No office rate
Both describe open treatment of an orbital fracture; 21407 is the related option when an implant is used, while 21406 is for treatment without one.
On this page
CMS RVU26D · Effective 2026-10-01
21406 Orbital fracture repair Medicare reimbursement rates in Rhode Island
Reports open surgical treatment of an orbital fracture when the fractured bone is treated without an implant or bone graft. Compare 21406 office and facility rates across CMS payment localities in Rhode Island.
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 21406 in Rhode Island?
Rhode Island has 1 payment locality in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the payment area shown below, using the same CMS release.
Office / nonfacility
No supported rate
Facility setting
$550.69
1 of 1 localities have a supported rate.
Payment area: Rhode Island
One mapped payment locality.
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.
Facial fracture surgery
About 21406: Open orbital fracture repair without implant
Reports open surgical treatment of an orbital fracture when the fractured bone is treated without an implant or bone graft.
This service involves surgically exposing an orbital fracture and treating the displaced bone without placing an implant or bone graft. It may be performed for an orbital floor or rim fracture that requires open access and reduction. Facial trauma surgeons, including oral and maxillofacial, plastic, and otolaryngology surgeons, commonly perform the repair in a hospital operating room.
Select this code when the operative report supports open treatment and documents the fracture site, exposure and reduction, and that no implant or bone graft was used. A repair using an implant or bone graft falls under a different orbital-fracture code. The code has a 90-day global period, including the day-before preoperative visit and related postoperative care through day 90. When multiple procedures are performed in the same session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% reduction. Bilateral reporting with modifier 50 is paid at 150%. Assistant-at-surgery payment may be allowed; co-surgeons require supporting documentation, and team surgery is not permitted.
CMS billing rules for 21406
- 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 procedure with modifier 50 is paid at 150%.
- Assistant at surgery
- Assistant at surgery may be paid.
- Co-surgeons
- Co-surgeons paid only with supporting documentation.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU7.23 · 45%
- Practice expense (office) RVU7.68 · 47%
- Malpractice RVU1.33 · 8%
30
Medicare services in 2024 · #5662 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.
21406 compared with similar codes
Office rates for Rhode Island, from the same CMS release.
No office rate
Use 21408 when bone graft is part of the open orbital-fracture treatment. This code is for treatment without a bone graft.
$244.49
21400 describes closed treatment without manipulation. This code is for a fracture treated through open surgical exposure.
$565.55
21401 describes closed treatment with manipulation. This code applies when open surgical treatment is performed.
Compare 21406 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.
1 of 1 payment localities
Rhode Island →
Office / nonfacility
Unavailable
Facility
$550.69
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How this local rate is calculated
Each RVU component is multiplied by its own geographic practice cost index (GPCI). The three adjusted components are added, then multiplied by the conversion factor. These are the inputs used for 21406 in Rhode Island.
PPRRVU2026_Oct_nonQPP.csv
1,971
- Code
- 21406
- Physician work
- 7.23
- Practice expense
- 7.68
- Malpractice
- 1.33
GPCI2026.csv
92
- Locality
- Rhode Island
- Physician work
- 1.019
- Practice expense
- 1.033
- Malpractice
- 0.892
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 7.23 | × 1.019 | 7.3674 |
| Practice expense | 7.68 | × 1.033 | 7.9334 |
| Malpractice | 1.33 | × 0.892 | 1.1864 |
| Total RVUs | 16.4872 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Rhode Island$550.69
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 7.23 | 1.019 |
| Practice expense | 7.68 | 1.033 |
| Malpractice | 1.33 | 0.892 |
(7.23 × 1.019 + 7.68 × 1.033 + 1.33 × 0.892) × $33.4009 = $550.69
The office and facility calculations use their respective practice-expense RVUs. The facility amount here is the physician fee, not a separate hospital or facility bill.
21406 billing questions
How does this differ from 21407?
Use 21406 for open treatment without an implant. When the orbital fracture repair includes an implant, consider 21407.
When would 21408 be a better fit?
21408 is the related code for open orbital fracture treatment with bone graft. This code describes treatment without an implant or bone graft.
How does open treatment differ from 21400 or 21401?
This code is for open surgical treatment. Codes 21400 and 21401 describe closed treatment, with 21401 involving manipulation.
What documentation supports reporting this code?
Document the orbital fracture site, the open surgical approach, how the fracture was treated, and whether an implant or bone graft was placed.
What postoperative care is included?
The 90-day global period includes the day-before preoperative visit and related postoperative care through 90 days after surgery.
Can this be reported bilaterally?
For bilateral treatment, modifier 50 is paid at 150% under the CMS rule 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 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.
1,96821395,,Opn tx orbit periorbt w/grft,A,,14.33,9.87,NA,9.87,,2.65,26.85,26.85,0,090,0.10,0.69,0.21,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,96921400,,Closed tx orbit w/o manipulj,A,,1.46,5.43,,3.48,,0.25,7.14,5.19,0,090,0.10,0.69,0.21,2,1,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,97021401,,Closed tx orbit w/manipulj,A,,3.59,12.28,,5.20,,0.66,16.53,9.45,0,090,0.10,0.69,0.21,2,1,2,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,97121406,,Opn tx orbit fx w/o implant,A,,7.23,7.68,NA,7.68,,1.33,16.24,16.24,0,090,0.10,0.69,0.21,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,97221407,,Opn tx orbit fx w/implant,A,,8.79,7.29,NA,7.29,,1.21,17.29,17.29,0,090,0.10,0.69,0.21,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,97321408,,Opn tx orbit fx w/bone grft,A,,12.46,9.60,NA,9.60,,2.32,24.38,24.38,0,090,0.10,0.69,0.21,2,1,2,2,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,97421421,,Cltx palatal/max fx wire fix,A,,5.87,13.23,,8.85,,0.66,19.76,15.38,0,090,0.10,0.69,0.21,2,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
8912502,PA,01,METROPOLITAN PHILADELPHIA,1.018,1.041,1.193
9012502,PA,99,REST OF PENNSYLVANIA,1.000,0.918,0.945
9109202,PR,20,PUERTO RICO,1.000,1.011,0.985
9214412,RI,01,RHODE ISLAND,1.019,1.033,0.892
9311202,SC,01,SOUTH CAROLINA,1.000,0.924,0.850
9403402,SD,02,SOUTH DAKOTA**,1.000,1.000,0.336
9510312,TN,35,TENNESSEE,1.000,0.909,0.537