Billing code 21079: Obturator prosthesisMedicare rate & RVUs in Rhode Island
Reports impression and preparation of an interim obturator prosthesis, commonly used during healing after removal of part of the palate or upper jaw.
Medicare pays $1,549.78 for 21079 in the office in Rhode Island (Rhode Island). 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 21079 covers
Code 21079 covers taking an impression and preparing an interim obturator prosthesis to help close a defect in the palate or upper jaw. A maxillofacial prosthodontist, dentist, or other qualified clinician may provide the service, often after maxillectomy while the surgical site is healing. The prosthesis can help separate the oral and nasal cavities and support speech and swallowing during this transitional period.
Choose this code for an interim obturator, rather than a surgical obturator placed at the time of surgery or a definitive obturator for longer-term use. Documentation should identify the defect, the interim purpose of the appliance, and the impression and 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 one session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% reduction. Modifier 50 is inappropriate; assistant-at-surgery payment is restricted, and 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.
21079 in Rhode Island
| Payment locality | Office | Facility |
|---|---|---|
| Rhode Island | $1,549.78 | $1,048.11 |
How the 21079 rate is calculated
Each of 21079’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 · 21079
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 21.75Practice expense 21.26Malpractice 2.55
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 21079
21079 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 21079
Obturator prosthesis
| 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) | 1 | Not paid (statutory restriction). |
| 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 · 21079
Obturator prosthesis
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
21079 without 51 · national office
$1,521.75
Obturator prosthesis
21079-51 · Second procedure: 50%
$760.88
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%).
21079 compared with similar codes
Compare codes
21079 vs 21076 vs 21080 vs 21081: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 21076Obturator prosthesis
- Choose 21076 for a surgical obturator; choose 21079 for an interim obturator used during healing.
- 21080Obturator prosthesis
- Choose 21080 for a definitive obturator. Code 21079 describes the interim prosthesis used during the healing period.
- 21081Mandibular prosthesis
- Code 21081 concerns a mandibular resection prosthesis, while 21079 is for an interim obturator addressing a palatal or upper-jaw defect.
21079 billing questions
How is an interim obturator different from a surgical obturator?
Use 21079 for an interim prosthesis used during healing. Code 21076 describes impression and preparation for a surgical obturator.
How does an interim obturator differ from a definitive obturator?
Code 21079 is for the transitional appliance used during healing; 21080 is for a definitive obturator.
Can the impression and prosthesis preparation be billed separately?
The code represents the impression and preparation service for the interim obturator. Do not separately report those same included steps as independent services.
Should modifier 50 be appended for a bilateral defect?
No. CMS identifies bilateral adjustment as inappropriate for this code, and modifier 50 should not be used.
Can an assistant surgeon or co-surgeon be paid for this service?
CMS applies a statutory restriction to assistant-at-surgery payment and does not permit co-surgeons or team surgery for this code.
What happens when this service is performed with another procedure in the same session?
Under the standard multiple procedure reduction, the highest-valued procedure is paid in full and other procedures are paid at 50%.
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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