Billing code 21077: Orbital prosthesisMedicare rate & RVUs in Florida
Reports the impression and custom preparation of an orbital prosthesis for a patient with loss or absence of orbital structures.
Medicare pays $2,214.05–$2,425.09 for 21077 in the office in Florida, from Rest Of Florida to Miami. Which amount applies depends on the service address.
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
On this page 9 sections
What 21077 covers
This service captures the patient’s orbital defect and prepares a custom prosthesis to restore the external appearance of the eye and surrounding orbital area. It is typically performed by a maxillofacial prosthodontist or other clinician with specialized facial prosthetic training, often after orbital exenteration for cancer or after traumatic loss. The prosthesis is distinct from a replacement for the globe alone because it addresses the broader orbital defect.
Report 21077 for the orbital prosthesis impression and custom preparation, supported by documentation of the defect and the patient-specific prosthetic work. CMS assigns a 90-day global period, which includes the day-before preoperative visit and related postoperative care through day 90. When multiple procedures occur in the same session, the highest-valued procedure is paid in full and other procedures are reduced to 50%. Bilateral reporting with modifier 50 is paid at 150%. Assistant-at-surgery payment requires documented medical necessity; co-surgeons and team surgery are not permitted.
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.
Where 21077 pays more and less in Florida
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
3 payment localities
$2214.05 to $2425.09
| Payment locality | Office | Facility |
|---|---|---|
| Fort Lauderdale | $2,307.60 | $1,633.60 |
| Miami | $2,425.09 | $1,732.47 |
| Rest Of Florida | $2,214.05 | $1,577.98 |
How the 21077 rate is calculated
Each of 21077’s three RVUs is multiplied by a geographic index (GPCI) for the payment locality, added up, and multiplied by the conversion factor. Drag the indexes or enter a ZIP to see what moves the rate.
How the rate is built · 21077
RVUs × geographic indexes × conversion factor
Work32.86
32.86 RVUs× 1.000 GPCI
Practice expense29.07
29.07 RVUs× 1.000 GPCI
Malpractice3.75
3.75 RVUs× 1.000 GPCI
Adjusted RVUs
65.6800
Conversion factor
$33.4009
Medicare rate
$2,193.77
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 21077
21077 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 21077
Orbital prosthesis
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 090 | Major surgery: the day before, the day of, and 90 days after are included. |
| Multiple procedures | 2 | Standard reduction: highest-valued procedure at 100%, others at 50%. |
| Bilateral (modifier 50) | 1 | Bilateral with modifier 50 pays 150% of the fee schedule amount. |
| Assistant at surgery (80/81/82/AS) | 0 | Not paid without supporting documentation. |
| Co-surgeons (62) | 0 | Not permitted. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 0 | Physician service: no professional/technical split. |
| Split (54/55/56) | 0.10/0.69/0.21 | Share of the payment for pre-op, the procedure itself, and post-op care. |
Global surgery period · 21077
Orbital prosthesis
90-day global period ends
Dec 30, 2026
Covers Sep 30, 2026 through Dec 30, 2026 (92 days, including the day before surgery).
Visit on Oct 31, 2026
Day 30 of the 90-day post-op period: related follow-up care is included in the surgical payment.
Pre-op dayGlobal period
What modifiers do to the payment
Modifier 50 · payment effect
With and without the modifier
21077 without 50 · national office
$2,193.77
Orbital prosthesis
21077-50 · Bilateral: 150%
$3,290.66
Both sides on one line with modifier 50 are paid at 150% of the fee schedule amount (subject to multiple-procedure rules with other procedures).
21077 compared with similar codes
Compare codes · National
5 codes, side by side
How to choose
- 21086Auricular prosthesis
- Use 21086 for an auricular prosthesis replacing external ear structures; 21077 is for an orbital defect.
- 21087Nasal prosthesis
- Use 21087 for a nasal prosthesis. 21077 applies when the prosthetic site is the orbit.
- 21088Impres&prep facial prosth
- Use 21088 for a facial prosthesis when the site is not specifically orbital; 21077 identifies the orbital prosthesis service.
- 21076Obturator prosthesis
- 21076 is for a surgical obturator, used in relation to a surgical defect of the palate or maxilla, not an orbital prosthesis.
21077 billing questions
When should 21077 be chosen instead of an ocular prosthesis service?
Use 21077 for a custom prosthesis addressing an orbital defect, including surrounding external structures. A prosthesis replacing only the eye itself is not the orbital prosthesis described by this code.
How does 21077 differ from 21088?
21077 is specific to an orbital prosthesis. 21088 is for a facial prosthesis when the prosthetic site is facial rather than orbital.
Does the 90-day global period include related postoperative care?
Yes. The CMS global period includes the day-before preoperative visit and 90 days of related postoperative care.
How is bilateral 21077 reported?
For bilateral orbital prostheses, report modifier 50; CMS pays the bilateral procedure at 150%.
Can an assistant surgeon or co-surgeon be reported?
Assistant-at-surgery payment is allowed only when medical necessity is documented. Co-surgeons and team surgery are not permitted.
What happens when 21077 is performed with another procedure in the same session?
The highest-valued procedure is paid in full, and other procedures in that session are subject to the standard 50% multiple-procedure reduction.
Where these rates come from
FeeBase calculates base physician payments from CMS work, practice-expense and malpractice RVUs, adjusted by each locality’s geographic indexes and the conversion factor. Services without a published rate are labeled, never given a made-up amount. Amounts are Medicare allowed amounts before claim adjustments: not a patient’s bill or a commercial rate.
CMS RVU26D · effective Oct 1, 2026 through the day before Jan 1, 2027
Show the CMS file lines behind this rate
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