No office rate
21385 describes a transantral-only approach. Choose 21387 when the operative report documents combined access.
On this page
CMS RVU26D · Effective 2026-10-01
21387 Orbital fracture repair Medicare reimbursement rates in Delaware
Reports open repair of an orbital floor blowout fracture when the surgeon uses combined access to reach and treat the fracture. Compare 21387 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 21387 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
$693.82
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.
Facial fracture surgery
About 21387: Combined-approach orbital floor fracture repair
Reports open repair of an orbital floor blowout fracture when the surgeon uses combined access to reach and treat the fracture.
This service repairs an orbital floor blowout fracture through a combined approach, typically using both periorbital and transantral access. The surgeon exposes the fracture, addresses displaced bone or tissue at the floor, and restores support to the orbit. It may be performed by an oculoplastic, facial plastic, oral and maxillofacial, or other surgeon treating complex facial trauma, usually in an operating room. Such fractures may follow blunt facial injury and can be associated with restricted eye movement, double vision, or a sunken appearance of the eye.
Report this code when the operative record supports open treatment through the combined approach; the documented approach, fracture site, and repair should distinguish it from a single-access repair. The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care. When multiple procedures occur in the same session, the highest-valued procedure is paid in full and the others at 50%. Modifier 50 is paid at 150% for bilateral procedures. Assistant-at-surgery payment may be allowed; co-surgeons and team surgery are not permitted.
CMS billing rules for 21387
- 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 RVU9.86 · 47%
- Practice expense (office) RVU9.33 · 44%
- Malpractice RVU1.83 · 9%
13
Medicare services in 2024 · #6121 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.
21387 compared with similar codes
Office rates for Delaware, from the same CMS release.
No office rate
21386 describes a periorbital-only approach; 21387 is for combined access to the orbital floor.
No office rate
21390 describes periorbital repair with an implant. This code is distinguished by combined access rather than that periorbital implant description.
No office rate
21395 describes periorbital repair with a bone graft. Use this code when combined access, rather than that graft-specific service, is documented.
Compare 21387 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
$693.82
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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 21387 in Delaware.
PPRRVU2026_Oct_nonQPP.csv
1,966
- Code
- 21387
- Physician work
- 9.86
- Practice expense
- 9.33
- Malpractice
- 1.83
GPCI2026.csv
40
- Locality
- Delaware
- Physician work
- 1.005
- Practice expense
- 0.988
- Malpractice
- 0.899
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 9.86 | × 1.005 | 9.9093 |
| Practice expense | 9.33 | × 0.988 | 9.2180 |
| Malpractice | 1.83 | × 0.899 | 1.6452 |
| Total RVUs | 20.7725 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Delaware$693.82
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 9.86 | 1.005 |
| Practice expense | 9.33 | 0.988 |
| Malpractice | 1.83 | 0.899 |
(9.86 × 1.005 + 9.33 × 0.988 + 1.83 × 0.899) × $33.4009 = $693.82
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.
21387 billing questions
When should this code be chosen over a single-approach orbital repair?
Use it when the operative documentation supports combined access to treat the orbital floor fracture. A transantral-only or periorbital-only repair points to a different code in the fracture family.
Does the code include the exposure and fracture repair?
The approach and work to treat the orbital floor fracture are part of the reported service. The combined access is not a separate service from the repair.
What documentation supports the combined approach?
The operative report should identify the orbital floor fracture and describe the access routes used and the treatment performed. A general statement that the orbit was repaired may not establish the combined approach.
How is bilateral treatment reported?
CMS identifies this as a bilateral procedure; modifier 50 is paid at 150%. The record should support treatment of fractures on both sides.
Can an assistant surgeon be paid, and can the case have co-surgeons?
Assistant-at-surgery payment may be allowed. CMS does not permit co-surgeons or team surgery for this code.
How does the multiple-procedure reduction affect payment?
For procedures performed in the same session, the highest-valued procedure is paid in full and other procedures are paid at 50%.
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.
1,96321366,,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
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
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