$954.95
21085 is for an oral surgical splint. Use 21076 when the prosthesis being prepared is a surgical obturator.
On this page
CMS RVU26D · Effective 2026-10-01
21085 Oral splint Medicare reimbursement rates in Hawaii
Reports impression-taking and preparation of an oral surgical splint used to support planned oral or maxillofacial surgery. Compare 21085 office and facility rates across CMS payment localities in Hawaii.
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 21085 in Hawaii?
Hawaii has 1 payment locality in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the payment area shown below, using the same CMS release.
Office / nonfacility
$747.31
1 of 1 localities have a supported rate.
Payment area: Hawaii, Guam
One mapped payment locality.
Facility setting
$428.69
1 of 1 localities have a supported rate.
Payment area: Hawaii, Guam
One mapped payment locality.
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.
Maxillofacial prosthetics
About 21085: Oral surgical splint impression and preparation
Reports impression-taking and preparation of an oral surgical splint used to support planned oral or maxillofacial surgery.
This service covers taking the impression and preparing an oral surgical splint for a patient undergoing oral or maxillofacial surgery. Oral and maxillofacial surgeons and prosthodontists may provide it in an office or facility setting. A common clinical context is orthognathic surgery, where a custom splint helps transfer or maintain a planned relationship between the jaws during treatment.
Report 21085 when the documented service is for an oral surgical splint, rather than an obturator, speech aid, or other maxillofacial prosthesis. The record should identify the surgical purpose and support the impression and preparation performed. The code has a 10-day global period, which includes related postoperative visits during that period. When multiple procedures are performed in the same session, the highest-valued procedure is paid in full and the others at 50%. Modifier 50 is inappropriate. Assistant-at-surgery payment requires documented medical necessity; co-surgeons and team surgery are not permitted.
CMS billing rules for 21085
- Global period
- Minor procedure with a 10-day global period: related postoperative visits for 10 days 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 adjustment does not apply; the descriptor or anatomy makes modifier 50 inappropriate.
- Assistant at surgery
- Assistant at surgery is paid only with documentation of medical necessity.
- Co-surgeons
- Co-surgeons not permitted.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU8.77 · 41%
- Practice expense (office) RVU11.42 · 54%
- Malpractice RVU1.07 · 5%
2K
Medicare services in 2024 · #2466 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.
21085 compared with similar codes
Office rates for Hawaii, from the same CMS release.
$1,684.34
21085 describes an oral surgical splint; 21084 is for a speech-aid prosthesis.
$1,658.45
21085 is for a surgical splint, while 21081 is for a prosthesis associated with mandibular resection.
Compare 21085 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.
1 of 1 payment localities
Hawaii, Guam →
Office / nonfacility
$747.31
Facility
$428.69
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How this local rate is calculated
Each RVU component is multiplied by its own geographic practice cost index (GPCI). The three adjusted components are added, then multiplied by the conversion factor. These are the inputs used for 21085 in Hawaii, Guam.
PPRRVU2026_Oct_nonQPP.csv
1,869
- Code
- 21085
- Physician work
- 8.77
- Practice expense
- 11.42
- Malpractice
- 1.07
GPCI2026.csv
46
- Locality
- Hawaii, Guam
- Physician work
- 1.000
- Practice expense
- 1.137
- Malpractice
- 0.579
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 8.77 | × 1.000 | 8.7700 |
| Practice expense | 11.42 | × 1.137 | 12.9845 |
| Malpractice | 1.07 | × 0.579 | 0.6195 |
| Total RVUs | 22.3741 | ||
| Conversion factor | × 33.4009 | ||
Office / nonfacility rate, Hawaii, Guam$747.31
Explore RVUs, geographic factors and the full formula
Office / nonfacility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 8.77 | 1 |
| Practice expense | 11.42 | 1.137 |
| Malpractice | 1.07 | 0.579 |
(8.77 × 1 + 11.42 × 1.137 + 1.07 × 0.579) × $33.4009 = $747.31
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 8.77 | 1 |
| Practice expense | 3.03 | 1.137 |
| Malpractice | 1.07 | 0.579 |
(8.77 × 1 + 3.03 × 1.137 + 1.07 × 0.579) × $33.4009 = $428.69
The office and facility calculations use their respective practice-expense RVUs. The facility amount here is the physician fee, not a separate hospital or facility bill.
21085 billing questions
How is 21085 different from 21076?
Use 21085 for an oral surgical splint. Code 21076 describes impression and preparation for a surgical obturator, a different type of maxillofacial prosthesis.
Does 21085 cover both the impression and splint preparation?
Yes. The service combines impression-taking and preparation of the oral surgical splint; document the work performed and its surgical purpose.
Can modifier 50 be used for a splint involving both sides?
No. The CMS bilateral adjustment does not apply, and modifier 50 is inappropriate for this code.
What postoperative care is included?
Related postoperative visits during the 10-day global period are included.
When can an assistant-at-surgery be paid?
Only when medical necessity for the assistant is documented. Co-surgeons and team surgery are not 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 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.
1,86621082,,Impres&prep paltl aug prosth,A,,20.32,22.14,,7.02,,2.40,44.86,29.74,0,090,0.10,0.69,0.21,2,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,86721083,,Impres&prep paltl lft prosth,A,,18.79,21.33,,6.49,,2.14,42.26,27.42,0,090,0.10,0.69,0.21,2,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,86821084,,Impres&prep sp aid prosth,A,,21.92,23.80,,7.22,,2.50,48.22,31.64,0,090,0.10,0.69,0.21,2,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,86921085,,Impres&prep oral surg splint,A,,8.77,11.42,,3.03,,1.07,21.26,12.87,0,010,0.10,0.80,0.10,2,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,87021086,,Impres&prep auricular prosth,A,,24.26,21.70,,6.71,,2.76,48.72,33.73,0,090,0.10,0.69,0.21,2,1,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,87121087,,Impres&prep nasal prosth,A,,24.26,21.70,,6.71,,2.76,48.72,33.73,0,090,0.10,0.69,0.21,2,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,87221088,,Impres&prep facial prosth,C,,0.00,0.00,,0.00,,0.00,0.00,0.00,0,090,0.10,0.69,0.21,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4309102,FL,99,REST OF FLORIDA,1.000,0.956,1.503
4410212,GA,01,ATLANTA,1.003,1.016,1.201
4510212,GA,99,REST OF GEORGIA,1.000,0.892,1.192
4601212,HI,01,"HAWAII, GUAM",1.000,1.137,0.579
4702202,ID,00,IDAHO,1.000,0.920,0.473
4806102,IL,16,CHICAGO,1.007,1.005,2.295
4906102,IL,12,EAST ST. LOUIS,1.000,0.920,2.014