Billing code 21395: Orbital fracture repairMedicare rate & RVUs in Florida
Open repair of an orbital floor fracture through a periorbital approach with bone grafting to reconstruct the floor and support orbital contents.
CMS doesn’t publish an office rate for 21395 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 21395 covers
This service treats an orbital floor blowout fracture through a periorbital surgical approach, with bone graft used to rebuild the injured floor. The surgeon exposes the fracture, addresses displaced orbital tissues as part of the repair, and places graft to restore support. It is typically performed by a surgeon experienced in facial or orbital trauma, such as an oculoplastic, facial plastic, otolaryngology, or oral and maxillofacial surgeon, in an operating room.
Report this code when the operative repair uses the periorbital approach and includes bone grafting. The operative report should identify the fracture, approach, graft use, and treated side. Medicare 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 the same session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% reduction. Bilateral reporting with modifier 50 is paid at 150%. Assistant-at-surgery payment may be available; co-surgeon payment requires supporting documentation, and team-surgery payment 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 21395 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 | $972.62 |
| Miami | Unavailable | $1,045.67 |
| Rest Of Florida | Unavailable | $926.83 |
How the 21395 rate is calculated
Each of 21395’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 · 21395
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 14.33Practice expense 9.87Malpractice 2.65
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 21395
21395 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 21395
Orbital fracture repair
| 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 · 21395
Orbital fracture repair
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
21395 without 50 · national facility
$896.81
Orbital fracture repair
21395-50 · Bilateral: 150%
$1,345.22
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).
21395 compared with similar codes
Compare codes
21395 vs 21386 vs 21390 vs 21387 vs 21385: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 21386Orbital fracture repair
- Choose 21395 when the periorbital repair includes bone grafting; 21386 represents the periorbital repair without that graft distinction.
- 21390Orbital fracture repair
- 21390 identifies periorbital repair with an implant. This code is for repair with bone graft.
- 21387Orbital fracture repair
- 21387 is for a combined approach. This code describes a periorbital approach with bone grafting.
- 21385Orbital fracture repair
- 21385 uses a transantral approach, while this code identifies a periorbital approach with bone grafting.
21395 billing questions
How is this code distinguished from 21386?
Both describe orbital fracture repair through a periorbital approach, but this code includes bone grafting. Use 21386 when the repair does not include a graft.
Does an orbital implant qualify as the graft in this code?
No. A repair using an implant rather than bone grafting is distinguished by 21390. The operative report should make the reconstruction material clear.
What documentation supports reporting this code?
Document the orbital floor fracture, periorbital approach, bone graft placement, and side treated. The operative report should describe the repair sufficiently to establish those elements.
How is bilateral repair reported under the CMS fee schedule?
For bilateral procedures reported with modifier 50, CMS pays this code at 150%. Document the repair performed on each side.
Are related postoperative visits separately included?
The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care.
Can an assistant or co-surgeon be reported?
Assistant-at-surgery payment may be available. Co-surgeon payment requires supporting documentation; CMS does not permit team-surgery payment for this service.
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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