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 Orbital fracture repair Medicare reimbursement rates in Alabama
Report this code for open surgical treatment of an orbital fracture when reconstruction uses a bone graft to restore the injured orbit. Compare 21408 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 21408 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
$740.60
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 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 Alabama, 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.
$212.19
21400 describes closed orbital fracture treatment without manipulation. It does not represent the open, bone-graft repair reported with 21408.
$491.28
21401 describes closed orbital fracture treatment with manipulation. Choose 21408 when the fracture is treated through open surgery with a bone graft.
Compare 21408 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
$740.60
Need rates for a whole code list?
Fee-sheet and API access are in early access. Tell us which codes and locations your team needs.
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 Alabama.
PPRRVU2026_Oct_nonQPP.csv
1,973
- Code
- 21408
- Physician work
- 12.46
- Practice expense
- 9.60
- Malpractice
- 2.32
GPCI2026.csv
4
- Locality
- Alabama
- Physician work
- 1.000
- Practice expense
- 0.875
- Malpractice
- 0.566
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 12.46 | × 1.000 | 12.4600 |
| Practice expense | 9.60 | × 0.875 | 8.4000 |
| Malpractice | 2.32 | × 0.566 | 1.3131 |
| Total RVUs | 22.1731 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Alabama$740.60
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 12.46 | 1 |
| Practice expense | 9.6 | 0.875 |
| Malpractice | 2.32 | 0.566 |
(12.46 × 1 + 9.6 × 0.875 + 2.32 × 0.566) × $33.4009 = $740.60
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.
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
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