$639.74–$670.15
Code 21356 is open treatment of a depressed zygomatic arch fracture; this code is for percutaneous treatment of a malar fracture.
On this page
CMS RVU26D · Effective 2026-10-01
21355 Cheekbone fracture Medicare reimbursement rates in New Jersey
Percutaneous reduction treats a malar fracture through a small access point, using manipulation to restore cheekbone position without open fracture exposure. Compare 21355 office and facility rates across CMS payment localities in New Jersey.
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 21355 in New Jersey?
New Jersey 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
$479.13–$500.89
2 of 2 localities have a supported rate.
Facility setting
$313.90–$325.38
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 treatment
About 21355: Percutaneous malar fracture reduction
Percutaneous reduction treats a malar fracture through a small access point, using manipulation to restore cheekbone position without open fracture exposure.
A surgeon reaches the malar, or cheekbone, fracture through a percutaneous access point and manipulates the bone to restore its position without open exposure. This approach may be performed by an oral and maxillofacial, plastic, or facial trauma surgeon in an operative setting. It is distinct from treatment of a fracture limited to the zygomatic arch and from open repair requiring exposure or fixation.
Report the service when the malar fracture is treated by this percutaneous method. The operative record should identify the fracture, side, access approach, and reduction performed. Related postoperative visits during the 10-day global period are included. 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 50% reduction. For bilateral treatment, modifier 50 is paid at 150%. Assistant-at-surgery payment requires documented medical necessity; co-surgeons and team surgery are not permitted.
CMS billing rules for 21355
- 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 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 RVU4.34 · 33%
- Practice expense (office) RVU8.38 · 63%
- Malpractice RVU0.62 · 5%
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.
21355 compared with similar codes
Office rates for New Jersey, from the same CMS release.
No office rate
Code 21360 describes open treatment of a depressed malar fracture, including internal fixation. Choose this code when the malar fracture is treated percutaneously instead.
No office rate
Code 21365 is for open treatment of a complicated malar fracture. This code describes percutaneous treatment rather than open repair.
Compare 21355 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
Northern Nj →
Office / nonfacility
$500.89
Facility
$325.38
Rest Of New Jersey →
Office / nonfacility
$479.13
Facility
$313.90
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21355 billing questions
How does this differ from treatment of a zygomatic arch fracture?
This code is for percutaneous reduction of a malar fracture. A fracture limited to the zygomatic arch may instead fit a code specific to arch treatment, depending on the approach.
Can the manipulation be billed separately?
No. Manipulation used to reduce the malar fracture is part of this percutaneous treatment.
When should an open malar fracture code be considered?
Use an open-treatment code when the surgeon treats the fracture through open exposure. The applicable code depends on the fracture’s characteristics and the repair performed.
How is bilateral treatment reported?
For bilateral treatment, report modifier 50; CMS pays this code at 150%.
What postoperative care is included?
Related postoperative visits for 10 days are included in the global period.
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 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.
1,95621346,,Opn tx nasomax fx w/fixj,A,,11.16,14.57,NA,14.57,,1.63,27.36,27.36,0,090,0.10,0.69,0.21,2,0,1,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,95721347,,Opn tx nasomax fx multple,A,,13.19,13.01,NA,13.01,,1.92,28.12,28.12,0,090,0.10,0.69,0.21,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,95821348,,Opn tx nasomax fx w/graft,A,,17.08,8.81,NA,8.81,,2.49,28.38,28.38,0,090,0.10,0.69,0.21,2,0,2,2,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,95921355,,Perq tx malar fracture,A,,4.34,8.38,,3.85,,0.62,13.34,8.81,0,010,0.10,0.80,0.10,2,1,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,96021356,,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