No office rate
Use 21385 when the documented open repair uses a transantral approach; 21386 identifies a periorbital approach.
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CMS RVU26D · Effective 2026-10-01
21386 Orbital fracture repair Medicare reimbursement rates in Alabama
Open repair of an orbital floor blowout fracture through a periorbital approach, selected when that route is documented for fracture treatment. Compare 21386 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 21386 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
$573.17
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.
Facial fracture surgery
About 21386: Orbital floor fracture repair, periorbital approach
Open repair of an orbital floor blowout fracture through a periorbital approach, selected when that route is documented for fracture treatment.
Code 21386 describes open repair of an orbital floor blowout fracture reached through a periorbital route, typically through an incision in the eyelid area. The surgeon exposes the fractured floor, addresses displaced bone and any orbital tissue caught at the defect, and restores support as needed. Ophthalmic or oculoplastic, facial plastic, otolaryngology, and oral and maxillofacial surgeons may perform this repair in an operating room, often for traumatic fractures associated with double vision, restricted eye movement, or a change in globe position.
Choose this code based on the documented periorbital approach, not merely the presence of an orbital fracture; transantral and combined approaches have different codes, as do repairs involving an implant or bone graft. The operative report should identify the fracture location, surgical route, findings such as tissue entrapment, and reconstruction performed. CMS assigns a 90-day global period, including the day-before preoperative visit and related postoperative care through day 90. In a session with multiple procedures, the highest-valued procedure is paid in full and others at 50%. Bilateral reporting with modifier 50 is paid at 150%. Assistant-at-surgery payment may be made; co-surgeons and team surgery are not permitted.
CMS billing rules for 21386
- 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 not permitted.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU9.33 · 49%
- Practice expense (office) RVU7.83 · 41%
- Malpractice RVU1.73 · 9%
41
Medicare services in 2024 · #5476 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.
21386 compared with similar codes
Office rates for Alabama, from the same CMS release.
No office rate
Code 21387 represents a combined approach. Code 21386 is for repair through the periorbital route.
No office rate
Code 21390 includes implant placement in the orbital floor repair. Code 21386 identifies the periorbital approach.
No office rate
Code 21395 is for orbital floor repair with a bone graft; 21386 identifies repair through a periorbital approach.
Compare 21386 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
$573.17
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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 21386 in Alabama.
PPRRVU2026_Oct_nonQPP.csv
1,965
- Code
- 21386
- Physician work
- 9.33
- Practice expense
- 7.83
- Malpractice
- 1.73
GPCI2026.csv
4
- Locality
- Alabama
- Physician work
- 1.000
- Practice expense
- 0.875
- Malpractice
- 0.566
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 9.33 | × 1.000 | 9.3300 |
| Practice expense | 7.83 | × 0.875 | 6.8513 |
| Malpractice | 1.73 | × 0.566 | 0.9792 |
| Total RVUs | 17.1604 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Alabama$573.17
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 9.33 | 1 |
| Practice expense | 7.83 | 0.875 |
| Malpractice | 1.73 | 0.566 |
(9.33 × 1 + 7.83 × 0.875 + 1.73 × 0.566) × $33.4009 = $573.17
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.
21386 billing questions
What documentation distinguishes 21386 from other orbital fracture repair codes?
The operative report should establish an open orbital floor fracture repair through a periorbital approach. A transantral or combined route points to a different code in the orbital fracture series.
How does 21386 differ from the implant and bone-graft codes?
Code 21390 describes orbital floor repair that includes implant placement, while 21395 describes repair with a bone graft. Select the code that matches the documented repair, rather than inferring the method from the diagnosis.
How is bilateral repair handled?
CMS identifies this as a bilateral procedure. When reporting both sides with modifier 50, payment is at 150%.
What postoperative care is included?
The 90-day global period includes the day-before preoperative visit and related postoperative care through day 90.
Can an assistant or co-surgeon be reported?
Assistant-at-surgery services may be paid. Co-surgeons and team surgery are not permitted for this code under the CMS rules provided.
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.
1,96221365,,Opn tx complx malar fx,A,,16.35,9.88,NA,9.88,,2.59,28.82,28.82,0,090,0.10,0.69,0.21,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,96321366,,Opn tx complx malar w/grft,A,,18.14,12.59,NA,12.59,,3.36,34.09,34.09,0,090,0.10,0.69,0.21,2,1,2,2,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,96421385,,Opn tx orbit fx transantral,A,,9.33,9.13,NA,9.13,,1.73,20.19,20.19,0,090,0.10,0.69,0.21,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,96521386,,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
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