$1,426.13
Choose 21076 for the surgical obturator. Code 21079 is for an interim obturator used during healing.
On this page
CMS RVU26D · Effective 2026-10-01
21076 Obturator prosthesis Medicare reimbursement rates in Indiana
Reports impression and preparation of a surgical obturator to cover a maxillary surgical defect, commonly in connection with maxillectomy. Compare 21076 office and facility rates across CMS payment localities in Indiana.
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 21076 in Indiana?
Indiana 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
$859.98
1 of 1 localities have a supported rate.
Payment area: Indiana
One mapped payment locality.
Facility setting
$589.68
1 of 1 localities have a supported rate.
Payment area: Indiana
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 21076: Surgical obturator impression and preparation
Reports impression and preparation of a surgical obturator to cover a maxillary surgical defect, commonly in connection with maxillectomy.
This service covers taking an impression and preparing a surgical obturator for a maxillary defect, commonly when a patient is undergoing maxillectomy. The device is intended for the surgical phase, helping separate the oral and nasal cavities after resection. A maxillofacial prosthodontist or other qualified dental or surgical specialist may perform the prosthetic work, often coordinating with the team treating an oral or maxillary tumor.
Report 21076 for the surgical obturator, not an interim device used during healing or a definitive device made after healing; those have separate codes. Document the defect and planned surgery, the impression and prosthetic work performed, and the device’s surgical purpose. Related postoperative visits for 10 days are included in the global period. When multiple procedures are performed in one session, the highest-valued procedure is paid in full and others at 50%. Modifier 50 is inappropriate for this service. Assistant-at-surgery payment requires documented medical necessity; co-surgeons and team surgery are not permitted.
CMS billing rules for 21076
- 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 RVU13.07 · 47%
- Practice expense (office) RVU12.80 · 46%
- Malpractice RVU1.67 · 6%
181
Medicare services in 2024 · #4415 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.
21076 compared with similar codes
Office rates for Indiana, from the same CMS release.
$1,620.26
Code 21080 describes a definitive obturator; 21076 is for the device prepared for the surgical phase.
$663.89
Code 21085 is for an oral surgical splint. Code 21076 is for an obturator intended to cover a maxillary surgical defect.
Compare 21076 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
Indiana →
Office / nonfacility
$859.98
Facility
$589.68
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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 21076 in Indiana.
PPRRVU2026_Oct_nonQPP.csv
1,861
- Code
- 21076
- Physician work
- 13.07
- Practice expense
- 12.80
- Malpractice
- 1.67
GPCI2026.csv
52
- Locality
- Indiana
- Physician work
- 1.000
- Practice expense
- 0.927
- Malpractice
- 0.486
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 13.07 | × 1.000 | 13.0700 |
| Practice expense | 12.80 | × 0.927 | 11.8656 |
| Malpractice | 1.67 | × 0.486 | 0.8116 |
| Total RVUs | 25.7472 | ||
| Conversion factor | × 33.4009 | ||
Office / nonfacility rate, Indiana$859.98
Explore RVUs, geographic factors and the full formula
Office / nonfacility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 13.07 | 1 |
| Practice expense | 12.8 | 0.927 |
| Malpractice | 1.67 | 0.486 |
(13.07 × 1 + 12.8 × 0.927 + 1.67 × 0.486) × $33.4009 = $859.98
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 13.07 | 1 |
| Practice expense | 4.07 | 0.927 |
| Malpractice | 1.67 | 0.486 |
(13.07 × 1 + 4.07 × 0.927 + 1.67 × 0.486) × $33.4009 = $589.68
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.
21076 billing questions
How is 21076 different from 21079?
21076 is for a surgical obturator intended for the surgical phase. Code 21079 describes an interim obturator used during healing.
When should 21080 be used instead?
Use 21080 for a definitive obturator, rather than the surgical-phase device reported with 21076.
Can the impression be billed separately from 21076?
The code covers the impression and preparation of the surgical obturator together. Document both parts of that prosthetic service.
What documentation supports 21076?
Record the maxillary defect and related surgery, the impression and preparation performed, and that the obturator is intended for the surgical phase.
Can modifier 50 be reported for bilateral work?
No. Modifier 50 is inappropriate for this service’s descriptor and anatomy.
What applies when other procedures are performed in the same session?
The highest-valued procedure is paid in full, with other procedures subject to the standard multiple-procedure reduction. Assistant-at-surgery payment requires documented medical necessity.
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.
1,85821060,,Remove jaw joint cartilage,A,,10.79,9.13,NA,9.13,,1.56,21.48,21.48,0,090,0.10,0.69,0.21,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,85921070,,Remove coronoid process,A,,8.40,6.54,NA,6.54,,1.23,16.17,16.17,0,090,0.10,0.69,0.21,2,1,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,86021073,,Mnpj of tmj w/anesth,A,,3.36,9.03,,2.85,,0.48,12.87,6.69,0,090,0.10,0.69,0.21,2,1,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,86121076,,Impres&prep surg obt prosth,A,,13.07,12.80,,4.07,,1.67,27.54,18.81,0,010,0.10,0.80,0.10,2,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,86221077,,Impres&prep orbital prosth,A,,32.86,29.07,,9.15,,3.75,65.68,45.76,0,090,0.10,0.69,0.21,2,1,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,86321079,,Impres&prep intrm obt prosth,A,,21.75,21.26,,6.72,,2.55,45.56,31.02,0,090,0.10,0.69,0.21,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,86421080,,Impres&prep def obt prosth,A,,24.43,24.45,,7.48,,2.91,51.79,34.82,0,090,0.10,0.69,0.21,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4906102,IL,12,EAST ST. LOUIS,1.000,0.920,2.014
5006102,IL,15,SUBURBAN CHICAGO,1.007,1.027,1.772
5106102,IL,99,REST OF ILLINOIS,1.000,0.913,1.563
5208102,IN,00,INDIANA,1.000,0.927,0.486
5305102,IA,00,IOWA,1.000,0.915,0.397
5405202,KS,00,KANSAS,1.000,0.904,0.504
5515102,KY,00,KENTUCKY,1.000,0.889,0.915