No office rate
Both belong to the eye-socket revision group. Use the code whose operative specification matches the documented reconstruction, rather than choosing by diagnosis alone.
On this page
CMS RVU26D · Effective 2026-10-01
21268 Orbital reconstruction Medicare reimbursement rates in Massachusetts
Reports extensive reconstruction of the eye socket framework to correct orbital position or shape when a major craniofacial operation is performed. Compare 21268 office and facility rates across CMS payment localities in Massachusetts.
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 21268 in Massachusetts?
Massachusetts has 2 payment localities in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the 2 payment areas shown below, using the same CMS release.
Office / nonfacility
No supported rate
Facility setting
$1843.46–$1990.18
2 of 2 localities have a supported rate.
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 21268: Extensive eye socket reconstruction
Reports extensive reconstruction of the eye socket framework to correct orbital position or shape when a major craniofacial operation is performed.
This code represents major reconstruction of the bony eye socket framework, rather than a limited eyelid or canthal procedure. It may be used when a craniofacial deformity requires substantial orbital repositioning or reshaping. Craniofacial, plastic, or oculoplastic surgeons typically perform the operation in a hospital operating room. The operative report should make clear the orbital structures addressed and the scope of reconstruction; the clinical indication and the actual technique guide selection among the related orbital-revision codes.
Report the code for the documented operation, not simply because the patient has an orbital deformity. The record should describe the preoperative problem, surgical approach, bony work, reconstruction, and laterality. CMS assigns a 90-day global period, which includes the day-before preoperative visit and 90 days of related postoperative care. For bilateral surgery, modifier 50 is paid at 150%. When multiple procedures are performed in one session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% reduction. An assistant at surgery may be paid; co-surgeons require supporting documentation, and team surgery is not permitted.
CMS billing rules for 21268
- 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 RVU26.39 · 48%
- Practice expense (office) RVU23.25 · 43%
- Malpractice RVU4.89 · 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.
21268 compared with similar codes
Office rates for Massachusetts, from the same CMS release.
No office rate
This is another orbital reconstruction code, but it represents a different operative circumstance. Base the choice on the specific procedure documented.
No office rate
Medial canthopexy tightens soft tissue at the inner corner of the eye; it is not reconstruction of the bony eye socket.
No office rate
Lateral canthopexy tightens the outer canthal support and is distinct from extensive reconstruction of the orbital framework.
Compare 21268 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.
2 of 2 payment localities
Metropolitan Boston →
Office / nonfacility
Unavailable
Facility
$1990.18
Rest Of Massachusetts →
Office / nonfacility
Unavailable
Facility
$1843.46
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21268 billing questions
How is this code distinguished from the other eye-socket revision codes?
Choose the code that matches the specific orbital reconstruction and extent documented in the operative report. The diagnosis alone does not establish that this code applies; compare the documented technique with the relevant sibling descriptors.
Can a separate eyelid or canthal procedure be reported with this operation?
A separately performed service may be reportable when it is distinct from the orbital reconstruction and has its own supporting documentation. CMS applies the multiple-procedure reduction when multiple procedures are performed in the same session.
How should bilateral surgery be billed?
Use modifier 50 for a bilateral procedure; CMS pays the bilateral service at 150%.
What postoperative care is included?
The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care. Document unrelated services separately when they meet applicable reporting requirements.
May an assistant or co-surgeon be reported?
An assistant at surgery may be paid. Co-surgeons are paid only with supporting documentation, and team surgery is not permitted under the CMS rules for this code.
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.
1,93221261,,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
1,93721275,,Revision orbitofacial bones,A,,11.47,9.28,NA,9.28,,2.13,22.88,22.88,0,090,0.10,0.69,0.21,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,93821280,,Medial canthopexy,A,,6.95,8.04,NA,8.04,,0.71,15.70,15.70,0,090,0.10,0.69,0.21,2,1,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00