No office rate
Both are closely related orbital reconstruction codes. Choose by matching the documented bony work and operative extent to the specific code descriptor, rather than relying on the diagnosis alone.
On this page
CMS RVU26D · Effective 2026-10-01
21261 Orbital reconstruction Medicare reimbursement rates in Delaware
Reports major reconstructive surgery of the orbital skeleton to correct a structural deformity or deficiency requiring bony reconstruction. Compare 21261 office and facility rates across CMS payment localities in Delaware.
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 21261 in Delaware?
Delaware 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
$2150.15
1 of 1 localities have a supported rate.
Payment area: Delaware
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 21261: Orbital skeletal reconstruction
Reports major reconstructive surgery of the orbital skeleton to correct a structural deformity or deficiency requiring bony reconstruction.
This code represents major reconstruction of the bony framework around the eye socket. Craniofacial, plastic, oral and maxillofacial, or oculoplastic surgeons may perform this work in an operating room to address a substantial orbital skeletal deformity or deficiency. The operative plan and extent of bony reconstruction—not simply the presence of an eye or eyelid problem—distinguish this service from limited canthal procedures or other facial bone work.
Select the code when the operative report supports the orbital reconstruction described by this code, including the affected anatomy and reconstructive work performed. 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 the others are subject to the standard multiple-procedure reduction. Modifier 50 is inappropriate for this code. An assistant at surgery may be paid; co-surgeon payment requires supporting documentation, and team surgery is not permitted.
CMS billing rules for 21261
- 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 adjustment does not apply; the descriptor or anatomy makes modifier 50 inappropriate.
- 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 RVU33.22 · 51%
- Practice expense (office) RVU25.75 · 40%
- Malpractice RVU6.17 · 9%
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.
21261 compared with similar codes
Office rates for Delaware, from the same CMS release.
No office rate
This code is for orbital repositioning. Compare its descriptor with 21261 and report the one that matches the actual reconstructive service performed.
No office rate
21280 is medial canthopexy, a canthal support procedure. It does not represent major reconstruction of the orbital bony framework.
No office rate
21256 is another orbital reconstruction code with a distinct descriptor. Use it when its described reconstructive service, rather than the work represented by 21261, was performed.
Compare 21261 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
Delaware →
Office / nonfacility
Unavailable
Facility
$2150.15
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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 21261 in Delaware.
PPRRVU2026_Oct_nonQPP.csv
1,932
- Code
- 21261
- Physician work
- 33.22
- Practice expense
- 25.75
- Malpractice
- 6.17
GPCI2026.csv
40
- Locality
- Delaware
- Physician work
- 1.005
- Practice expense
- 0.988
- Malpractice
- 0.899
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 33.22 | × 1.005 | 33.3861 |
| Practice expense | 25.75 | × 0.988 | 25.4410 |
| Malpractice | 6.17 | × 0.899 | 5.5468 |
| Total RVUs | 64.3739 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Delaware$2150.15
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 33.22 | 1.005 |
| Practice expense | 25.75 | 0.988 |
| Malpractice | 6.17 | 0.899 |
(33.22 × 1.005 + 25.75 × 0.988 + 6.17 × 0.899) × $33.4009 = $2150.15
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.
21261 billing questions
How is 21261 distinguished from nearby orbital reconstruction codes?
Use the operative report to match the specific bony reconstruction and extent to the applicable descriptor. A diagnosis involving the orbit alone does not establish which reconstruction code applies.
Should modifier 50 be appended when both sides are involved?
No. CMS identifies bilateral adjustment as inappropriate for this code; do not report it with modifier 50.
Are routine postoperative visits separately reported?
Related postoperative care during the 90-day global period is included. The global period also includes the day-before preoperative visit.
How does the multiple-procedure rule affect payment?
When other procedures are performed in the same session, the highest-valued procedure is paid in full and the other procedures are subject to the standard 50% multiple-procedure reduction.
Can an assistant or co-surgeon be reported?
Assistant-at-surgery payment may be made. Co-surgeon payment requires supporting documentation; team surgery is not permitted.
What documentation supports reporting 21261?
Document the orbital anatomy treated, the structural problem, and the bony reconstructive work performed. The operative detail should support selecting this code over a less extensive orbital or canthal procedure.
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.
1,92921255,,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
1,93421267,,Revise eye sockets,A,,20.17,19.99,NA,19.99,,3.75,43.91,43.91,0,090,0.10,0.69,0.21,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,93521268,,Revise eye sockets,A,,26.39,23.25,NA,23.25,,4.89,54.53,54.53,0,090,0.10,0.69,0.21,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
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
4109102,FL,03,FORT LAUDERDALE,1.000,1.013,1.808
4209102,FL,04,MIAMI,1.000,1.041,2.529
4309102,FL,99,REST OF FLORIDA,1.000,0.956,1.503