Billing code 21085: Oral splintMedicare rate & RVUs in Illinois
Reports impression-taking and preparation of an oral surgical splint used to support planned oral or maxillofacial surgery.
Medicare pays $697.04–$760.34 for 21085 in the office in Illinois, from Rest Of Illinois to Chicago. Which amount applies depends on the service address.
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 21085 covers
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.
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 21085 pays more and less in Illinois
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
4 payment localities
$697.04 to $760.34
| Payment locality | Office | Facility |
|---|---|---|
| Chicago | $760.34 | $478.71 |
| East St. Louis | $715.83 | $458.01 |
| Rest Of Illinois | $697.04 | $441.19 |
| Suburban Chicago | $750.04 | $462.24 |
How the 21085 rate is calculated
Each of 21085’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 · 21085
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 8.77Practice expense 11.42Malpractice 1.07
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 21085
21085 has a 10-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 21085
Oral splint
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 010 | Minor procedure: the day of the procedure plus 10 days after are included. |
| Multiple procedures | 2 | Standard reduction: highest-valued procedure at 100%, others at 50%. |
| Bilateral (modifier 50) | 0 | The 150% bilateral adjustment doesn’t apply. |
| Assistant at surgery (80/81/82/AS) | 0 | Not paid without supporting documentation. |
| Co-surgeons (62) | 0 | Not permitted. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 0 | Physician service: no professional/technical split. |
| Split (54/55/56) | 0.10/0.80/0.10 | Share of the payment for pre-op, the procedure itself, and post-op care. |
Global surgery period · 21085
Oral splint
10-day global period ends
Oct 11, 2026
Covers Oct 1, 2026 through Oct 11, 2026 (11 days).
Visit on Oct 31, 2026
After the global period ends: visits and procedures are billed normally.
What modifiers do to the payment
Modifier 51 · payment effect
With and without the modifier
21085 without 51 · national office
$710.10
Oral splint
21085-51 · Second procedure: 50%
$355.05
When this isn’t the highest-valued procedure in the session, Medicare pays 50% of its fee schedule amount (the highest is paid at 100%).
21085 compared with similar codes
Compare codes
21085 vs 21076 vs 21084 vs 21081: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 21076Obturator prosthesis
- 21085 is for an oral surgical splint. Use 21076 when the prosthesis being prepared is a surgical obturator.
- 21084Speech aid prosthesis
- 21085 describes an oral surgical splint; 21084 is for a speech-aid prosthesis.
- 21081Mandibular prosthesis
- 21085 is for a surgical splint, while 21081 is for a prosthesis associated with mandibular resection.
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 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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