Billing code 21256: Orbital reconstructionMedicare rate & RVUs in Florida
Rebuilds orbital bone with a graft when a structural defect requires reconstruction, such as after trauma, tumor removal, or congenital deformity.
CMS doesn’t publish an office rate for 21256 in Florida.
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 21256 covers
This operation rebuilds part of the bony orbit using a bone graft to restore support and contour around the eye. It may be considered for a substantial orbital defect after trauma or tumor removal, or for a congenital abnormality requiring structural reconstruction. Oral and maxillofacial surgeons, craniofacial surgeons, and plastic surgeons commonly perform orbital reconstruction in a hospital or other surgical facility.
Report the code when the documented work reconstructs the orbit with bone graft, rather than treating an isolated acute orbital floor fracture by a fracture-repair approach. The operative report should identify the orbital defect, the reconstruction performed, and the graft used. 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 other procedures are subject to the standard 50% reduction. For bilateral surgery, modifier 50 is paid at 150%. Assistant-at-surgery services may be paid; co-surgeons require supporting documentation, and team surgery is 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 21256 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.
| Payment locality | Office | Facility |
|---|---|---|
| Fort Lauderdale | Unavailable | $1,206.65 |
| Miami | Unavailable | $1,295.60 |
| Rest Of Florida | Unavailable | $1,149.45 |
How the 21256 rate is calculated
Each of 21256’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 · 21256
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 17.22Practice expense 12.97Malpractice 3.19
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 21256
21256 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 21256
Orbital reconstruction
| 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) | 2 | Paid. |
| Co-surgeons (62) | 1 | Permitted with supporting documentation. |
| 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 · 21256
Orbital reconstruction
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
21256 without 50 · national facility
$1,114.92
Orbital reconstruction
21256-50 · Bilateral: 150%
$1,672.38
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).
21256 compared with similar codes
Compare codes
21256 vs 21386 vs 21390 vs 21275: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 21386Orbital fracture repair
- This code describes reconstruction of an orbital defect with bone graft. Code 21386 is for repair of an acute blowout fracture using a periorbital approach.
- 21390Orbital fracture repair
- Choose this code for orbital reconstruction with bone graft; code 21390 describes acute blowout fracture repair using a transantral approach.
- 21275Orbitofacial revision
- Code 21256 rebuilds the orbit with bone graft. Code 21275 describes revision of orbitofacial bones rather than the orbital reconstruction service described here.
21256 billing questions
When is this code preferable to an orbital floor fracture repair code?
Use this code for reconstruction of an orbital defect with bone graft. An acute, isolated blowout fracture treated through a specified fracture-repair approach may instead fit a fracture-repair code such as 21386 or 21390.
What documentation supports reporting this service?
The operative report should describe the orbital defect, the structural reconstruction, and use of a bone graft. Document the clinical context, such as a post-traumatic, post-resection, or congenital defect, when applicable.
How is bilateral orbital reconstruction handled?
CMS identifies this as a bilateral procedure; modifier 50 is paid at 150%. The operative documentation should support reconstruction on both sides.
How does the 90-day global period affect postoperative reporting?
The day-before preoperative visit and 90 days of related postoperative care are included in the global period. CMS classifies this as major surgery.
Can an assistant or co-surgeon be reported?
CMS permits payment for an assistant at surgery. Co-surgeons are paid only with supporting documentation; team surgery is not permitted.
What happens when another procedure is performed in the same session?
Under CMS's standard multiple procedure reduction, the highest-valued procedure is paid in full and other procedures are paid at 50% when performed in the same session.
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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