No office rate
Use 21390 when the periorbital fracture repair includes an implant. 21386 describes periorbital repair without that implant distinction.
On this page
CMS RVU26D · Effective 2026-10-01
21390 Orbital fracture repair Medicare reimbursement rates in Colorado
Reports operative reconstruction of an orbital floor blowout fracture through a periorbital approach when the surgeon places an implant to support the repaired floor. Compare 21390 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 21390 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
$720.86
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 21390: Orbital floor fracture repair with implant
Reports operative reconstruction of an orbital floor blowout fracture through a periorbital approach when the surgeon places an implant to support the repaired floor.
Code 21390 covers operative repair of an orbital floor blowout fracture through an incision around the orbit, with an implant used to support the reconstructed floor. The surgeon exposes the fracture, addresses displaced orbital tissue as needed, and places the implant across the defect. This repair is typically performed by an oculoplastic, oral and maxillofacial, plastic, or facial trauma surgeon in an operating room after facial trauma has caused a floor defect or orbital tissue displacement.
Choose this code when the documented repair uses the periorbital approach and includes an implant. The operative report should identify the fracture and side, describe the approach and repair, and document implant placement. The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care. When multiple procedures are performed in the same session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% reduction. For bilateral repair, modifier 50 is paid at 150%. An assistant at surgery may be paid; co-surgeon payment requires supporting documentation, and team surgery is not permitted.
CMS billing rules for 21390
- 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 RVU10.95 · 52%
- Practice expense (office) RVU8.79 · 41%
- Malpractice RVU1.47 · 7%
615
Medicare services in 2024 · #3369 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.
21390 compared with similar codes
Office rates for Colorado, from the same CMS release.
No office rate
Both describe periorbital orbital floor fracture repair, but 21395 specifies bone graft reconstruction rather than implant placement.
No office rate
21385 uses a transantral route to repair the orbital floor; 21390 uses a periorbital route and includes an implant.
No office rate
21387 is for a repair using both periorbital and transantral approaches, rather than the periorbital approach represented by 21390.
Compare 21390 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
$720.86
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 21390 in Colorado.
PPRRVU2026_Oct_nonQPP.csv
1,967
- Code
- 21390
- Physician work
- 10.95
- Practice expense
- 8.79
- Malpractice
- 1.47
GPCI2026.csv
37
- Locality
- Colorado
- Physician work
- 1.012
- Practice expense
- 1.064
- Malpractice
- 0.781
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 10.95 | × 1.012 | 11.0814 |
| Practice expense | 8.79 | × 1.064 | 9.3526 |
| Malpractice | 1.47 | × 0.781 | 1.1481 |
| Total RVUs | 21.5820 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Colorado$720.86
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 10.95 | 1.012 |
| Practice expense | 8.79 | 1.064 |
| Malpractice | 1.47 | 0.781 |
(10.95 × 1.012 + 8.79 × 1.064 + 1.47 × 0.781) × $33.4009 = $720.86
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.
21390 billing questions
How does 21390 differ from 21386?
Both involve a periorbital approach to orbital floor fracture repair. Report 21390 when an implant is placed; 21386 describes the periorbital repair without that implant distinction.
When would 21395 be considered instead?
21395 is the related periorbital repair code when bone graft is used. The operative report should support whether the reconstruction used an implant or bone graft.
Can the implant placement be reported as a separate fracture repair?
The implant is part of the repair represented by 21390. Do not report another orbital floor fracture repair code for the same repair.
How is bilateral repair reported?
When the service is performed on both sides, report modifier 50. CMS pays bilateral procedures at 150% under the stated rule.
What postoperative care is included?
The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care.
What documentation supports co-surgeon payment?
Co-surgeon payment requires supporting documentation. The operative record should substantiate the surgeons' distinct roles in the repair.
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.
1,96421385,,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
1,96921400,,Closed tx orbit w/o manipulj,A,,1.46,5.43,,3.48,,0.25,7.14,5.19,0,090,0.10,0.69,0.21,2,1,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
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
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