No office rate
Use 21406 for open orbital fracture treatment without implant or bone graft. Use 21408 when the repair includes a bone graft.
On this page
CMS RVU26D · Effective 2026-10-01
21408 in Wyoming**
Office / nonfacility
Not available in this setting
Base rate per service
Facility setting
$794.17
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 21408: Open orbital fracture repair with bone graft
Report this code for open surgical treatment of an orbital fracture when reconstruction uses a bone graft to restore the injured orbit.
This service involves surgically exposing and treating an orbital fracture, then using a bone graft to reconstruct the damaged area. It is performed by surgeons who manage facial and orbital trauma, such as oculoplastic, plastic, or oral and maxillofacial surgeons. A typical setting is an operating room for a fracture requiring open repair rather than closed treatment.
Choose this code when the operative record supports both open fracture treatment and use of a bone graft; distinguish it from open repairs using an implant or no implant. Document the fracture and side, the surgical approach and repair, and the graft’s use. The code has a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. For same-session procedures, the highest-valued procedure is paid in full and other procedures at 50%. Bilateral reporting with modifier 50 is paid at 150%. Assistant-at-surgery payment may be made, and co-surgeons are permitted; team surgery is not permitted.
CMS billing rules for 21408
- 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 permitted.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU12.46 · 51%
- Practice expense (office) RVU9.60 · 39%
- Malpractice RVU2.32 · 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.
21408 compared with similar codes
Office rates for Wyoming**, from the same CMS release.
No office rate
Use 21407 when an implant is used in open orbital fracture repair; use 21408 when reconstruction uses a bone graft.
$236.31
21400 describes closed orbital fracture treatment without manipulation. It does not represent the open, bone-graft repair reported with 21408.
$546.39
21401 describes closed orbital fracture treatment with manipulation. Choose 21408 when the fracture is treated through open surgery with a bone graft.
The same code, a different location
How does Wyoming** compare?
21408 across payment areas
Same release and payment basis · bars start at $0
Wyoming** · This locality
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 Wyoming 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
Alabama
Alabama · 21408
Office
Unavailable
Facility
$740.60
No comparable office rate is available.
Arkansas
Arkansas · 21408
Office
Unavailable
Facility
$731.52
No comparable office rate is available.
Arizona
Arizona · 21408
Office
Unavailable
Facility
$793.22
No comparable office rate is available.
Bakersfield
California · 21408
Office
Unavailable
Facility
$822.70
No comparable office rate is available.
Chico
California · 21408
Office
Unavailable
Facility
$816.22
No comparable office rate is available.
El Centro
California · 21408
Office
Unavailable
Facility
$816.60
No comparable office rate is available.
Fresno
California · 21408
Office
Unavailable
Facility
$816.22
No comparable office rate is available.
Hanford-Corcoran
California · 21408
Office
Unavailable
Facility
$816.22
No comparable office rate is available.
Madera
California · 21408
Office
Unavailable
Facility
$816.22
No comparable office rate is available.
Merced
California · 21408
Office
Unavailable
Facility
$816.22
No comparable office rate is available.
Modesto
California · 21408
Office
Unavailable
Facility
$816.22
No comparable office rate is available.
Napa
California · 21408
Office
Unavailable
Facility
$904.37
No comparable office rate is available.
Oxnard-Thousand Oaks-Ventura
California · 21408
Office
Unavailable
Facility
$855.11
No comparable office rate is available.
Redding
California · 21408
Office
Unavailable
Facility
$816.22
No comparable office rate is available.
Rest Of California
California · 21408
Office
Unavailable
Facility
$816.22
No comparable office rate is available.
Riverside-San Bernardino-Ontario
California · 21408
Office
Unavailable
Facility
$841.20
No comparable office rate is available.
Sacramento-Roseville-Folsom
California · 21408
Office
Unavailable
Facility
$845.61
No comparable office rate is available.
Salinas
California · 21408
Office
Unavailable
Facility
$842.24
No comparable office rate is available.
San Diego-Chula Vista-Carlsbad
California · 21408
Office
Unavailable
Facility
$854.16
No comparable office rate is available.
San Francisco-Oakland-Berkeley (Marin Cnty)
California · 21408
Office
Unavailable
Facility
$943.39
No comparable office rate is available.
San Francisco-Oakland-Berkeley (San Francisco/San Mateo/Alameda/Contra Costa Cnty)
California · 21408
Office
Unavailable
Facility
$940.76
No comparable office rate is available.
San Jose-Sunnyvale-Santa Clara (San Benito Cnty)
California · 21408
Office
Unavailable
Facility
$965.86
No comparable office rate is available.
San Jose-Sunnyvale-Santa Clara (Santa Clara Cnty)
California · 21408
Office
Unavailable
Facility
$955.09
No comparable office rate is available.
San Luis Obispo-Paso Robles
California · 21408
Office
Unavailable
Facility
$830.00
No comparable office rate is available.
Santa Cruz-Watsonville
California · 21408
Office
Unavailable
Facility
$856.04
No comparable office rate is available.
Santa Maria-Santa Barbara
California · 21408
Office
Unavailable
Facility
$843.24
No comparable office rate is available.
Santa Rosa-Petaluma
California · 21408
Office
Unavailable
Facility
$863.95
No comparable office rate is available.
Stockton
California · 21408
Office
Unavailable
Facility
$816.22
No comparable office rate is available.
Vallejo
California · 21408
Office
Unavailable
Facility
$900.58
No comparable office rate is available.
Visalia
California · 21408
Office
Unavailable
Facility
$816.22
No comparable office rate is available.
Yuba City
California · 21408
Office
Unavailable
Facility
$816.22
No comparable office rate is available.
Colorado
Colorado · 21408
Office
Unavailable
Facility
$822.86
No comparable office rate is available.
Connecticut
Connecticut · 21408
Office
Unavailable
Facility
$863.60
No comparable office rate is available.
Delaware
Delaware · 21408
Office
Unavailable
Facility
$804.72
No comparable office rate is available.
Fort Lauderdale
Florida · 21408
Office
Unavailable
Facility
$881.09
No comparable office rate is available.
Rest Of Florida
Florida · 21408
Office
Unavailable
Facility
$839.18
No comparable office rate is available.
Atlanta
Georgia · 21408
Office
Unavailable
Facility
$836.27
No comparable office rate is available.
Rest Of Georgia
Georgia · 21408
Office
Unavailable
Facility
$794.56
No comparable office rate is available.
Hawaii, Guam
Hawaii · 21408
Office
Unavailable
Facility
$825.62
No comparable office rate is available.
Iowa
Iowa · 21408
Office
Unavailable
Facility
$740.33
No comparable office rate is available.
Idaho
Idaho · 21408
Office
Unavailable
Facility
$747.82
No comparable office rate is available.
East St. Louis
Illinois · 21408
Office
Unavailable
Facility
$867.24
No comparable office rate is available.
Rest Of Illinois
Illinois · 21408
Office
Unavailable
Facility
$830.04
No comparable office rate is available.
Suburban Chicago
Illinois · 21408
Office
Unavailable
Facility
$885.71
No comparable office rate is available.
Indiana
Indiana · 21408
Office
Unavailable
Facility
$751.08
No comparable office rate is available.
Kansas
Kansas · 21408
Office
Unavailable
Facility
$745.10
No comparable office rate is available.
Kentucky
Kentucky · 21408
Office
Unavailable
Facility
$772.14
No comparable office rate is available.
New Orleans
Louisiana · 21408
Office
Unavailable
Facility
$805.93
No comparable office rate is available.
Rest Of Louisiana
Louisiana · 21408
Office
Unavailable
Facility
$774.18
No comparable office rate is available.
Metropolitan Boston
Massachusetts · 21408
Office
Unavailable
Facility
$885.06
No comparable office rate is available.
Rest Of Massachusetts
Massachusetts · 21408
Office
Unavailable
Facility
$822.24
No comparable office rate is available.
Baltimore/Surr. Cntys
Maryland · 21408
Office
Unavailable
Facility
$862.75
No comparable office rate is available.
Rest Of Maryland
Maryland · 21408
Office
Unavailable
Facility
$815.97
No comparable office rate is available.
Rest Of Maine
Maine · 21408
Office
Unavailable
Facility
$759.37
No comparable office rate is available.
Southern Maine
Maine · 21408
Office
Unavailable
Facility
$782.83
No comparable office rate is available.
Detroit
Michigan · 21408
Office
Unavailable
Facility
$856.25
No comparable office rate is available.
Rest Of Michigan
Michigan · 21408
Office
Unavailable
Facility
$796.41
No comparable office rate is available.
Minnesota
Minnesota · 21408
Office
Unavailable
Facility
$769.06
No comparable office rate is available.
Metropolitan Kansas City
Missouri · 21408
Office
Unavailable
Facility
$792.97
No comparable office rate is available.
Metropolitan St. Louis
Missouri · 21408
Office
Unavailable
Facility
$799.08
No comparable office rate is available.
Rest Of Missouri
Missouri · 21408
Office
Unavailable
Facility
$768.05
No comparable office rate is available.
Mississippi
Mississippi · 21408
Office
Unavailable
Facility
$749.52
No comparable office rate is available.
Montana**
Montana · 21408
Office
Unavailable
Facility
$814.16
No comparable office rate is available.
North Carolina
North Carolina · 21408
Office
Unavailable
Facility
$764.86
No comparable office rate is available.
North Dakota**
North Dakota · 21408
Office
Unavailable
Facility
$768.28
No comparable office rate is available.
Nebraska
Nebraska · 21408
Office
Unavailable
Facility
$741.43
No comparable office rate is available.
New Hampshire
New Hampshire · 21408
Office
Unavailable
Facility
$817.77
No comparable office rate is available.
Northern Nj
New Jersey · 21408
Office
Unavailable
Facility
$897.11
No comparable office rate is available.
Rest Of New Jersey
New Jersey · 21408
Office
Unavailable
Facility
$867.98
No comparable office rate is available.
New Mexico
New Mexico · 21408
Office
Unavailable
Facility
$803.28
No comparable office rate is available.
Nevada**
Nevada · 21408
Office
Unavailable
Facility
$801.69
No comparable office rate is available.
Nyc Suburbs/Long Island
New York · 21408
Office
Unavailable
Facility
$967.96
No comparable office rate is available.
Poughkpsie/N Nyc Suburbs
New York · 21408
Office
Unavailable
Facility
$879.78
No comparable office rate is available.
Queens
New York · 21408
Office
Unavailable
Facility
$933.56
No comparable office rate is available.
Rest Of New York
New York · 21408
Office
Unavailable
Facility
$775.27
No comparable office rate is available.
Ohio
Ohio · 21408
Office
Unavailable
Facility
$787.04
No comparable office rate is available.
Oklahoma
Oklahoma · 21408
Office
Unavailable
Facility
$762.72
No comparable office rate is available.
Portland
Oregon · 21408
Office
Unavailable
Facility
$836.73
No comparable office rate is available.
Rest Of Oregon
Oregon · 21408
Office
Unavailable
Facility
$790.02
No comparable office rate is available.
Metropolitan Philadelphia
Pennsylvania · 21408
Office
Unavailable
Facility
$849.91
No comparable office rate is available.
Rest Of Pennsylvania
Pennsylvania · 21408
Office
Unavailable
Facility
$783.76
No comparable office rate is available.
Puerto Rico
Puerto Rico · 21408
Office
Unavailable
Facility
$816.68
No comparable office rate is available.
Rhode Island
Rhode Island · 21408
Office
Unavailable
Facility
$824.43
No comparable office rate is available.
South Carolina
South Carolina · 21408
Office
Unavailable
Facility
$778.32
No comparable office rate is available.
South Dakota**
South Dakota · 21408
Office
Unavailable
Facility
$762.86
No comparable office rate is available.
Tennessee
Tennessee · 21408
Office
Unavailable
Facility
$749.26
No comparable office rate is available.
Austin
Texas · 21408
Office
Unavailable
Facility
$824.91
No comparable office rate is available.
Beaumont
Texas · 21408
Office
Unavailable
Facility
$779.95
No comparable office rate is available.
Brazoria
Texas · 21408
Office
Unavailable
Facility
$797.71
No comparable office rate is available.
Dallas
Texas · 21408
Office
Unavailable
Facility
$805.77
No comparable office rate is available.
Fort Worth
Texas · 21408
Office
Unavailable
Facility
$803.57
No comparable office rate is available.
Galveston
Texas · 21408
Office
Unavailable
Facility
$802.07
No comparable office rate is available.
Houston
Texas · 21408
Office
Unavailable
Facility
$844.54
No comparable office rate is available.
Rest Of Texas
Texas · 21408
Office
Unavailable
Facility
$790.44
No comparable office rate is available.
Utah
Utah · 21408
Office
Unavailable
Facility
$787.17
No comparable office rate is available.
Virginia
Virginia · 21408
Office
Unavailable
Facility
$786.08
No comparable office rate is available.
Virgin Islands
United States Virgin Islands · 21408
Office
Unavailable
Facility
$816.68
No comparable office rate is available.
Vermont
Vermont · 21408
Office
Unavailable
Facility
$772.83
No comparable office rate is available.
Rest Of Washington
Washington · 21408
Office
Unavailable
Facility
$818.20
No comparable office rate is available.
Seattle (King Cnty)
Washington · 21408
Office
Unavailable
Facility
$893.73
No comparable office rate is available.
Wisconsin
Wisconsin · 21408
Office
Unavailable
Facility
$747.22
No comparable office rate is available.
West Virginia
West Virginia · 21408
Office
Unavailable
Facility
$805.71
No comparable office rate is available.
See how rates vary across the country
21408 · 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?
Wyoming** is a Medicare payment area. Our Census mapping connects it to 205 cities and communities in Wyoming, 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.
Use this rate
What is a percentage of Medicare worth?
Turn a percentage into dollars for 21408 in Wyoming**. This uses the base rate on this page, so the locality and release stay consistent.
Reference amount per service
$873.59
$794.17 × 110% = $873.59
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 21408 in Wyoming**.
PPRRVU2026_Oct_nonQPP.csv
1,973
- Code
- 21408
- Physician work
- 12.46
- Practice expense
- 9.60
- Malpractice
- 2.32
GPCI2026.csv
112
- Locality
- Wyoming**
- Physician work
- 1.000
- Practice expense
- 1.000
- Malpractice
- 0.740
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 12.46 | × 1.000 | 12.4600 |
| Practice expense | 9.60 | × 1.000 | 9.6000 |
| Malpractice | 2.32 | × 0.740 | 1.7168 |
| Total RVUs | 23.7768 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Wyoming**$794.17
Open 21408 in the RVU calculator →
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 12.46 | 1 |
| Practice expense | 9.6 | 1 |
| Malpractice | 2.32 | 0.74 |
(12.46 × 1 + 9.6 × 1 + 2.32 × 0.74) × $33.4009 = $794.17
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
21408 · 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 | $794.17 | RVU26D |
| 2026-07-01 | Not available in this setting | $794.17 | RVU26C |
| 2026-04-01 | Not available in this setting | $794.17 | RVU26B |
| 2026-01-01 | Not available in this setting | $794.17 | RVU26A |
| 2025-10-01 | Not available in this setting | $865.01 | RVU25D |
| 2025-07-01 | Not available in this setting | $865.01 | RVU25C |
| 2025-04-01 | Not available in this setting | $865.01 | RVU25B |
| 2025-01-01 | Not available in this setting | $865.01 | RVU25A |
21408 billing questions
When should this code be chosen instead of 21407?
Choose 21408 when the open orbital fracture repair uses a bone graft. Code 21407 is the related open-repair option when an implant is used instead.
How does this differ from 21406?
Both describe open orbital fracture treatment, but 21408 includes bone-graft reconstruction while 21406 is the option without an implant.
Can this code be used for closed fracture treatment?
No. Closed treatment is represented by 21400 or 21401, depending on whether manipulation is performed; this code is for open repair with a bone graft.
What documentation supports reporting 21408?
The operative report should establish the orbital fracture, open surgical treatment, and use of a bone graft in the repair. Record the treated side and the repair performed.
How is bilateral repair reported under the CMS payment rule?
When the procedure is performed bilaterally, modifier 50 is paid at 150% under the CMS rule provided for this code.
What should a practice know about the global period and surgical assistance?
The 90-day global includes the day-before preoperative visit and 90 days of related postoperative care. Assistant-at-surgery payment may be made, and co-surgeons are permitted.
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.
1,97021401,,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
1,97221407,,Opn tx orbit fx w/implant,A,,8.79,7.29,NA,7.29,,1.21,17.29,17.29,0,090,0.10,0.69,0.21,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,97321408,,Opn tx orbit fx w/bone grft,A,,12.46,9.60,NA,9.60,,2.32,24.38,24.38,0,090,0.10,0.69,0.21,2,1,2,2,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,97421421,,Cltx palatal/max fx wire fix,A,,5.87,13.23,,8.85,,0.66,19.76,15.38,0,090,0.10,0.69,0.21,2,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,97521422,,Optx palatal/max fracture,A,,8.51,7.92,NA,7.92,,1.24,17.67,17.67,0,090,0.10,0.69,0.21,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,97621423,,Optx palatal/max fx comp,A,,10.58,9.07,NA,9.07,,1.96,21.61,21.61,0,090,0.10,0.69,0.21,2,0,2,2,0,9,,33.4009,09,0,99,0.00,0.00,0.00
10902402,WA,99,REST OF WASHINGTON,1.013,1.053,0.761
11011402,WV,16,WEST VIRGINIA,1.000,0.869,1.431
11106302,WI,00,WISCONSIN,1.000,0.958,0.308
11203602,WY,21,WYOMING**,1.000,1.000,0.740
113"MAC Assignments as of November 22, 2023",,,,,,
114,,,,,,
115*Work GPCI reflects a 1.5 floor in Alaska established by the MIPPA.,,,,,,