$460.69
21355 describes percutaneous treatment of a malar fracture. Report 21360 when the surgeon uses an open approach for a depressed malar fracture.
On this page
CMS RVU26D · Effective 2026-10-01
21360 Malar fracture repair Medicare reimbursement rates in Colorado
Report open surgical reduction of a depressed malar fracture when the surgeon restores the cheekbone’s position, with fixation if performed. Compare 21360 office and facility rates across CMS payment localities in Colorado.
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 21360 in Colorado?
Colorado 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
$476.60
1 of 1 localities have a supported rate.
Payment area: Colorado
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 21360: Open repair of depressed malar fracture
Report open surgical reduction of a depressed malar fracture when the surgeon restores the cheekbone’s position, with fixation if performed.
This service covers open repair of a depressed fracture of the malar, or cheekbone, typically after blunt facial trauma has displaced and flattened the cheek. A facial plastic surgeon, otolaryngologist, or oral and maxillofacial surgeon exposes the fracture, restores the bone’s position, and may use internal fixation. The repair is generally performed in an operating room; the operative report should identify the fracture site and describe the open reduction and any fixation.
Choose this code for an open repair of a depressed malar fracture, rather than a percutaneous reduction or repair of a complex malar fracture. Document the fracture pattern, laterality, approach, reduction, and fixation when performed. CMS assigns a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. For multiple procedures in one session, 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 services may be paid; co-surgeons and team surgery are not permitted.
CMS billing rules for 21360
- 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 RVU7.01 · 50%
- Practice expense (office) RVU5.98 · 43%
- Malpractice RVU1.04 · 7%
32
Medicare services in 2024 · #5611 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.
21360 compared with similar codes
Office rates for Colorado, from the same CMS release.
$614.67
21356 applies to open treatment of a depressed zygomatic arch fracture. This code concerns a depressed malar fracture; document the specific injured site.
No office rate
21365 is for open treatment of a complex malar fracture. Use 21360 for the depressed malar fracture service when the case is not documented as complex.
No office rate
21366 describes complex malar fracture treatment with a graft. It is not the code for an open repair of a depressed malar fracture without that complex graft procedure.
Compare 21360 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
Colorado →
Office / nonfacility
Unavailable
Facility
$476.60
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 21360 in Colorado.
PPRRVU2026_Oct_nonQPP.csv
1,961
- Code
- 21360
- Physician work
- 7.01
- Practice expense
- 5.98
- Malpractice
- 1.04
GPCI2026.csv
37
- Locality
- Colorado
- Physician work
- 1.012
- Practice expense
- 1.064
- Malpractice
- 0.781
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 7.01 | × 1.012 | 7.0941 |
| Practice expense | 5.98 | × 1.064 | 6.3627 |
| Malpractice | 1.04 | × 0.781 | 0.8122 |
| Total RVUs | 14.2691 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Colorado$476.60
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 7.01 | 1.012 |
| Practice expense | 5.98 | 1.064 |
| Malpractice | 1.04 | 0.781 |
(7.01 × 1.012 + 5.98 × 1.064 + 1.04 × 0.781) × $33.4009 = $476.60
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.
21360 billing questions
When should this code be chosen over a percutaneous malar fracture code?
Use this code when the surgeon treats the depressed malar fracture through an open approach. A percutaneous reduction is reported with 21355.
Does internal fixation support separate reporting?
Internal fixation may be part of the open fracture repair described by this code. Document fixation in the operative report, but do not treat it as a separate procedure solely because hardware was used.
How is a complex malar fracture distinguished?
Use 21365 when the surgeon performs open treatment of a complex malar fracture. The operative documentation should support the fracture’s complexity and the work performed.
What postoperative care is included?
The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care.
Can this procedure be reported bilaterally?
CMS identifies this as a bilateral procedure. Modifier 50 is paid at 150%.
Can an assistant or co-surgeon be reported?
Assistant-at-surgery services may be paid. CMS does not permit co-surgeons or team surgery 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.
1,95821348,,Opn tx nasomax fx w/graft,A,,17.08,8.81,NA,8.81,,2.49,28.38,28.38,0,090,0.10,0.69,0.21,2,0,2,2,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,95921355,,Perq tx malar fracture,A,,4.34,8.38,,3.85,,0.62,13.34,8.81,0,010,0.10,0.80,0.10,2,1,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,96021356,,Opn tx dprsd zygomatic arch,A,,4.71,12.17,,5.78,,0.88,17.76,11.37,0,010,0.10,0.80,0.10,2,1,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,96121360,,Opn tx dprsd malar fracture,A,,7.01,5.98,NA,5.98,,1.04,14.03,14.03,0,090,0.10,0.69,0.21,2,1,2,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,96221365,,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
3401112,CA,69,VISALIA,1.017,1.096,0.536
3501112,CA,70,YUBA CITY,1.017,1.096,0.536
3601112,CA,75,REST OF CALIFORNIA,1.017,1.096,0.536
3704112,CO,01,COLORADO,1.012,1.064,0.781
3813102,CT,00,CONNECTICUT,1.020,1.077,1.210
3912202,DC,01,DC + MD/VA SUBURBS,1.054,1.178,1.113
4012102,DE,01,DELAWARE,1.005,0.988,0.899