No office rate
21256 describes a different orbital reconstruction service. Choose based on the specific orbital structure and reconstructive technique documented, rather than treating all orbital reconstruction as interchangeable.
On this page
CMS RVU26D · Effective 2026-10-01
21260 Orbital reconstruction Medicare reimbursement rates in Nebraska
Reports craniofacial surgery that mobilizes and repositions the orbital bones, commonly to correct orbital spacing or other structural deformity. Compare 21260 office and facility rates across CMS payment localities in Nebraska.
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 21260 in Nebraska?
Nebraska 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
No supported rate
Facility setting
$1141.55
1 of 1 localities have a supported rate.
Payment area: Nebraska
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.
Craniofacial surgery
About 21260: Orbital repositioning with osteotomy
Reports craniofacial surgery that mobilizes and repositions the orbital bones, commonly to correct orbital spacing or other structural deformity.
This service involves surgically cutting and mobilizing orbital bones so the eye sockets can be repositioned to address a structural deformity, such as orbital hypertelorism. A craniofacial, plastic, or oral and maxillofacial surgeon typically performs the operation in a hospital or other surgical facility. The work is more extensive than a localized repair of an orbital wall or adjustment of the eyelid-supporting canthus; the operative plan must support reconstruction and repositioning of the orbital framework.
Report the code when the documented procedure matches the orbital osteotomy and repositioning service, using the operative report to show the bones mobilized, the repositioning performed, and any grafting or other reconstructive work. CMS assigns a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. When multiple procedures are performed in the same session, the highest-valued procedure is paid in full and other procedures are subject to the standard multiple-procedure reduction. Modifier 50 is inappropriate for this code. Assistant-at-surgery payment may be available; co-surgeon payment requires supporting documentation, and team surgery is not permitted.
CMS billing rules for 21260
- 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 adjustment does not apply; the descriptor or anatomy makes modifier 50 inappropriate.
- 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 RVU17.45 · 47%
- Practice expense (office) RVU16.80 · 45%
- Malpractice RVU3.23 · 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.
21260 compared with similar codes
Office rates for Nebraska, from the same CMS release.
No office rate
This is a closely related orbital reconstruction code. Compare its full descriptor with the operative report to distinguish the coded scope and technique from the repositioning service reported here.
No office rate
21275 concerns revision of orbitofacial bones. This code is for an operation that mobilizes and repositions the orbital framework.
No office rate
21280 is a medial canthal procedure involving eyelid-supporting structures, not reconstruction and repositioning of the orbital bones.
Compare 21260 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
Nebraska →
Office / nonfacility
Unavailable
Facility
$1141.55
Need rates for a whole code list?
Fee-sheet and API access are in early access. Tell us which codes and locations your team needs.
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 21260 in Nebraska.
PPRRVU2026_Oct_nonQPP.csv
1,931
- Code
- 21260
- Physician work
- 17.45
- Practice expense
- 16.80
- Malpractice
- 3.23
GPCI2026.csv
72
- Locality
- Nebraska
- Physician work
- 1.000
- Practice expense
- 0.923
- Malpractice
- 0.378
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 17.45 | × 1.000 | 17.4500 |
| Practice expense | 16.80 | × 0.923 | 15.5064 |
| Malpractice | 3.23 | × 0.378 | 1.2209 |
| Total RVUs | 34.1773 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Nebraska$1141.55
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 17.45 | 1 |
| Practice expense | 16.8 | 0.923 |
| Malpractice | 3.23 | 0.378 |
(17.45 × 1 + 16.8 × 0.923 + 3.23 × 0.378) × $33.4009 = $1141.55
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.
21260 billing questions
When is this code appropriate instead of an orbital wall repair?
Use it for an operation that mobilizes and repositions orbital bones as part of craniofacial reconstruction. A localized repair of an orbital wall, such as a floor repair, is a different service.
Should modifier 50 be used for surgery involving both orbits?
No. CMS identifies bilateral adjustment as inappropriate for this code because of its descriptor or anatomy.
What postoperative care is included?
The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care.
Can an assistant surgeon or co-surgeon be reported?
Assistant-at-surgery payment may be available. Co-surgeon payment requires supporting documentation, and CMS does not permit team surgery for this code.
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% when performed in the same session.
What operative documentation supports this code?
Document the orbital bones cut and mobilized, the repositioning performed, the structural problem treated, and the reconstructive steps, including any grafting.
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.
1,92821249,,Reconstruction of jaw,A,,18.30,21.44,,9.64,,2.31,42.05,30.25,0,090,0.10,0.69,0.21,2,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,92921255,,Reconstruct lower jaw bone,A,,18.00,15.95,NA,15.95,,2.61,36.56,36.56,0,090,0.10,0.69,0.21,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,93021256,,Reconstruction of orbit,A,,17.22,12.97,NA,12.97,,3.19,33.38,33.38,0,090,0.10,0.69,0.21,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,93121260,,Revise eye sockets,A,,17.45,16.80,NA,16.80,,3.23,37.48,37.48,0,090,0.10,0.69,0.21,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,93221261,,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
6905302,MO,01,METROPOLITAN ST. LOUIS,1.000,0.952,1.002
7005302,MO,99,REST OF MISSOURI,1.000,0.862,0.974
7103202,MT,01,MONTANA**,1.000,1.000,0.998
7205402,NE,00,NEBRASKA,1.000,0.923,0.378
7301312,NV,00,NEVADA**,1.000,1.001,0.833
7414312,NH,40,NEW HAMPSHIRE,1.000,1.041,0.875
7512402,NJ,01,NORTHERN NJ,1.063,1.160,1.068