$2,125.45–$2,245.71
21086 is for an external ear prosthesis; 21077 is for an orbital prosthesis.
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CMS RVU26D · Effective 2026-10-01
21086 Auricular prosthesis Medicare reimbursement rates in Michigan
Report 21086 for the impression and preparation work involved in providing a custom external ear prosthesis after congenital absence, trauma, or surgical removal. Compare 21086 office and facility rates across CMS payment localities in Michigan.
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 21086 in Michigan?
Michigan 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
$1576.13–$1665.16
2 of 2 localities have a supported rate.
Facility setting
$1119.01–$1182.01
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.
Maxillofacial prosthetics
About 21086: Auricular prosthesis impression and preparation
Report 21086 for the impression and preparation work involved in providing a custom external ear prosthesis after congenital absence, trauma, or surgical removal.
This service covers taking the impression and preparing a custom prosthesis to replace an external ear. It is used when an auricle is absent or has been removed, such as after cancer surgery or traumatic injury. A maxillofacial prosthodontist or another qualified clinician may perform the work, commonly in an office-based prosthetic practice. The service addresses the ear specifically, rather than an orbital, nasal, or broader facial defect.
Report 21086 for the auricular prosthesis impression and preparation service, supported by documentation of the affected site and the work performed. CMS assigns a 90-day global period: the day-before preoperative visit and 90 days of related postoperative care are included. When multiple procedures are performed in the same session, the highest-valued procedure is paid in full and the others at 50%. Modifier 50 identifies bilateral work and is paid at 150%. An assistant at surgery is paid only when medical necessity is documented; co-surgeons and team surgery are not permitted.
CMS billing rules for 21086
- 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 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 RVU24.26 · 50%
- Practice expense (office) RVU21.70 · 45%
- Malpractice RVU2.76 · 6%
15
Medicare services in 2024 · #6057 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.
21086 compared with similar codes
Office rates for Michigan, from the same CMS release.
$1,576.13–$1,665.16
Use 21086 for an auricular prosthesis and 21087 for a nasal prosthesis.
21088
No office rateImpres&prep facial prosth
21086 identifies the ear site specifically. 21088 is for a facial prosthesis when a more specific site code does not describe the service.
21089
No office rateUnlisted maxlfcl prosth px
21086 describes the auricular prosthesis service specifically; 21089 is the unlisted option when no specific maxillofacial prosthetic code fits.
Compare 21086 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
Detroit →
Office / nonfacility
$1665.16
Facility
$1182.01
Rest Of Michigan →
Office / nonfacility
$1576.13
Facility
$1119.01
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21086 billing questions
When should 21086 be chosen over 21088?
Use 21086 for an auricular, or external ear, prosthesis. Code 21088 addresses a facial prosthesis for a defect not described by a more specific site code.
Does 21086 cover the impression and preparation for an orbital or nasal prosthesis?
No. The site determines the code: 21077 is for an orbital prosthesis, and 21087 is for a nasal prosthesis.
What documentation supports reporting 21086?
Document the ear defect or absence and the impression and preparation work performed for the auricular prosthesis.
How does the 90-day global period affect reporting?
The day-before preoperative visit and 90 days of related postoperative care are included in the global period for 21086.
How is bilateral work handled?
CMS identifies 21086 as a bilateral procedure; modifier 50 is paid at 150%.
Can an assistant or co-surgeon be reported?
Assistant-at-surgery payment requires documentation of medical necessity. Co-surgeons and team surgery are 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.
1,86721083,,Impres&prep paltl lft prosth,A,,18.79,21.33,,6.49,,2.14,42.26,27.42,0,090,0.10,0.69,0.21,2,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,86821084,,Impres&prep sp aid prosth,A,,21.92,23.80,,7.22,,2.50,48.22,31.64,0,090,0.10,0.69,0.21,2,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,86921085,,Impres&prep oral surg splint,A,,8.77,11.42,,3.03,,1.07,21.26,12.87,0,010,0.10,0.80,0.10,2,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,87021086,,Impres&prep auricular prosth,A,,24.26,21.70,,6.71,,2.76,48.72,33.73,0,090,0.10,0.69,0.21,2,1,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,87121087,,Impres&prep nasal prosth,A,,24.26,21.70,,6.71,,2.76,48.72,33.73,0,090,0.10,0.69,0.21,2,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,87221088,,Impres&prep facial prosth,C,,0.00,0.00,,0.00,,0.00,0.00,0.00,0,090,0.10,0.69,0.21,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,87321089,,Unlisted maxlfcl prosth px,C,,0.00,0.00,,0.00,,0.00,0.00,0.00,0,YYY,0.00,0.00,0.00,0,0,1,1,1,9,,33.4009,09,0,99,0.00,0.00,0.00