Billing code 21260: Orbital reconstructionMedicare rate & RVUs in Ohio
Reports craniofacial surgery that mobilizes and repositions the orbital bones, commonly to correct orbital spacing or other structural deformity.
CMS doesn’t publish an office rate for 21260 in Ohio.
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
On this page 9 sections
What 21260 covers
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.
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 in Ohio
| Payment locality | Office | Facility |
|---|---|---|
| Ohio | Unavailable | $1,203.91 |
How the 21260 rate is calculated
Each of 21260’s three RVUs is multiplied by a geographic index (GPCI) for the payment locality, added up, and multiplied by the conversion factor. Drag the indexes or enter a ZIP to see what moves the rate.
How the rate is built · 21260
RVUs × geographic indexes × conversion factor
Work17.45
17.45 RVUs× 1.000 GPCI
Practice expense16.80
16.80 RVUs× 1.000 GPCI
Malpractice3.23
3.23 RVUs× 1.000 GPCI
Adjusted RVUs
37.4800
Conversion factor
$33.4009
Medicare rate
$1,251.87
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 21260
21260 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 21260
Orbital reconstruction
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 090 | Major surgery: the day before, the day of, and 90 days after are included. |
| Multiple procedures | 2 | Standard reduction: highest-valued procedure at 100%, others at 50%. |
| Bilateral (modifier 50) | 0 | The 150% bilateral adjustment doesn’t apply. |
| Assistant at surgery (80/81/82/AS) | 2 | Paid. |
| Co-surgeons (62) | 1 | Permitted with supporting documentation. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 0 | Physician service: no professional/technical split. |
| Split (54/55/56) | 0.10/0.69/0.21 | Share of the payment for pre-op, the procedure itself, and post-op care. |
Global surgery period · 21260
Orbital reconstruction
90-day global period ends
Dec 30, 2026
Covers Sep 30, 2026 through Dec 30, 2026 (92 days, including the day before surgery).
Visit on Oct 31, 2026
Day 30 of the 90-day post-op period: related follow-up care is included in the surgical payment.
Pre-op dayGlobal period
What modifiers do to the payment
Modifier 51 · payment effect
With and without the modifier
21260 without 51 · national facility
$1,251.87
Orbital reconstruction
21260-51 · Second procedure: 50%
$625.94
When this isn’t the highest-valued procedure in the session, Medicare pays 50% of its fee schedule amount (the highest is paid at 100%).
21260 compared with similar codes
Compare codes · National
5 codes, side by side
How to choose
- 21256Orbital reconstruction
- 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.
- 21261Orbital reconstruction
- 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.
- 21275Orbitofacial revision
- 21275 concerns revision of orbitofacial bones. This code is for an operation that mobilizes and repositions the orbital framework.
- 21280Canthopexy
- 21280 is a medial canthal procedure involving eyelid-supporting structures, not reconstruction and repositioning of the orbital bones.
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 indexes and the conversion factor. Services without a published rate are labeled, never given a made-up amount. Amounts are Medicare allowed amounts before claim adjustments: not a patient’s bill or a commercial rate.
CMS RVU26D · effective Oct 1, 2026 through the day before Jan 1, 2027
Show the CMS file lines behind this rate
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