No office rate
21260 represents a more limited periorbital osteotomy extent. Use 21263 when the operative work includes the forehead and superior, lateral, and inferior orbital rims.
On this page
CMS RVU26D · Effective 2026-10-01
21263 Orbital osteotomy Medicare reimbursement rates in Hawaii
Reports extensive periorbital osteotomies that advance or reposition the forehead and orbital rims to correct a major craniofacial or orbital deformity. Compare 21263 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 21263 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
No supported rate
Facility setting
$2054.71
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.
Craniofacial surgery
About 21263: Extensive periorbital osteotomy and repositioning
Reports extensive periorbital osteotomies that advance or reposition the forehead and orbital rims to correct a major craniofacial or orbital deformity.
This major craniofacial operation uses osteotomies to mobilize and advance or reposition the forehead and the superior, lateral, and inferior orbital rims. It may be performed for complex congenital craniofacial deformity, including abnormal orbital position associated with craniosynostosis. Craniofacial, plastic, or oral and maxillofacial surgeons typically perform the reconstruction in an operating room; oculoplastic surgeons may participate in care involving the orbits.
Select this code when the operative report supports the full extent of periorbital bone work, rather than a more limited osteotomy or a reconstruction focused on another part of the orbit. Documentation should identify the deformity, bones and rims treated, osteotomies, and the advancement or repositioning performed. The service has a 90-day global period, including the day-before preoperative visit and related postoperative care. When multiple procedures occur in the same session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% reduction. Modifier 50 is inappropriate for this code. An assistant at surgery may be paid; co-surgeon payment requires supporting documentation, and team surgery is not permitted.
CMS billing rules for 21263
- 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 adjustment does not apply; the descriptor or anatomy makes modifier 50 inappropriate.
- 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 RVU30.23 · 50%
- Practice expense (office) RVU24.66 · 41%
- Malpractice RVU5.61 · 9%
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.
21263 compared with similar codes
Office rates for Hawaii, from the same CMS release.
No office rate
21261 covers a different, more limited extent of periorbital osteotomy. The operative report must support the additional inferior orbital rim work for 21263.
No office rate
21256 concerns orbital reconstruction; 21263 describes extensive periorbital osteotomies with advancement or repositioning of the forehead and orbital rims.
Compare 21263 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
Unavailable
Facility
$2054.71
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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 21263 in Hawaii, Guam.
PPRRVU2026_Oct_nonQPP.csv
1,933
- Code
- 21263
- Physician work
- 30.23
- Practice expense
- 24.66
- Malpractice
- 5.61
GPCI2026.csv
46
- Locality
- Hawaii, Guam
- Physician work
- 1.000
- Practice expense
- 1.137
- Malpractice
- 0.579
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 30.23 | × 1.000 | 30.2300 |
| Practice expense | 24.66 | × 1.137 | 28.0384 |
| Malpractice | 5.61 | × 0.579 | 3.2482 |
| Total RVUs | 61.5166 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Hawaii, Guam$2054.71
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 30.23 | 1 |
| Practice expense | 24.66 | 1.137 |
| Malpractice | 5.61 | 0.579 |
(30.23 × 1 + 24.66 × 1.137 + 5.61 × 0.579) × $33.4009 = $2054.71
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.
21263 billing questions
How is 21263 distinguished from 21260 or 21261?
Choose 21263 when the documented osteotomies include the forehead and superior, lateral, and inferior orbital rims. Codes 21260 and 21261 describe more limited extents of periorbital osteotomy.
Should modifier 50 be appended for bilateral work?
No. CMS identifies bilateral adjustment as inappropriate for this code because of its descriptor or anatomy.
What postoperative care is included?
The 90-day global period includes the day-before preoperative visit and related postoperative care during the 90 days after surgery.
Can an assistant or co-surgeon be reported?
Assistant-at-surgery payment may be available. Co-surgeon payment requires supporting documentation; team surgery is not permitted.
How does the multiple-procedure rule affect payment?
For procedures performed in the same session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% 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.
1,93021256,,Reconstruction of orbit,A,,17.22,12.97,NA,12.97,,3.19,33.38,33.38,0,090,0.10,0.69,0.21,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,93121260,,Revise eye sockets,A,,17.45,16.80,NA,16.80,,3.23,37.48,37.48,0,090,0.10,0.69,0.21,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,93221261,,Revise eye sockets,A,,33.22,25.75,NA,25.75,,6.17,65.14,65.14,0,090,0.10,0.69,0.21,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,93321263,,Revise eye sockets,A,,30.23,24.66,NA,24.66,,5.61,60.50,60.50,0,090,0.10,0.69,0.21,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,93421267,,Revise eye sockets,A,,20.17,19.99,NA,19.99,,3.75,43.91,43.91,0,090,0.10,0.69,0.21,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,93521268,,Revise eye sockets,A,,26.39,23.25,NA,23.25,,4.89,54.53,54.53,0,090,0.10,0.69,0.21,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,93621270,,Augmentation cheek bone,A,,10.36,20.78,,7.94,,1.92,33.06,20.22,0,090,0.10,0.69,0.21,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
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