Billing code 21360: Malar fracture repairMedicare rate & RVUs in Oregon
Report open surgical reduction of a depressed malar fracture when the surgeon restores the cheekbone’s position, with fixation if performed.
CMS doesn’t publish an office rate for 21360 in Oregon.
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 21360 covers
This service covers open repair of a depressed fracture of the malar, or cheekbone, typically after blunt facial trauma has displaced and flattened the cheek. A facial plastic surgeon, otolaryngologist, or oral and maxillofacial surgeon exposes the fracture, restores the bone’s position, and may use internal fixation. The repair is generally performed in an operating room; the operative report should identify the fracture site and describe the open reduction and any fixation.
Choose this code for an open repair of a depressed malar fracture, rather than a percutaneous reduction or repair of a complex malar fracture. Document the fracture pattern, laterality, approach, reduction, and fixation when performed. CMS assigns a 90-day global period, including 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%. Assistant-at-surgery services may be paid; co-surgeons and team surgery are 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.
Where 21360 pays more and less in Oregon
| Payment locality | Office | Facility |
|---|---|---|
| Portland | Unavailable | $485.64 |
| Rest Of Oregon | Unavailable | $457.50 |
How the 21360 rate is calculated
Each of 21360’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 · 21360
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 7.01Practice expense 5.98Malpractice 1.04
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 21360
21360 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 21360
Malar fracture 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) | 0 | Not permitted. |
| 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 · 21360
Malar fracture 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
21360 without 50 · national facility
$468.61
Malar fracture repair
21360-50 · Bilateral: 150%
$702.92
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).
21360 compared with similar codes
Compare codes
21360 vs 21355 vs 21356 vs 21365 vs 21366: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 21355Cheekbone fracture
- 21355 describes percutaneous treatment of a malar fracture. Report 21360 when the surgeon uses an open approach for a depressed malar fracture.
- 21356Facial fracture repair
- 21356 applies to open treatment of a depressed zygomatic arch fracture. This code concerns a depressed malar fracture; document the specific injured site.
- 21365Malar fracture repair
- 21365 is for open treatment of a complex malar fracture. Use 21360 for the depressed malar fracture service when the case is not documented as complex.
- 21366Malar fracture repair
- 21366 describes complex malar fracture treatment with a graft. It is not the code for an open repair of a depressed malar fracture without that complex graft procedure.
21360 billing questions
When should this code be chosen over a percutaneous malar fracture code?
Use this code when the surgeon treats the depressed malar fracture through an open approach. A percutaneous reduction is reported with 21355.
Does internal fixation support separate reporting?
Internal fixation may be part of the open fracture repair described by this code. Document fixation in the operative report, but do not treat it as a separate procedure solely because hardware was used.
How is a complex malar fracture distinguished?
Use 21365 when the surgeon performs open treatment of a complex malar fracture. The operative documentation should support the fracture’s complexity and the work performed.
What postoperative care is included?
The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care.
Can this procedure be reported bilaterally?
CMS identifies this as a bilateral procedure. Modifier 50 is paid at 150%.
Can an assistant or co-surgeon be reported?
Assistant-at-surgery services may be paid. CMS does not permit co-surgeons or team surgery 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 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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