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CMS RVU26D · Effective 2026-10-01

21086 in Chico

Office / nonfacility

$1667.87

Base rate per service

Facility setting

$1119.13

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.

Maxillofacial prosthetics

About 21086: Auricular prosthesis impression and preparation

Report 21086 for the impression and preparation work involved in providing a custom external ear prosthesis after congenital absence, trauma, or surgical removal.

This service covers taking the impression and preparing a custom prosthesis to replace an external ear. It is used when an auricle is absent or has been removed, such as after cancer surgery or traumatic injury. A maxillofacial prosthodontist or another qualified clinician may perform the work, commonly in an office-based prosthetic practice. The service addresses the ear specifically, rather than an orbital, nasal, or broader facial defect.

Report 21086 for the auricular prosthesis impression and preparation service, supported by documentation of the affected site and the work performed. CMS assigns a 90-day global period: the day-before preoperative visit and 90 days of related postoperative care are included. When multiple procedures are performed in the same session, the highest-valued procedure is paid in full and the others at 50%. Modifier 50 identifies bilateral work and is paid at 150%. An assistant at surgery is paid only when medical necessity is documented; co-surgeons and team surgery are not permitted.

CMS billing rules for 21086

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 is paid only with documentation of medical necessity.
Co-surgeons
Co-surgeons not permitted.
Team surgery
Team surgery not permitted.

Where the value comes from

  • Work RVU24.26 · 50%
  • Practice expense (office) RVU21.70 · 45%
  • Malpractice RVU2.76 · 6%

15

Medicare services in 2024 · #6057 by national volume

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.

21086 compared with similar codes

Office rates for Chico, from the same CMS release.

21077

Orbital prosthesis

Impression and custom preparation

$2,247.52

21086 is for an external ear prosthesis; 21077 is for an orbital prosthesis.

21087

Nasal prosthesis

Impression and custom preparation

$1,667.87

Use 21086 for an auricular prosthesis and 21087 for a nasal prosthesis.

21088

Impres&prep facial prosth

No office rate

21086 identifies the ear site specifically. 21088 is for a facial prosthesis when a more specific site code does not describe the service.

21089

Unlisted maxlfcl prosth px

No office rate

21086 describes the auricular prosthesis service specifically; 21089 is the unlisted option when no specific maxillofacial prosthetic code fits.

The same code, a different location

How does Chico compare?

In Bakersfield, the office rate for 21086 is $1676.22—$8.35 higher than the $1667.87 rate in Chico. Both use the same code, release and participation basis.

21086 across payment areas

Same release and payment basis · bars start at $0

  1. Chico · This locality

    $1667.87

  2. Bakersfield

    $1676.22

    $8.35 higher than Chico

  3. El Centro

    $1668.33

    $0.46 higher than Chico

  4. Fresno

    $1667.87

    The same base rate than Chico

  5. Hanford-Corcoran

    $1667.87

    The same base rate than Chico

  6. Los Angeles-Long Beach-Anaheim (Los Angeles/Orange Cnty)

    $1762.18

    $94.31 higher than Chico

  7. Madera

    $1667.87

    The same base rate than Chico

Other payment areas listed in California appear first, followed by selected cross-country examples. The chart compares amounts, not distance.

Across 109 of 109 CMS payment localities with a supported office rate, 21086 ranges from $1480.38 in Arkansas to $2038.17 in Alaska*. This is a geographic range, not an average.

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

  • Merced

    California · 21086

    Office

    $1667.87

    Facility

    $1119.13

    The same base rate than Chico for the office setting.

  • Modesto

    California · 21086

    Office

    $1667.87

    Facility

    $1119.13

    The same base rate than Chico for the office setting.

  • Napa

    California · 21086

    Office

    $1863.47

    Facility

    $1203.58

    $195.60 higher than Chico for the office setting.

  • Oxnard-Thousand Oaks-Ventura

    California · 21086

    Office

    $1747.14

    Facility

    $1155.34

    $79.27 higher than Chico for the office setting.

  • Redding

    California · 21086

    Office

    $1667.87

    Facility

    $1119.13

    The same base rate than Chico for the office setting.

  • Rest Of California

    California · 21086

    Office

    $1667.87

    Facility

    $1119.13

    The same base rate than Chico for the office setting.

  • Riverside-San Bernardino-Ontario

    California · 21086

    Office

    $1697.91

    Facility

    $1149.16

    $30.04 higher than Chico for the office setting.

  • Sacramento-Roseville-Folsom

    California · 21086

    Office

    $1731.83

    Facility

    $1149.54

    $63.96 higher than Chico for the office setting.

  • Salinas

    California · 21086

    Office

    $1724.88

    Facility

    $1144.59

    $57.01 higher than Chico for the office setting.

  • San Diego-Chula Vista-Carlsbad

    California · 21086

    Office

    $1751.44

    Facility

    $1152.63

    $83.57 higher than Chico for the office setting.

  • San Francisco-Oakland-Berkeley (Marin Cnty)

    California · 21086

    Office

    $1951.57

    Facility

    $1245.61

    $283.70 higher than Chico for the office setting.

  • San Francisco-Oakland-Berkeley (San Francisco/San Mateo/Alameda/Contra Costa Cnty)

    California · 21086

    Office

    $1948.43

    Facility

    $1242.47

    $280.56 higher than Chico for the office setting.

  • San Jose-Sunnyvale-Santa Clara (San Benito Cnty)

    California · 21086

    Office

    $1994.01

    Facility

    $1272.03

    $326.14 higher than Chico for the office setting.

  • San Jose-Sunnyvale-Santa Clara (Santa Clara Cnty)

    California · 21086

    Office

    $1981.20

    Facility

    $1259.22

    $313.33 higher than Chico for the office setting.

  • San Luis Obispo-Paso Robles

    California · 21086

    Office

    $1699.04

    Facility

    $1128.77

    $31.17 higher than Chico for the office setting.

  • Santa Cruz-Watsonville

    California · 21086

    Office

    $1757.37

    Facility

    $1149.04

    $89.50 higher than Chico for the office setting.

  • Santa Maria-Santa Barbara

    California · 21086

    Office

    $1727.52

    Facility

    $1143.73

    $59.65 higher than Chico for the office setting.

  • Santa Rosa-Petaluma

    California · 21086

    Office

    $1774.08

    Facility

    $1159.25

    $106.21 higher than Chico for the office setting.

  • Stockton

    California · 21086

    Office

    $1667.87

    Facility

    $1119.13

    The same base rate than Chico for the office setting.

  • Vallejo

    California · 21086

    Office

    $1858.95

    Facility

    $1199.06

    $191.08 higher than Chico for the office setting.

  • Visalia

    California · 21086

    Office

    $1667.87

    Facility

    $1119.13

    The same base rate than Chico for the office setting.

  • Yuba City

    California · 21086

    Office

    $1667.87

    Facility

    $1119.13

    The same base rate than Chico for the office setting.

  • Dc + Md/Va Suburbs

    District of Columbia · 21086

    Office

    $1810.48

    Facility

    $1220.68

    $142.61 higher than Chico for the office setting.

  • Miami

    Florida · 21086

    Office

    $1797.96

    Facility

    $1276.75

    $130.09 higher than Chico for the office setting.

  • Chicago

    Illinois · 21086

    Office

    $1755.97

    Facility

    $1252.79

    $88.10 higher than Chico for the office setting.

  • Manhattan

    New York · 21086

    Office

    $1850.59

    Facility

    $1268.80

    $182.72 higher than Chico for the office setting.

  • Alaska*

    Alaska · 21086

    Office

    $2038.17

    Facility

    $1504.94

    $370.30 higher than Chico for the office setting.

  • Alabama

    Alabama · 21086

    Office

    $1496.68

    Facility

    $1058.59

    $171.19 lower than Chico for the office setting.

  • Arkansas

    Arkansas · 21086

    Office

    $1480.38

    Facility

    $1050.30

    $187.49 lower than Chico for the office setting.

  • Arizona

    Arizona · 21086

    Office

    $1591.55

    Facility

    $1106.39

    $76.32 lower than Chico for the office setting.

  • Colorado

    Colorado · 21086

    Office

    $1663.21

    Facility

    $1130.49

    $4.66 lower than Chico for the office setting.

  • Connecticut

    Connecticut · 21086

    Office

    $1718.67

    Facility

    $1179.43

    $50.80 higher than Chico for the office setting.

  • Delaware

    Delaware · 21086

    Office

    $1613.33

    Facility

    $1118.66

    $54.54 lower than Chico for the office setting.

  • Fort Lauderdale

    Florida · 21086

    Office

    $1711.20

    Facility

    $1204.01

    $43.33 higher than Chico for the office setting.

  • Rest Of Florida

    Florida · 21086

    Office

    $1641.77

    Facility

    $1163.12

    $26.10 lower than Chico for the office setting.

  • Atlanta

    Georgia · 21086

    Office

    $1659.85

    Facility

    $1151.16

    $8.02 lower than Chico for the office setting.

  • Rest Of Georgia

    Georgia · 21086

    Office

    $1566.71

    Facility

    $1120.11

    $101.16 lower than Chico for the office setting.

  • Hawaii, Guam

    Hawaii · 21086

    Office

    $1687.78

    Facility

    $1118.51

    $19.91 higher than Chico for the office setting.

  • Iowa

    Iowa · 21086

    Office

    $1510.10

    Facility

    $1051.97

    $157.77 lower than Chico for the office setting.

  • Idaho

    Idaho · 21086

    Office

    $1520.73

    Facility

    $1060.10

    $147.14 lower than Chico for the office setting.

  • East St. Louis

    Illinois · 21086

    Office

    $1662.78

    Facility

    $1202.16

    $5.09 lower than Chico for the office setting.

  • Rest Of Illinois

    Illinois · 21086

    Office

    $1616.14

    Facility

    $1159.01

    $51.73 lower than Chico for the office setting.

  • Suburban Chicago

    Illinois · 21086

    Office

    $1723.70

    Facility

    $1209.50

    $55.83 higher than Chico for the office setting.

  • Indiana

    Indiana · 21086

    Office

    $1527.00

    Facility

    $1062.87

    $140.87 lower than Chico for the office setting.

  • Kansas

    Kansas · 21086

    Office

    $1511.99

    Facility

    $1059.37

    $155.88 lower than Chico for the office setting.

  • Kentucky

    Kentucky · 21086

    Office

    $1539.00

    Facility

    $1093.90

    $128.87 lower than Chico for the office setting.

  • New Orleans

    Louisiana · 21086

    Office

    $1597.07

    Facility

    $1125.93

    $70.80 lower than Chico for the office setting.

  • Rest Of Louisiana

    Louisiana · 21086

    Office

    $1540.07

    Facility

    $1096.97

    $127.80 lower than Chico for the office setting.

  • Metropolitan Boston

    Massachusetts · 21086

    Office

    $1790.98

    Facility

    $1193.17

    $123.11 higher than Chico for the office setting.

  • Rest Of Massachusetts

    Massachusetts · 21086

    Office

    $1659.96

    Facility

    $1132.74

    $7.91 lower than Chico for the office setting.

  • Baltimore/Surr. Cntys

    Maryland · 21086

    Office

    $1715.02

    Facility

    $1177.79

    $47.15 higher than Chico for the office setting.

  • Rest Of Maryland

    Maryland · 21086

    Office

    $1636.53

    Facility

    $1129.85

    $31.34 lower than Chico for the office setting.

  • Rest Of Maine

    Maine · 21086

    Office

    $1534.46

    Facility

    $1073.84

    $133.41 lower than Chico for the office setting.

  • Southern Maine

    Maine · 21086

    Office

    $1586.75

    Facility

    $1090.58

    $81.12 lower than Chico for the office setting.

  • Detroit

    Michigan · 21086

    Office

    $1665.16

    Facility

    $1182.01

    $2.71 lower than Chico for the office setting.

  • Rest Of Michigan

    Michigan · 21086

    Office

    $1576.13

    Facility

    $1119.01

    $91.74 lower than Chico for the office setting.

  • Minnesota

    Minnesota · 21086

    Office

    $1583.41

    Facility

    $1068.21

    $84.46 lower than Chico for the office setting.

  • Metropolitan Kansas City

    Missouri · 21086

    Office

    $1580.96

    Facility

    $1110.82

    $86.91 lower than Chico for the office setting.

  • Metropolitan St. Louis

    Missouri · 21086

    Office

    $1592.69

    Facility

    $1116.04

    $75.18 lower than Chico for the office setting.

  • Rest Of Missouri

    Missouri · 21086

    Office

    $1524.87

    Facility

    $1093.29

    $143.00 lower than Chico for the office setting.

  • Mississippi

    Mississippi · 21086

    Office

    $1502.48

    Facility

    $1071.40

    $165.39 lower than Chico for the office setting.

  • Montana**

    Montana · 21086

    Office

    $1627.11

    Facility

    $1126.43

    $40.76 lower than Chico for the office setting.

  • North Carolina

    North Carolina · 21086

    Office

    $1545.45

    Facility

    $1078.32

    $122.42 lower than Chico for the office setting.

  • North Dakota**

    North Dakota · 21086

    Office

    $1572.53

    Facility

    $1071.85

    $95.34 lower than Chico for the office setting.

  • Nebraska

    Nebraska · 21086

    Office

    $1514.14

    Facility

    $1052.02

    $153.73 lower than Chico for the office setting.

  • New Hampshire

    New Hampshire · 21086

    Office

    $1645.49

    Facility

    $1124.28

    $22.38 lower than Chico for the office setting.

  • Northern Nj

    New Jersey · 21086

    Office

    $1800.58

    Facility

    $1219.79

    $132.71 higher than Chico for the office setting.

  • Rest Of New Jersey

    New Jersey · 21086

    Office

    $1735.33

    Facility

    $1188.59

    $67.46 higher than Chico for the office setting.

  • New Mexico

    New Mexico · 21086

    Office

    $1585.66

    Facility

    $1126.54

    $82.21 lower than Chico for the office setting.

  • Nevada**

    Nevada · 21086

    Office

    $1612.62

    Facility

    $1111.44

    $55.25 lower than Chico for the office setting.

  • Nyc Suburbs/Long Island

    New York · 21086

    Office

    $1895.14

    Facility

    $1299.83

    $227.27 higher than Chico for the office setting.

  • Poughkpsie/N Nyc Suburbs

    New York · 21086

    Office

    $1751.97

    Facility

    $1203.73

    $84.10 higher than Chico for the office setting.

  • Queens

    New York · 21086

    Office

    $1851.81

    Facility

    $1260.01

    $183.94 higher than Chico for the office setting.

  • Rest Of New York

    New York · 21086

    Office

    $1563.67

    Facility

    $1088.03

    $104.20 lower than Chico for the office setting.

  • Ohio

    Ohio · 21086

    Office

    $1564.97

    Facility

    $1107.85

    $102.90 lower than Chico for the office setting.

  • Oklahoma

    Oklahoma · 21086

    Office

    $1529.18

    Facility

    $1082.07

    $138.69 lower than Chico for the office setting.

  • Portland

    Oregon · 21086

    Office

    $1697.11

    Facility

    $1140.85

    $29.24 higher than Chico for the office setting.

  • Rest Of Oregon

    Oregon · 21086

    Office

    $1597.01

    Facility

    $1098.34

    $70.86 lower than Chico for the office setting.

  • Metropolitan Philadelphia

    Pennsylvania · 21086

    Office

    $1689.39

    Facility

    $1168.18

    $21.52 higher than Chico for the office setting.

  • Rest Of Pennsylvania

    Pennsylvania · 21086

    Office

    $1562.79

    Facility

    $1103.16

    $105.08 lower than Chico for the office setting.

  • Puerto Rico

    Puerto Rico · 21086

    Office

    $1633.88

    Facility

    $1127.69

    $33.99 lower than Chico for the office setting.

  • Rhode Island

    Rhode Island · 21086

    Office

    $1656.65

    Facility

    $1139.45

    $11.22 lower than Chico for the office setting.

  • South Carolina

    South Carolina · 21086

    Office

    $1558.38

    Facility

    $1095.75

    $109.49 lower than Chico for the office setting.

  • South Dakota**

    South Dakota · 21086

    Office

    $1566.08

    Facility

    $1065.40

    $101.79 lower than Chico for the office setting.

  • Tennessee

    Tennessee · 21086

    Office

    $1518.65

    Facility

    $1063.54

    $149.22 lower than Chico for the office setting.

  • Austin

    Texas · 21086

    Office

    $1660.44

    Facility

    $1130.72

    $7.43 lower than Chico for the office setting.

  • Beaumont

    Texas · 21086

    Office

    $1555.51

    Facility

    $1099.90

    $112.36 lower than Chico for the office setting.

  • Brazoria

    Texas · 21086

    Office

    $1606.97

    Facility

    $1110.80

    $60.90 lower than Chico for the office setting.

  • Dallas

    Texas · 21086

    Office

    $1618.59

    Facility

    $1119.92

    $49.28 lower than Chico for the office setting.

  • Fort Worth

    Texas · 21086

    Office

    $1612.55

    Facility

    $1118.88

    $55.32 lower than Chico for the office setting.

  • Galveston

    Texas · 21086

    Office

    $1612.84

    Facility

    $1115.67

    $55.03 lower than Chico for the office setting.

  • Houston

    Texas · 21086

    Office

    $1663.36

    Facility

    $1166.19

    $4.51 lower than Chico for the office setting.

  • Rest Of Texas

    Texas · 21086

    Office

    $1581.38

    Facility

    $1106.24

    $86.49 lower than Chico for the office setting.

  • Utah

    Utah · 21086

    Office

    $1574.40

    Facility

    $1103.76

    $93.47 lower than Chico for the office setting.

  • Virginia

    Virginia · 21086

    Office

    $1587.87

    Facility

    $1095.70

    $80.00 lower than Chico for the office setting.

  • Virgin Islands

    United States Virgin Islands · 21086

    Office

    $1633.88

    Facility

    $1127.69

    $33.99 lower than Chico for the office setting.

  • Vermont

    Vermont · 21086

    Office

    $1574.50

    Facility

    $1078.83

    $93.37 lower than Chico for the office setting.

  • Rest Of Washington

    Washington · 21086

    Office

    $1654.21

    Facility

    $1126.99

    $13.66 lower than Chico for the office setting.

  • Seattle (King Cnty)

    Washington · 21086

    Office

    $1815.47

    Facility

    $1201.13

    $147.60 higher than Chico for the office setting.

  • Wisconsin

    Wisconsin · 21086

    Office

    $1533.06

    Facility

    $1053.41

    $134.81 lower than Chico for the office setting.

  • West Virginia

    West Virginia · 21086

    Office

    $1572.08

    Facility

    $1136.99

    $95.79 lower than Chico for the office setting.

  • Wyoming**

    Wyoming · 21086

    Office

    $1603.32

    Facility

    $1102.64

    $64.55 lower than Chico for the office setting.

See how rates vary across the country

21086 · Office / nonfacility · Non-QP. Choose a state to explore its payment localities. A range means the amount varies within that state.

MEWIVTNHMTNDMNMINYMARIWAIDWYSDIAILINOHPANJCTORNVUTCONEMOKYWVVAMDDECAAZNMKSOKARTNNCSCDCTXLAMSALGAFLAKHI

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.

$1,480.38

$2,038.17

Color shows the midpoint of each state’s locality range.

View all state and territory rates as a table
State / territoryRate rangeLocalities
AK$2,038.171
AL$1,496.681
AR$1,480.381
AZ$1,591.551
CA$1,667.87–$1,994.0129
CO$1,663.211
CT$1,718.671
DC$1,810.481
DE$1,613.331
FL$1,641.77–$1,797.963
GA$1,566.71–$1,659.852
GU$1,687.781
HI$1,687.781
IA$1,510.101
ID$1,520.731
IL$1,616.14–$1,755.974
IN$1,527.001
KS$1,511.991
KY$1,539.001
LA$1,540.07–$1,597.072
MA$1,659.96–$1,790.982
MD$1,636.53–$1,810.483
ME$1,534.46–$1,586.752
MI$1,576.13–$1,665.162
MN$1,583.411
MO$1,524.87–$1,592.693
MS$1,502.481
MT$1,627.111
NC$1,545.451
ND$1,572.531
NE$1,514.141
NH$1,645.491
NJ$1,735.33–$1,800.582
NM$1,585.661
NV$1,612.621
NY$1,563.67–$1,895.145
OH$1,564.971
OK$1,529.181
OR$1,597.01–$1,697.112
PA$1,562.79–$1,689.392
PR$1,633.881
RI$1,656.651
SC$1,558.381
SD$1,566.081
TN$1,518.651
TX$1,555.51–$1,663.368
UT$1,574.401
VA$1,587.87–$1,810.482
VI$1,633.881
VT$1,574.501
WA$1,654.21–$1,815.472
WI$1,533.061
WV$1,572.081
WY$1,603.321

Explore 21086 on the national rate map →

Where does this rate apply?

Chico is a Medicare payment area. Our Census mapping connects it to 30 cities and communities in California, 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.

Browse all communities in California →

Why are the office and facility amounts different?

For 21086 in Chico, the physician’s office rate is $1667.87 and the facility-setting rate is $1119.13: a difference of $548.74.

The calculation uses a different practice-expense RVU for each setting. Both amounts here are physician fee-schedule amounts. The facility figure does not include a hospital’s separate charges, so this comparison does not tell you the total cost of receiving care in each setting.

See the inputs behind this difference →

Use this rate

What is a percentage of Medicare worth?

Turn a percentage into dollars for 21086 in Chico. This uses the base rate on this page, so the locality and release stay consistent.

Reference amount per service

$1834.66

$1667.87 × 110% = $1834.66

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.

Compare your contract offer →

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 21086 in Chico.

PPRRVU2026_Oct_nonQPP.csv

1,870

Code
21086
Physician work
24.26
Practice expense
21.70
Malpractice
2.76

GPCI2026.csv

9

Locality
Chico
Physician work
1.017
Practice expense
1.096
Malpractice
0.536
Office / nonfacility calculation for 21086 in Chico
ComponentRVULocality factorAdjusted
Physician work24.26× 1.01724.6724
Practice expense21.70× 1.09623.7832
Malpractice2.76× 0.5361.4794
Total RVUs49.9350
Conversion factor× 33.4009

Office / nonfacility rate, Chico$1667.87

Values as parsed from CMS release RVU26D, effective 2026-10-01. The amount is rounded to the nearest cent only at the end.

Open 21086 in the RVU calculator →

Explore RVUs, geographic factors and the full formula

Office / nonfacility

Office / nonfacility calculation inputs
ComponentRVULocal GPCI
Work24.261.017
Practice expense21.71.096
Malpractice2.760.536

(24.26 × 1.017 + 21.7 × 1.096 + 2.76 × 0.536) × $33.4009 = $1667.87

Facility

Facility calculation inputs
ComponentRVULocal GPCI
Work24.261.017
Practice expense6.711.096
Malpractice2.760.536

(24.26 × 1.017 + 6.71 × 1.096 + 2.76 × 0.536) × $33.4009 = $1119.13

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

21086 · Office / nonfacility

$1667.87

Effective 2026-10-01

The base rate is $72.63 higher than on 2025-10-01, moving from $1595.24 to $1667.87 (4.6%).

It is unchanged from the immediately preceding available release, effective 2026-07-01.

Base rate by release · bars start at $0 · select a bar to compare

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

  1. January 1, 2026

    RVU26A

    $1595.24changed to$1667.87

    • Conversion factor 32.3465 changed to 33.4009
    • Work RVU 24.88 changed to 24.26
    • Practice expense RVU 20.82 changed to 21.70
    • Malpractice RVU 2.38 changed to 2.76
    • Work GPCI 1.014 changed to 1.017
    • Practice expense GPCI 1.093 changed to 1.096
    • Malpractice GPCI 0.560 changed to 0.536

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    Earliest loaded release: $1595.24

    Held through RVU25B, RVU25C, RVU25D.

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 fromOffice / nonfacilityFacilityCMS release
2026-10-01$1667.87$1119.13RVU26D
2026-07-01$1667.87$1119.13RVU26C
2026-04-01$1667.87$1119.13RVU26B
2026-01-01$1667.87$1119.13RVU26A
2025-10-01$1595.24$1274.22RVU25D
2025-07-01$1595.24$1274.22RVU25C
2025-04-01$1595.24$1274.22RVU25B
2025-01-01$1595.24$1274.22RVU25A

21086 billing questions

When should 21086 be chosen over 21088?

Use 21086 for an auricular, or external ear, prosthesis. Code 21088 addresses a facial prosthesis for a defect not described by a more specific site code.

Does 21086 cover the impression and preparation for an orbital or nasal prosthesis?

No. The site determines the code: 21077 is for an orbital prosthesis, and 21087 is for a nasal prosthesis.

What documentation supports reporting 21086?

Document the ear defect or absence and the impression and preparation work performed for the auricular prosthesis.

How does the 90-day global period affect reporting?

The day-before preoperative visit and 90 days of related postoperative care are included in the global period for 21086.

How is bilateral work handled?

CMS identifies 21086 as a bilateral procedure; modifier 50 is paid at 150%.

Can an assistant or co-surgeon be reported?

Assistant-at-surgery payment requires documentation of medical necessity. Co-surgeons and team surgery are not permitted under the CMS rules 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 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.

RVUs for 21086PPRRVU2026_Oct_nonQPP.csv, line 1,870 (RVU26D)
Geographic factors for ChicoGPCI2026.csv, line 9 (RVU26D)
Open CMS sourceHow this rate is calculatedBuild a fee sheet