$234.70–$258.69
21400 is closed treatment without manipulation. Choose 21407 when the fracture is treated through an open operation with implant placement.
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CMS RVU26D · Effective 2026-10-01
21407 Orbital repair Medicare reimbursement rates in Florida
Open repair of an orbital fracture with implant placement, reported when operative reconstruction uses an implant to restore support at the fractured orbital site. Compare 21407 office and facility rates across CMS payment localities in Florida.
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 21407 in Florida?
Florida has 3 payment localities in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the 3 payment areas shown below, using the same CMS release.
Office / nonfacility
No supported rate
Facility setting
$587.12–$649.28
3 of 3 localities have a supported rate.
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.
Where 21407 pays more and less in Florida
Orbital fracture repair
About 21407: Open orbital fracture repair with implant
Open repair of an orbital fracture with implant placement, reported when operative reconstruction uses an implant to restore support at the fractured orbital site.
This service is an open operation to repair an orbital fracture with placement of an implant as part of reconstruction. A surgeon exposes the fracture, addresses the displaced or disrupted orbital structures, and places the implant to support the repaired area. Orbital floor and other orbital wall fractures may require this approach. Ophthalmic, plastic, otolaryngology, and oral and maxillofacial surgeons may perform the operation, commonly in a hospital operating room.
Report this code when the operative treatment is open and includes an implant; document the fracture site, surgical approach, and implant use. Distinguish it from open repair without an implant or repair using bone graft. The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care. For multiple procedures in one session, the highest-valued procedure is paid in full and other procedures at 50%. Bilateral reporting with modifier 50 is paid at 150%. An assistant at surgery may be paid; co-surgeons are paid only with supporting documentation, and team surgery is not permitted.
CMS billing rules for 21407
- 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 paid only with supporting documentation.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU8.79 · 51%
- Practice expense (office) RVU7.29 · 42%
- Malpractice RVU1.21 · 7%
81
Medicare services in 2024 · #5033 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.
21407 compared with similar codes
Office rates for Florida, from the same CMS release.
$545.16–$602.64
21401 is closed treatment with manipulation. It does not describe open orbital reconstruction with an implant.
No office rate
21406 describes open orbital fracture treatment without an implant; 21407 includes implant placement in the repair.
No office rate
21408 is the open orbital fracture treatment code for repair with bone graft. This code is for repair using an implant.
Compare 21407 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.
3 of 3 payment localities
Fort Lauderdale →
Office / nonfacility
Unavailable
Facility
$613.32
Miami →
Office / nonfacility
Unavailable
Facility
$649.28
Rest Of Florida →
Office / nonfacility
Unavailable
Facility
$587.12
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21407 billing questions
How does this differ from open orbital fracture repair without an implant?
Use this code when the open repair includes implant placement. Open treatment without an implant is represented by 21406.
When is 21408 a better fit?
21408 represents open orbital fracture treatment with bone graft. This code describes the implant approach, so the operative report should establish which reconstructive material was used.
Can modifier 50 be used for bilateral orbital fractures?
CMS identifies this as a bilateral procedure; when reported bilaterally with modifier 50, payment is 150%.
Does the surgical global period include postoperative visits?
Yes. 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?
An assistant at surgery may be paid. Co-surgeons are paid only with supporting documentation; team surgery is not permitted.
How are other procedures in the same session paid?
The highest-valued procedure is paid in full, and other procedures are paid at 50% under the standard 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 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.
1,96921400,,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
1,97021401,,Closed tx orbit w/manipulj,A,,3.59,12.28,,5.20,,0.66,16.53,9.45,0,090,0.10,0.69,0.21,2,1,2,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,97121406,,Opn tx orbit fx w/o implant,A,,7.23,7.68,NA,7.68,,1.33,16.24,16.24,0,090,0.10,0.69,0.21,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,97221407,,Opn tx orbit fx w/implant,A,,8.79,7.29,NA,7.29,,1.21,17.29,17.29,0,090,0.10,0.69,0.21,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,97321408,,Opn tx orbit fx w/bone grft,A,,12.46,9.60,NA,9.60,,2.32,24.38,24.38,0,090,0.10,0.69,0.21,2,1,2,2,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,97421421,,Cltx palatal/max fx wire fix,A,,5.87,13.23,,8.85,,0.66,19.76,15.38,0,090,0.10,0.69,0.21,2,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,97521422,,Optx palatal/max fracture,A,,8.51,7.92,NA,7.92,,1.24,17.67,17.67,0,090,0.10,0.69,0.21,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00