Billing code 21407: Orbital repairMedicare rate & RVUs in Oklahoma
Open repair of an orbital fracture with implant placement, reported when operative reconstruction uses an implant to restore support at the fractured orbital site.
CMS doesn’t publish an office rate for 21407 in Oklahoma.
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 21407 covers
This service is an open operation to repair an orbital fracture with placement of an implant as part of reconstruction. A surgeon exposes the fracture, addresses the displaced or disrupted orbital structures, and places the implant to support the repaired area. Orbital floor and other orbital wall fractures may require this approach. Ophthalmic, plastic, otolaryngology, and oral and maxillofacial surgeons may perform the operation, commonly in a hospital operating room.
Report this code when the operative treatment is open and includes an implant; document the fracture site, surgical approach, and implant use. Distinguish it from open repair without an implant or repair using bone graft. The 90-day global period includes 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 other procedures at 50%. Bilateral reporting with modifier 50 is paid at 150%. An assistant at surgery may be paid; co-surgeons are paid only with 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.
21407 in Oklahoma
| Payment locality | Office | Facility |
|---|---|---|
| Oklahoma | Unavailable | $542.44 |
How the 21407 rate is calculated
Each of 21407’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 · 21407
RVUs × geographic indexes × conversion factor
Work8.79
8.79 RVUs× 1.000 GPCI
Practice expense7.29
7.29 RVUs× 1.000 GPCI
Malpractice1.21
1.21 RVUs× 1.000 GPCI
Adjusted RVUs
17.2900
Conversion factor
$33.4009
Medicare rate
$577.50
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 21407
21407 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 21407
Orbital repair
| 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) | 1 | Bilateral with modifier 50 pays 150% of the fee schedule amount. |
| 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 · 21407
Orbital repair
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 50 · payment effect
With and without the modifier
21407 without 50 · national facility
$577.50
Orbital repair
21407-50 · Bilateral: 150%
$866.25
Both sides on one line with modifier 50 are paid at 150% of the fee schedule amount (subject to multiple-procedure rules with other procedures).
21407 compared with similar codes
Compare codes · National
5 codes, side by side
How to choose
- 21400Orbital fracture treatment
- 21400 is closed treatment without manipulation. Choose 21407 when the fracture is treated through an open operation with implant placement.
- 21401Orbital fracture treatment
- 21401 is closed treatment with manipulation. It does not describe open orbital reconstruction with an implant.
- 21406Orbital fracture repair
- 21406 describes open orbital fracture treatment without an implant; 21407 includes implant placement in the repair.
- 21408Orbital fracture repair
- 21408 is the open orbital fracture treatment code for repair with bone graft. This code is for repair using an implant.
21407 billing questions
How does this differ from open orbital fracture repair without an implant?
Use this code when the open repair includes implant placement. Open treatment without an implant is represented by 21406.
When is 21408 a better fit?
21408 represents open orbital fracture treatment with bone graft. This code describes the implant approach, so the operative report should establish which reconstructive material was used.
Can modifier 50 be used for bilateral orbital fractures?
CMS identifies this as a bilateral procedure; when reported bilaterally with modifier 50, payment is 150%.
Does the surgical global period include postoperative visits?
Yes. The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care.
Can an assistant or co-surgeon be reported?
An assistant at surgery may be paid. Co-surgeons are paid only with supporting documentation; team surgery is not permitted.
How are other procedures in the same session paid?
The highest-valued procedure is paid in full, and other procedures are paid at 50% under the standard multiple procedure reduction.
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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