No office rate
21360 is for open treatment of a depressed malar fracture. Use 21365 when the documented fracture is complex rather than selecting by open approach alone.
On this page
CMS RVU26D · Effective 2026-10-01
21365 Malar fracture repair Medicare reimbursement rates in Hawaii
Reports open repair of a complex cheekbone fracture, typically when the zygoma is displaced or disrupted across multiple facial connections. Compare 21365 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 21365 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
$971.40
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.
Facial fracture surgery
About 21365: Complex malar fracture open repair
Reports open repair of a complex cheekbone fracture, typically when the zygoma is displaced or disrupted across multiple facial connections.
This service involves surgically exposing and reducing a complex fracture of the malar bone, or cheekbone, with stabilization as needed. It is typically performed by an oral and maxillofacial, plastic, or facial trauma surgeon in a hospital or other surgical facility. A displaced zygomaticomaxillary complex fracture involving several facial connections is a common clinical pattern; the fracture’s complexity, rather than the mere use of an open approach or fixation, distinguishes this service.
Choose the code based on the documented fracture pattern and complexity. The operative report should describe the malar injury, the reduction performed, and any stabilization. Medicare assigns a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. When multiple procedures occur in the same session, the highest-valued procedure is paid in full and the others at 50%. 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 is not permitted.
CMS billing rules for 21365
- 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 RVU16.35 · 57%
- Practice expense (office) RVU9.88 · 34%
- Malpractice RVU2.59 · 9%
282
Medicare services in 2024 · #4039 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.
21365 compared with similar codes
Office rates for Hawaii, from the same CMS release.
No office rate
21366 is the complex malar fracture repair code when bone grafting is performed; 21365 describes complex repair without that graft distinction.
$475.20
21355 describes percutaneous treatment of a malar fracture. Choose 21365 when the surgeon uses an open approach for a complex fracture.
$636.51
21356 addresses open treatment of a depressed zygomatic arch fracture. 21365 applies to a complex malar fracture pattern, not an isolated arch injury.
Compare 21365 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
$971.40
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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 21365 in Hawaii, Guam.
PPRRVU2026_Oct_nonQPP.csv
1,962
- Code
- 21365
- Physician work
- 16.35
- Practice expense
- 9.88
- Malpractice
- 2.59
GPCI2026.csv
46
- Locality
- Hawaii, Guam
- Physician work
- 1.000
- Practice expense
- 1.137
- Malpractice
- 0.579
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 16.35 | × 1.000 | 16.3500 |
| Practice expense | 9.88 | × 1.137 | 11.2336 |
| Malpractice | 2.59 | × 0.579 | 1.4996 |
| Total RVUs | 29.0832 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Hawaii, Guam$971.40
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 16.35 | 1 |
| Practice expense | 9.88 | 1.137 |
| Malpractice | 2.59 | 0.579 |
(16.35 × 1 + 9.88 × 1.137 + 2.59 × 0.579) × $33.4009 = $971.40
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.
21365 billing questions
How does this differ from 21360?
Use 21365 for a complex malar fracture pattern. Code 21360 describes open treatment of a depressed malar fracture; the operative documentation should support the injury pattern being treated.
When should 21366 be considered instead?
Code 21366 is the related complex malar fracture service when bone grafting is performed. Document the graft and the fracture repair.
Can 21365 be reported with modifier 50?
For bilateral reporting, CMS pays the procedure at 150% when modifier 50 is used. The record should support treatment on both sides.
What postoperative care is 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 paid?
Assistant-at-surgery payment may be made. Co-surgeon payment requires supporting documentation; team surgery is 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.
1,95921355,,Perq tx malar fracture,A,,4.34,8.38,,3.85,,0.62,13.34,8.81,0,010,0.10,0.80,0.10,2,1,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,96021356,,Opn tx dprsd zygomatic arch,A,,4.71,12.17,,5.78,,0.88,17.76,11.37,0,010,0.10,0.80,0.10,2,1,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,96121360,,Opn tx dprsd malar fracture,A,,7.01,5.98,NA,5.98,,1.04,14.03,14.03,0,090,0.10,0.69,0.21,2,1,2,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,96221365,,Opn tx complx malar fx,A,,16.35,9.88,NA,9.88,,2.59,28.82,28.82,0,090,0.10,0.69,0.21,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,96321366,,Opn tx complx malar w/grft,A,,18.14,12.59,NA,12.59,,3.36,34.09,34.09,0,090,0.10,0.69,0.21,2,1,2,2,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,96421385,,Opn tx orbit fx transantral,A,,9.33,9.13,NA,9.13,,1.73,20.19,20.19,0,090,0.10,0.69,0.21,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,96521386,,Opn tx orbit fx periorbital,A,,9.33,7.83,NA,7.83,,1.73,18.89,18.89,0,090,0.10,0.69,0.21,2,1,2,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
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