rate is available.
Yuba City
California · 21395
Office
Unavailable
Facility
$895.53
No comparable office rate is available.
Colorado
Colorado · 21395
Office
Unavailable
Facility
$904.27
No comparable office rate is available.
Connecticut
Connecticut · 21395
Office
Unavailable
Facility
$950.36
No comparable office rate is available.
Delaware
Delaware · 21395
Office
Unavailable
Facility
$886.31
No comparable office rate is available.
Fort Lauderdale
Florida · 21395
Office
Unavailable
Facility
$972.62
No comparable office rate is available.
Rest Of Florida
Florida · 21395
Office
Unavailable
Facility
$926.83
No comparable office rate is available.
Atlanta
Georgia · 21395
Office
Unavailable
Facility
$921.32
No comparable office rate is available.
Rest Of Georgia
Georgia · 21395
Office
Unavailable
Facility
$878.20
No comparable office rate is available.
Hawaii, Guam
Hawaii · 21395
Office
Unavailable
Facility
$904.71
No comparable office rate is available.
Iowa
Iowa · 21395
Office
Unavailable
Facility
$815.42
No comparable office rate is available.
Idaho
Idaho · 21395
Office
Unavailable
Facility
$823.79
No comparable office rate is available.
East St. Louis
Illinois · 21395
Office
Unavailable
Facility
$960.19
No comparable office rate is available.
Rest Of Illinois
Illinois · 21395
Office
Unavailable
Facility
$917.97
No comparable office rate is available.
Suburban Chicago
Illinois · 21395
Office
Unavailable
Facility
$977.40
No comparable office rate is available.
Indiana
Indiana · 21395
Office
Unavailable
Facility
$827.25
No comparable office rate is available.
Kansas
Kansas · 21395
Office
Unavailable
Facility
$821.26
No comparable office rate is available.
Kentucky
Kentucky · 21395
Office
Unavailable
Facility
$852.70
No comparable office rate is available.
New Orleans
Louisiana · 21395
Office
Unavailable
Facility
$889.40
No comparable office rate is available.
Rest Of Louisiana
Louisiana · 21395
Office
Unavailable
Facility
$855.18
No comparable office rate is available.
Metropolitan Boston
Massachusetts · 21395
Office
Unavailable
Facility
$970.66
No comparable office rate is available.
Rest Of Massachusetts
Massachusetts · 21395
Office
Unavailable
Facility
$903.98
No comparable office rate is available.
Baltimore/Surr. Cntys
Maryland · 21395
Office
Unavailable
Facility
$949.52
No comparable office rate is available.
Rest Of Maryland
Maryland · 21395
Office
Unavailable
Facility
$898.30
No comparable office rate is available.
Rest Of Maine
Maine · 21395
Office
Unavailable
Facility
$836.98
No comparable office rate is available.
Southern Maine
Maine · 21395
Office
Unavailable
Facility
$861.19
No comparable office rate is available.
Detroit
Michigan · 21395
Office
Unavailable
Facility
$946.00
No comparable office rate is available.
Rest Of Michigan
Michigan · 21395
Office
Unavailable
Facility
$879.55
No comparable office rate is available.
Minnesota
Minnesota · 21395
Office
Unavailable
Facility
$844.06
No comparable office rate is available.
Metropolitan Kansas City
Missouri · 21395
Office
Unavailable
Facility
$874.67
No comparable office rate is available.
Metropolitan St. Louis
Missouri · 21395
Office
Unavailable
Facility
$881.17
No comparable office rate is available.
Rest Of Missouri
Missouri · 21395
Office
Unavailable
Facility
$849.02
No comparable office rate is available.
Mississippi
Mississippi · 21395
Office
Unavailable
Facility
$827.89
No comparable office rate is available.
Montana**
Montana · 21395
Office
Unavailable
Facility
$896.64
No comparable office rate is available.
North Carolina
North Carolina · 21395
Office
Unavailable
Facility
$842.77
No comparable office rate is available.
North Dakota**
North Dakota · 21395
Office
Unavailable
Facility
$844.24
No comparable office rate is available.
Nebraska
Nebraska · 21395
Office
Unavailable
Facility
$816.38
No comparable office rate is available.
New Hampshire
New Hampshire · 21395
Office
Unavailable
Facility
$899.27
No comparable office rate is available.
Northern Nj
New Jersey · 21395
Office
Unavailable
Facility
$985.73
No comparable office rate is available.
Rest Of New Jersey
New Jersey · 21395
Office
Unavailable
Facility
$954.87
No comparable office rate is available.
New Mexico
New Mexico · 21395
Office
Unavailable
Facility
$887.24
No comparable office rate is available.
Nevada**
Nevada · 21395
Office
Unavailable
Facility
$882.36
No comparable office rate is available.
Nyc Suburbs/Long Island
New York · 21395
Office
Unavailable
Facility
$1065.61
No comparable office rate is available.
Poughkpsie/N Nyc Suburbs
New York · 21395
Office
Unavailable
Facility
$968.26
No comparable office rate is available.
Queens
New York · 21395
Office
Unavailable
Facility
$1026.57
No comparable office rate is available.
Rest Of New York
New York · 21395
Office
Unavailable
Facility
$854.04
No comparable office rate is available.
Ohio
Ohio · 21395
Office
Unavailable
Facility
$868.84
No comparable office rate is available.
Oklahoma
Oklahoma · 21395
Office
Unavailable
Facility
$841.80
No comparable office rate is available.
Portland
Oregon · 21395
Office
Unavailable
Facility
$918.41
No comparable office rate is available.
Rest Of Oregon
Oregon · 21395
Office
Unavailable
Facility
$869.21
No comparable office rate is available.
Metropolitan Philadelphia
Pennsylvania · 21395
Office
Unavailable
Facility
$936.03
No comparable office rate is available.
Rest Of Pennsylvania
Pennsylvania · 21395
Office
Unavailable
Facility
$864.91
No comparable office rate is available.
Puerto Rico
Puerto Rico · 21395
Office
Unavailable
Facility
$899.11
No comparable office rate is available.
Rhode Island
Rhode Island · 21395
Office
Unavailable
Facility
$907.23
No comparable office rate is available.
South Carolina
South Carolina · 21395
Office
Unavailable
Facility
$858.48
No comparable office rate is available.
South Dakota**
South Dakota · 21395
Office
Unavailable
Facility
$838.04
No comparable office rate is available.
Tennessee
Tennessee · 21395
Office
Unavailable
Facility
$825.83
No comparable office rate is available.
Utah
Utah · 21395
Office
Unavailable
Facility
$868.01
No comparable office rate is available.
Virginia
Virginia · 21395
Office
Unavailable
Facility
$865.19
No comparable office rate is available.
Virgin Islands
United States Virgin Islands · 21395
Office
Unavailable
Facility
$899.11
No comparable office rate is available.
Vermont
Vermont · 21395
Office
Unavailable
Facility
$849.79
No comparable office rate is available.
Rest Of Washington
Washington · 21395
Office
Unavailable
Facility
$899.35
No comparable office rate is available.
Seattle (King Cnty)
Washington · 21395
Office
Unavailable
Facility
$979.38
No comparable office rate is available.
Wisconsin
Wisconsin · 21395
Office
Unavailable
Facility
$821.72
No comparable office rate is available.
West Virginia
West Virginia · 21395
Office
Unavailable
Facility
$891.78
No comparable office rate is available.
Wyoming**
Wyoming · 21395
Office
Unavailable
Facility
$873.80
No comparable office rate is available.
See how rates vary across the country
21395 · Office / nonfacility · Non-QP. Choose a state to explore its payment localities. A range means the amount varies within that state.
Explore a state
Local rates. Clear comparisons.
Hover or focus a tile to see its rate range. Select it to open the state’s fee schedule.
View all state and territory rates as a table
| State / territory | Rate range | Localities |
|---|---|---|
| AK | No published base rate | 1 |
| AL | No published base rate | 1 |
| AR | No published base rate | 1 |
| AZ | No published base rate | 1 |
| CA | No published base rate | 29 |
| CO | No published base rate | 1 |
| CT | No published base rate | 1 |
| DC | No published base rate | 1 |
| DE | No published base rate | 1 |
| FL | No published base rate | 3 |
| GA | No published base rate | 2 |
| GU | No published base rate | 1 |
| HI | No published base rate | 1 |
| IA | No published base rate | 1 |
| ID | No published base rate | 1 |
| IL | No published base rate | 4 |
| IN | No published base rate | 1 |
| KS | No published base rate | 1 |
| KY | No published base rate | 1 |
| LA | No published base rate | 2 |
| MA | No published base rate | 2 |
| MD | No published base rate | 3 |
| ME | No published base rate | 2 |
| MI | No published base rate | 2 |
| MN | No published base rate | 1 |
| MO | No published base rate | 3 |
| MS | No published base rate | 1 |
| MT | No published base rate | 1 |
| NC | No published base rate | 1 |
| ND | No published base rate | 1 |
| NE | No published base rate | 1 |
| NH | No published base rate | 1 |
| NJ | No published base rate | 2 |
| NM | No published base rate | 1 |
| NV | No published base rate | 1 |
| NY | No published base rate | 5 |
| OH | No published base rate | 1 |
| OK | No published base rate | 1 |
| OR | No published base rate | 2 |
| PA | No published base rate | 2 |
| PR | No published base rate | 1 |
| RI | No published base rate | 1 |
| SC | No published base rate | 1 |
| SD | No published base rate | 1 |
| TN | No published base rate | 1 |
| TX | No published base rate | 8 |
| UT | No published base rate | 1 |
| VA | No published base rate | 2 |
| VI | No published base rate | 1 |
| VT | No published base rate | 1 |
| WA | No published base rate | 2 |
| WI | No published base rate | 1 |
| WV | No published base rate | 1 |
| WY | No published base rate | 1 |
Where does this rate apply?
Austin is a Medicare payment area. Our Census mapping connects it to 31 cities and communities in Texas, including the examples shown here.
Some communities span more than one payment area. Follow a city link to compare all of its mapped areas, or check the service-location ZIP above for an address-level starting point.
- 21395 in Austin
Multiple payment areas
- 21395 in Barton Creek
- 21395 in Bee Cave
- 21395 in Briarcliff
- 21395 in Cedar Park
Multiple payment areas
- 21395 in Creedmoor
Multiple payment areas
- 21395 in Elgin
Multiple payment areas
- 21395 in Garfield
Use this rate
What is a percentage of Medicare worth?
Turn a percentage into dollars for 21395 in Austin. This uses the base rate on this page, so the locality and release stay consistent.
Reference amount per service
$997.48
$906.80 × 110% = $997.48
A contract may specify another Medicare year or additional adjustments. This is percentage arithmetic on the displayed base rate, not a claim adjudication.
Working with a whole code list?
Compare an offer across your annual code mix, including an older Medicare schedule or flat per-code rates.
How this local rate is calculated
Each RVU component is multiplied by its own geographic practice cost index (GPCI). The three adjusted components are added, then multiplied by the conversion factor. These are the inputs used for 21395 in Austin.
PPRRVU2026_Oct_nonQPP.csv
1,968
- Code
- 21395
- Physician work
- 14.33
- Practice expense
- 9.87
- Malpractice
- 2.65
GPCI2026.csv
96
- Locality
- Austin
- Physician work
- 1.002
- Practice expense
- 1.058
- Malpractice
- 0.886
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 14.33 | × 1.002 | 14.3587 |
| Practice expense | 9.87 | × 1.058 | 10.4425 |
| Malpractice | 2.65 | × 0.886 | 2.3479 |
| Total RVUs | 27.1490 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Austin$906.80
Open 21395 in the RVU calculator →
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 14.33 | 1.002 |
| Practice expense | 9.87 | 1.058 |
| Malpractice | 2.65 | 0.886 |
(14.33 × 1.002 + 9.87 × 1.058 + 2.65 × 0.886) × $33.4009 = $906.80
The office and facility calculations use their respective practice-expense RVUs. The facility amount here is the physician fee, not a separate hospital or facility bill.
How this rate has changed
21395 · Office / nonfacility
Rate unavailable
Effective 2026-10-01
A rate is unavailable in one of these releases, so a change cannot be calculated.
One bar per available release, ordered by effective date. Missing rates remain gaps. These comparisons hold the code, setting and locality identifiers constant; they do not isolate which policy or input caused a change.
What changed, release by release
Explore release dates and calculate this code in an earlier period →
Each row uses the accepted CMS release effective on that date and the same contractor and locality identifiers. Missing rates stay visible. Historical boundaries may differ; verify the service address for an older claim.
Inspect every release and its CMS source
| Effective from | Office / nonfacility | Facility | CMS release |
|---|---|---|---|
| 2026-10-01 | Not available in this setting | $906.80 | RVU26D |
| 2026-07-01 | Not available in this setting | $906.80 | RVU26C |
| 2026-04-01 | Not available in this setting | $906.80 | RVU26B |
| 2026-01-01 | Not available in this setting | $906.80 | RVU26A |
| 2025-10-01 | Not available in this setting | $995.59 | RVU25D |
| 2025-07-01 | Not available in this setting | $995.59 | RVU25C |
| 2025-04-01 | Not available in this setting | $995.59 | RVU25B |
| 2025-01-01 | Not available in this setting | $995.59 | RVU25A |
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 indices and the applicable conversion factor. Unavailable or separately priced services are labeled rather than assigned a made-up amount.
Source: RVU26D. Effective 2026-10-01 through the day before 2027-01-01.
1,96521386,,Opn tx orbit fx periorbital,A,,9.33,7.83,NA,7.83,,1.73,18.89,18.89,0,090,0.10,0.69,0.21,2,1,2,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,96621387,,Opn tx orbit fx combined,A,,9.86,9.33,NA,9.33,,1.83,21.02,21.02,0,090,0.10,0.69,0.21,2,1,2,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,96721390,,Opn tx orbit periorbtl implt,A,,10.95,8.79,NA,8.79,,1.47,21.21,21.21,0,090,0.10,0.69,0.21,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,96821395,,Opn tx orbit periorbt w/grft,A,,14.33,9.87,NA,9.87,,2.65,26.85,26.85,0,090,0.10,0.69,0.21,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,96921400,,Closed tx orbit w/o manipulj,A,,1.46,5.43,,3.48,,0.25,7.14,5.19,0,090,0.10,0.69,0.21,2,1,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,97021401,,Closed tx orbit w/manipulj,A,,3.59,12.28,,5.20,,0.66,16.53,9.45,0,090,0.10,0.69,0.21,2,1,2,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,97121406,,Opn tx orbit fx w/o implant,A,,7.23,7.68,NA,7.68,,1.33,16.24,16.24,0,090,0.10,0.69,0.21,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
9311202,SC,01,SOUTH CAROLINA,1.000,0.924,0.850
9403402,SD,02,SOUTH DAKOTA**,1.000,1.000,0.336
9510312,TN,35,TENNESSEE,1.000,0.909,0.537
9604412,TX,31,AUSTIN,1.002,1.058,0.886
9704412,TX,20,BEAUMONT,1.000,0.910,0.929
9804412,TX,09,BRAZORIA,1.008,0.991,0.780
9904412,TX,11,DALLAS,1.009,0.996,0.858