$1,562.79–$1,689.39
21086 is for an auricular prosthesis. Choose 21087 when the prosthesis is for the nose.
On this page
CMS RVU26D · Effective 2026-10-01
21087 Nasal prosthesis Medicare reimbursement rates in Pennsylvania
Captures the nasal defect and custom-prepares a nasal prosthesis, typically for a patient with acquired nasal loss or deformity after cancer, trauma, or surgery. Compare 21087 office and facility rates across CMS payment localities in Pennsylvania.
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 21087 in Pennsylvania?
Pennsylvania 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
$1562.79–$1689.39
2 of 2 localities have a supported rate.
Facility setting
$1103.16–$1168.18
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.
Maxillofacial prosthetics
About 21087: Custom nasal prosthesis preparation
Captures the nasal defect and custom-prepares a nasal prosthesis, typically for a patient with acquired nasal loss or deformity after cancer, trauma, or surgery.
This service covers taking an impression of the nasal area and custom-preparing a prosthesis to replace or restore the external nose. It is used for acquired defects, such as after tumor removal or trauma, when a patient needs a prosthetic rather than surgical reconstruction. A maxillofacial prosthodontist, oral and maxillofacial surgeon, or another clinician with relevant prosthetic expertise may perform the work in an office or facility setting.
Report the code for the nasal prosthetic service, not for surgical repair of the nose. Documentation should identify the defect and clinical need and support the impression and custom preparation performed. CMS assigns a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. When multiple procedures occur in the same session, the highest-valued procedure is paid in full and other procedures are reduced to 50%. Report the nasal service without modifier 50. Assistant-at-surgery payment requires documented medical necessity; co-surgeons and team surgery are not permitted.
CMS billing rules for 21087
- Global period
- Major surgery with a 90-day global period: the day-before preoperative visit and 90 days of related postoperative care 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 adjustment does not apply; the descriptor or anatomy makes modifier 50 inappropriate.
- 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 RVU24.26 · 50%
- Practice expense (office) RVU21.70 · 45%
- Malpractice RVU2.76 · 6%
63
Medicare services in 2024 · #5206 by national volume
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.
21087 compared with similar codes
Office rates for Pennsylvania, from the same CMS release.
21088
No office rateImpres&prep facial prosth
21088 addresses a facial prosthesis, while 21087 is specific to a nasal prosthesis.
21089
No office rateUnlisted maxlfcl prosth px
21089 is for an unlisted maxillofacial prosthetic procedure. Use 21087 when the service is the specifically described nasal prosthesis work.
Compare 21087 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
Metropolitan Philadelphia →
Office / nonfacility
$1689.39
Facility
$1168.18
Rest Of Pennsylvania →
Office / nonfacility
$1562.79
Facility
$1103.16
Need rates for a whole code list?
Fee-sheet and API access are in early access. Tell us which codes and locations your team needs.
21087 billing questions
When is 21087 appropriate instead of a facial prosthesis code?
Use 21087 when the custom prosthesis is for the nose. A prosthesis replacing a broader facial area is represented by 21088.
Does this code describe surgical reconstruction of the nose?
No. It covers impression work and custom preparation of a nasal prosthesis, rather than operative repair or reconstruction.
What documentation supports reporting 21087?
Document the nasal defect, the reason a prosthesis is needed, and the impression and custom-preparation work performed.
Should modifier 50 be appended for a nasal prosthesis?
No. Report the nasal prosthetic service without modifier 50.
How are other procedures in the same session paid?
The highest-valued procedure is paid in full, and other procedures performed in that session are subject to the standard multiple-procedure reduction.
What is included in the global period?
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 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.
1,86821084,,Impres&prep sp aid prosth,A,,21.92,23.80,,7.22,,2.50,48.22,31.64,0,090,0.10,0.69,0.21,2,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,86921085,,Impres&prep oral surg splint,A,,8.77,11.42,,3.03,,1.07,21.26,12.87,0,010,0.10,0.80,0.10,2,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,87021086,,Impres&prep auricular prosth,A,,24.26,21.70,,6.71,,2.76,48.72,33.73,0,090,0.10,0.69,0.21,2,1,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,87121087,,Impres&prep nasal prosth,A,,24.26,21.70,,6.71,,2.76,48.72,33.73,0,090,0.10,0.69,0.21,2,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,87221088,,Impres&prep facial prosth,C,,0.00,0.00,,0.00,,0.00,0.00,0.00,0,090,0.10,0.69,0.21,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,87321089,,Unlisted maxlfcl prosth px,C,,0.00,0.00,,0.00,,0.00,0.00,0.00,0,YYY,0.00,0.00,0.00,0,0,1,1,1,9,,33.4009,09,0,99,0.00,0.00,0.00
1,87421100,,Maxillofacial fixation,A,,4.61,13.77,,4.83,,0.51,18.89,9.95,0,090,0.10,0.69,0.21,2,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00