No office rate
This code describes reconstruction of an orbital defect with bone graft. Code 21386 is for repair of an acute blowout fracture using a periorbital approach.
On this page
CMS RVU26D · Effective 2026-10-01
21256 Orbital reconstruction Medicare reimbursement rates in Alabama
Rebuilds orbital bone with a graft when a structural defect requires reconstruction, such as after trauma, tumor removal, or congenital deformity. Compare 21256 office and facility rates across CMS payment localities in Alabama.
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.
What does Medicare pay for 21256 in Alabama?
Alabama has 1 payment locality in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the payment area shown below, using the same CMS release.
Office / nonfacility
No supported rate
Facility setting
$1014.53
1 of 1 localities have a supported rate.
Payment area: Alabama
One mapped payment locality.
These are locality ranges, not averages or address-specific quotes. A facility-setting amount covers the physician service; it does not include a hospital’s separate bill. Choose a locality below to inspect its calculation, compare other payment areas, or price a percentage of Medicare.
Craniofacial surgery
About 21256: Orbital reconstruction with bone graft
Rebuilds orbital bone with a graft when a structural defect requires reconstruction, such as after trauma, tumor removal, or congenital deformity.
This operation rebuilds part of the bony orbit using a bone graft to restore support and contour around the eye. It may be considered for a substantial orbital defect after trauma or tumor removal, or for a congenital abnormality requiring structural reconstruction. Oral and maxillofacial surgeons, craniofacial surgeons, and plastic surgeons commonly perform orbital reconstruction in a hospital or other surgical facility.
Report the code when the documented work reconstructs the orbit with bone graft, rather than treating an isolated acute orbital floor fracture by a fracture-repair approach. The operative report should identify the orbital defect, the reconstruction performed, and the graft used. CMS 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 one session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% reduction. For bilateral surgery, modifier 50 is paid at 150%. Assistant-at-surgery services may be paid; co-surgeons require supporting documentation, and team surgery is not permitted.
CMS billing rules for 21256
- 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 RVU17.22 · 52%
- Practice expense (office) RVU12.97 · 39%
- Malpractice RVU3.19 · 10%
35
Medicare services in 2024 · #5563 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.
21256 compared with similar codes
Office rates for Alabama, from the same CMS release.
No office rate
Choose this code for orbital reconstruction with bone graft; code 21390 describes acute blowout fracture repair using a transantral approach.
No office rate
Code 21256 rebuilds the orbit with bone graft. Code 21275 describes revision of orbitofacial bones rather than the orbital reconstruction service described here.
Compare 21256 by payment locality
Find the payment area for your service address, then open its rate page for calculation inputs, release history and the percentage-of-Medicare tool. A city may cross payment-area boundaries; the ZIP lookup above helps resolve the location.
1 of 1 payment localities
Alabama →
Office / nonfacility
Unavailable
Facility
$1014.53
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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 21256 in Alabama.
PPRRVU2026_Oct_nonQPP.csv
1,930
- Code
- 21256
- Physician work
- 17.22
- Practice expense
- 12.97
- Malpractice
- 3.19
GPCI2026.csv
4
- Locality
- Alabama
- Physician work
- 1.000
- Practice expense
- 0.875
- Malpractice
- 0.566
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 17.22 | × 1.000 | 17.2200 |
| Practice expense | 12.97 | × 0.875 | 11.3488 |
| Malpractice | 3.19 | × 0.566 | 1.8055 |
| Total RVUs | 30.3743 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Alabama$1014.53
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 17.22 | 1 |
| Practice expense | 12.97 | 0.875 |
| Malpractice | 3.19 | 0.566 |
(17.22 × 1 + 12.97 × 0.875 + 3.19 × 0.566) × $33.4009 = $1014.53
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.
21256 billing questions
When is this code preferable to an orbital floor fracture repair code?
Use this code for reconstruction of an orbital defect with bone graft. An acute, isolated blowout fracture treated through a specified fracture-repair approach may instead fit a fracture-repair code such as 21386 or 21390.
What documentation supports reporting this service?
The operative report should describe the orbital defect, the structural reconstruction, and use of a bone graft. Document the clinical context, such as a post-traumatic, post-resection, or congenital defect, when applicable.
How is bilateral orbital reconstruction handled?
CMS identifies this as a bilateral procedure; modifier 50 is paid at 150%. The operative documentation should support reconstruction on both sides.
How does the 90-day global period affect postoperative reporting?
The day-before preoperative visit and 90 days of related postoperative care are included in the global period. CMS classifies this as major surgery.
Can an assistant or co-surgeon be reported?
CMS permits payment for an assistant at surgery. Co-surgeons are paid only with supporting documentation; team surgery is not permitted.
What happens when another procedure is performed in the same session?
Under CMS's standard multiple procedure reduction, the highest-valued procedure is paid in full and other procedures are paid at 50% when performed in the same session.
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.
1,92721248,,Reconstruction of jaw,A,,12.42,16.71,,7.79,,1.51,30.64,21.72,0,090,0.10,0.69,0.21,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,92821249,,Reconstruction of jaw,A,,18.30,21.44,,9.64,,2.31,42.05,30.25,0,090,0.10,0.69,0.21,2,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,92921255,,Reconstruct lower jaw bone,A,,18.00,15.95,NA,15.95,,2.61,36.56,36.56,0,090,0.10,0.69,0.21,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,93021256,,Reconstruction of orbit,A,,17.22,12.97,NA,12.97,,3.19,33.38,33.38,0,090,0.10,0.69,0.21,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,93121260,,Revise eye sockets,A,,17.45,16.80,NA,16.80,,3.23,37.48,37.48,0,090,0.10,0.69,0.21,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,93221261,,Revise eye sockets,A,,33.22,25.75,NA,25.75,,6.17,65.14,65.14,0,090,0.10,0.69,0.21,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,93321263,,Revise eye sockets,A,,30.23,24.66,NA,24.66,,5.61,60.50,60.50,0,090,0.10,0.69,0.21,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1ADDENDUM E. FINAL CY 2026 GEOGRAPHIC PRACTICE COST INDICES (GPCIs) BY STATE AND MEDICARE LOCALITY,,,,,,
2,,,,,,
3Medicare Administrative Contractor (MAC),State,Locality Number,Locality Name,2026 PW GPCI (with 1.0 Floor)***,2026 PE GPCI,2026 MP GPCI
410112,AL,00,ALABAMA,1.000,0.875,0.566
502102,AK,01,ALASKA*,1.500,1.065,0.551
603102,AZ,00,ARIZONA,1.000,0.969,0.856
707102,AR,13,ARKANSAS,1.000,0.859,0.515