Billing code 21401: Orbital fracture treatmentMedicare rate & RVUs in Oregon
Closed reduction of an orbital fracture with manipulation is reported when the surgeon restores fracture alignment without open exposure.
Medicare pays $543.93–$593.92 for 21401 in the office in Oregon, from Rest Of Oregon to Portland. Which amount applies depends on the service address.
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 21401 covers
This service covers closed management of an orbital fracture in which the surgeon manipulates the fracture to restore alignment rather than exposing it through an incision. Orbital fractures may involve the rim or walls of the orbit after facial trauma. The operative record should identify the fracture and describe the reduction maneuver. Ophthalmologists, oculoplastic surgeons, and facial trauma or oral and maxillofacial surgeons may perform this treatment in a hospital or ambulatory surgical setting.
Choose 21401 when closed treatment includes manipulation; 21400 describes closed treatment without manipulation. When the fracture is treated through open exposure, select the applicable open-treatment code instead. Document the fracture, laterality, operative details, and the manipulation performed. CMS assigns a 90-day major-surgery global period, including the day-before preoperative visit and 90 days of related postoperative care. In a same-session multiple-procedure claim, 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 payment may be made; 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 21401 pays more and less in Oregon
| Payment locality | Office | Facility |
|---|---|---|
| Portland | $593.92 | $331.19 |
| Rest Of Oregon | $543.93 | $308.40 |
How the 21401 rate is calculated
Each of 21401’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 · 21401
RVUs × geographic indexes × conversion factor
Work3.59
3.59 RVUs× 1.000 GPCI
Practice expense12.28
12.28 RVUs× 1.000 GPCI
Malpractice0.66
0.66 RVUs× 1.000 GPCI
Adjusted RVUs
16.5300
Conversion factor
$33.4009
Medicare rate
$552.12
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 21401
21401 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 21401
Orbital fracture treatment
| 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 · 21401
Orbital fracture treatment
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
21401 without 50 · national office
$552.12
Orbital fracture treatment
21401-50 · Bilateral: 150%
$828.18
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).
21401 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 21400Orbital fracture treatment
- Both describe closed orbital fracture treatment, but 21401 includes manipulation to reduce the fracture; 21400 is for treatment without manipulation.
- 21406Orbital fracture repair
- 21406 is for open treatment of an orbital fracture without an implant. 21401 describes closed treatment with manipulation.
- 21407Orbital repair
- 21407 describes open orbital fracture treatment with an implant; 21401 is the closed-treatment option when manipulation is performed.
21401 billing questions
How does 21401 differ from 21400?
Use 21401 when the closed reduction involves manipulation of the fracture. Use 21400 for closed treatment without manipulation.
When is an open-treatment code more appropriate?
When the surgeon exposes the fracture for treatment, report the applicable open-treatment code rather than 21401. Codes 21406, 21407, and 21408 distinguish open orbital fracture treatment by the procedure performed.
What documentation supports 21401?
The operative record should identify the orbital fracture and laterality and describe the closed manipulation used to reduce it.
How is bilateral treatment reported under the CMS payment rule?
For a bilateral procedure reported with modifier 50, CMS pays 150% under the rule supplied for this code.
What postoperative care is included?
The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care.
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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