Billing code 21268: Orbital reconstructionMedicare rate & RVUs in Texas
Reports extensive reconstruction of the eye socket framework to correct orbital position or shape when a major craniofacial operation is performed.
CMS doesn’t publish an office rate for 21268 in Texas.
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 21268 covers
This code represents major reconstruction of the bony eye socket framework, rather than a limited eyelid or canthal procedure. It may be used when a craniofacial deformity requires substantial orbital repositioning or reshaping. Craniofacial, plastic, or oculoplastic surgeons typically perform the operation in a hospital operating room. The operative report should make clear the orbital structures addressed and the scope of reconstruction; the clinical indication and the actual technique guide selection among the related orbital-revision codes.
Report the code for the documented operation, not simply because the patient has an orbital deformity. The record should describe the preoperative problem, surgical approach, bony work, reconstruction, and laterality. CMS assigns a 90-day global period, which includes the day-before preoperative visit and 90 days of related postoperative care. For bilateral surgery, modifier 50 is paid at 150%. When multiple procedures are performed in one session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% reduction. An assistant at surgery may be paid; co-surgeons require supporting documentation, and team surgery is 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 21268 pays more and less in Texas
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
8 of 8 payment localities
| Payment locality | Office | Facility |
|---|---|---|
| Austin | Unavailable | $1,849.54 |
| Beaumont | Unavailable | $1,739.86 |
| Brazoria | Unavailable | $1,785.48 |
| Dallas | Unavailable | $1,802.98 |
| Fort Worth | Unavailable | $1,797.34 |
| Galveston | Unavailable | $1,794.87 |
| Houston | Unavailable | $1,884.38 |
| Rest Of Texas | Unavailable | $1,765.90 |
How the 21268 rate is calculated
Each of 21268’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 · 21268
RVUs × geographic indexes × conversion factor
Work26.39
26.39 RVUs× 1.000 GPCI
Practice expense23.25
23.25 RVUs× 1.000 GPCI
Malpractice4.89
4.89 RVUs× 1.000 GPCI
Adjusted RVUs
54.5300
Conversion factor
$33.4009
Medicare rate
$1,821.35
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 21268
21268 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 21268
Orbital reconstruction
| 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) | 1 | Permitted with supporting documentation. |
| 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 · 21268
Orbital reconstruction
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
21268 without 50 · national facility
$1,821.35
Orbital reconstruction
21268-50 · Bilateral: 150%
$2,732.03
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).
21268 compared with similar codes
Compare codes · National
5 codes, side by side
How to choose
- 21267Orbital repositioning
- Both belong to the eye-socket revision group. Use the code whose operative specification matches the documented reconstruction, rather than choosing by diagnosis alone.
- 21256Orbital reconstruction
- This is another orbital reconstruction code, but it represents a different operative circumstance. Base the choice on the specific procedure documented.
- 21280Canthopexy
- Medial canthopexy tightens soft tissue at the inner corner of the eye; it is not reconstruction of the bony eye socket.
- 21282Canthopexy
- Lateral canthopexy tightens the outer canthal support and is distinct from extensive reconstruction of the orbital framework.
21268 billing questions
How is this code distinguished from the other eye-socket revision codes?
Choose the code that matches the specific orbital reconstruction and extent documented in the operative report. The diagnosis alone does not establish that this code applies; compare the documented technique with the relevant sibling descriptors.
Can a separate eyelid or canthal procedure be reported with this operation?
A separately performed service may be reportable when it is distinct from the orbital reconstruction and has its own supporting documentation. CMS applies the multiple-procedure reduction when multiple procedures are performed in the same session.
How should bilateral surgery be billed?
Use modifier 50 for a bilateral procedure; CMS pays the bilateral service at 150%.
What postoperative care is included?
The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care. Document unrelated services separately when they meet applicable reporting requirements.
May an assistant or co-surgeon be reported?
An assistant at surgery may be paid. Co-surgeons are paid only with supporting documentation, and team surgery is not permitted under the CMS rules 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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