No office rate
Use 21366 when the complex malar fracture repair includes a bone graft. Use 21365 for complex open treatment without grafting.
On this page
CMS RVU26D · Effective 2026-10-01
21366 Malar fracture repair Medicare reimbursement rates in Massachusetts
Open repair of a complex cheekbone fracture with bone grafting, reported when reconstruction requires graft support or replacement of missing bone. Compare 21366 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 21366 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
$1147.84–$1232.71
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.
Facial fracture surgery
About 21366: Complex malar fracture repair with graft
Open repair of a complex cheekbone fracture with bone grafting, reported when reconstruction requires graft support or replacement of missing bone.
This service is an open reconstruction of a complex malar, or cheekbone, fracture using a bone graft. It is typically performed by an oral and maxillofacial surgeon, facial plastic surgeon, or other surgeon treating facial trauma, often in an operating room. The fracture may involve the malar bone and its connections to surrounding facial bones; the operative report must support a complex injury and graft-assisted repair, not simply an isolated depressed cheekbone fracture.
Report the code when the surgeon opens the fracture site and uses a graft as part of the complex malar repair. Documentation should identify the fracture pattern, open approach, graft placement, and treated side. CMS assigns a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. For multiple procedures in one session, the highest-valued procedure is paid in full and others at 50%. Bilateral reporting with modifier 50 is paid at 150%. Assistant-at-surgery and co-surgeon payment are permitted; team-surgery payment is not.
CMS billing rules for 21366
- 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 permitted.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU18.14 · 53%
- Practice expense (office) RVU12.59 · 37%
- Malpractice RVU3.36 · 10%
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.
21366 compared with similar codes
Office rates for Massachusetts, from the same CMS release.
No office rate
21360 describes open treatment of a depressed malar fracture. 21366 is for a complex malar fracture repaired with a graft.
$458.52–$503.53
21355 is for percutaneous malar fracture treatment; 21366 involves open repair of a complex fracture with grafting.
Compare 21366 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
$1232.71
Rest Of Massachusetts →
Office / nonfacility
Unavailable
Facility
$1147.84
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21366 billing questions
How does this differ from 21365?
Both describe open treatment of a complex malar fracture, but 21366 is the graft-assisted service. Use 21365 when the documented complex repair does not include a bone graft.
Is the bone graft part of this service?
Yes. The code identifies complex malar fracture repair with grafting; it is not the code for the same repair without a graft.
When is modifier 50 appropriate?
Use modifier 50 for bilateral treatment when both sides are treated. CMS payment for the bilateral procedure is 150%.
What should the operative note establish?
Document the complex malar fracture pattern, open repair, graft placement, and laterality. The record should distinguish this repair from treatment of an isolated depressed malar fracture or zygomatic arch fracture.
How are other procedures in the same session paid?
Under the standard multiple procedure reduction, the highest-valued procedure is paid in full and other procedures are paid at 50%. The code has a 90-day global period for related postoperative care.
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.
1,96021356,,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
1,96621387,,Opn tx orbit fx combined,A,,9.86,9.33,NA,9.33,,1.83,21.02,21.02,0,090,0.10,0.69,0.21,2,1,2,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00