Billing code 21408: Orbital fracture repairMedicare rate & RVUs in Florida
Report this code for open surgical treatment of an orbital fracture when reconstruction uses a bone graft to restore the injured orbit.
CMS doesn’t publish an office rate for 21408 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 21408 covers
This service involves surgically exposing and treating an orbital fracture, then using a bone graft to reconstruct the damaged area. It is performed by surgeons who manage facial and orbital trauma, such as oculoplastic, plastic, or oral and maxillofacial surgeons. A typical setting is an operating room for a fracture requiring open repair rather than closed treatment.
Choose this code when the operative record supports both open fracture treatment and use of a bone graft; distinguish it from open repairs using an implant or no implant. Document the fracture and side, the surgical approach and repair, and the graft’s use. The code has a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. For same-session procedures, the highest-valued procedure is paid in full and other procedures at 50%. Bilateral reporting with modifier 50 is paid at 150%. Assistant-at-surgery payment may be made, and co-surgeons are permitted; 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 21408 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 | $881.09 |
| Miami | Unavailable | $945.94 |
| Rest Of Florida | Unavailable | $839.18 |
How the 21408 rate is calculated
Each of 21408’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 · 21408
RVUs × geographic indexes × conversion factor
Work12.46
12.46 RVUs× 1.000 GPCI
Practice expense9.60
9.60 RVUs× 1.000 GPCI
Malpractice2.32
2.32 RVUs× 1.000 GPCI
Adjusted RVUs
24.3800
Conversion factor
$33.4009
Medicare rate
$814.31
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 21408
21408 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 21408
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) | 2 | 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 · 21408
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
21408 without 50 · national facility
$814.31
Orbital fracture repair
21408-50 · Bilateral: 150%
$1,221.47
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).
21408 compared with similar codes
Compare codes · National
5 codes, side by side
How to choose
- 21406Orbital fracture repair
- Use 21406 for open orbital fracture treatment without implant or bone graft. Use 21408 when the repair includes a bone graft.
- 21407Orbital repair
- Use 21407 when an implant is used in open orbital fracture repair; use 21408 when reconstruction uses a bone graft.
- 21400Orbital fracture treatment
- 21400 describes closed orbital fracture treatment without manipulation. It does not represent the open, bone-graft repair reported with 21408.
- 21401Orbital fracture treatment
- 21401 describes closed orbital fracture treatment with manipulation. Choose 21408 when the fracture is treated through open surgery with a bone graft.
21408 billing questions
When should this code be chosen instead of 21407?
Choose 21408 when the open orbital fracture repair uses a bone graft. Code 21407 is the related open-repair option when an implant is used instead.
How does this differ from 21406?
Both describe open orbital fracture treatment, but 21408 includes bone-graft reconstruction while 21406 is the option without an implant.
Can this code be used for closed fracture treatment?
No. Closed treatment is represented by 21400 or 21401, depending on whether manipulation is performed; this code is for open repair with a bone graft.
What documentation supports reporting 21408?
The operative report should establish the orbital fracture, open surgical treatment, and use of a bone graft in the repair. Record the treated side and the repair performed.
How is bilateral repair reported under the CMS payment rule?
When the procedure is performed bilaterally, modifier 50 is paid at 150% under the CMS rule provided for this code.
What should a practice know about the global period and surgical assistance?
The 90-day global includes the day-before preoperative visit and 90 days of related postoperative care. Assistant-at-surgery payment may be made, and co-surgeons are permitted.
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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