No office rate
21256 describes reconstruction of the orbit. Report 21275 when the documented service is revision of orbitofacial bones instead.
On this page
CMS RVU26D · Effective 2026-10-01
21275 Orbitofacial revision Medicare reimbursement rates in Utah
Reports corrective surgery revising the bony framework around the orbits and adjacent face, rather than a separately defined orbital reconstruction. Compare 21275 office and facility rates across CMS payment localities in Utah.
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 21275 in Utah?
Utah 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
$738.36
1 of 1 localities have a supported rate.
Payment area: Utah
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.
Craniofacial surgery
About 21275: Revision of orbitofacial bones
Reports corrective surgery revising the bony framework around the orbits and adjacent face, rather than a separately defined orbital reconstruction.
This code describes operative revision of orbitofacial bones, the skeletal structures surrounding the eye sockets and adjoining face. It may be used when a surgeon corrects residual or recurrent bony deformity after prior craniofacial surgery, trauma, or congenital reconstruction. Craniofacial, plastic, or oral and maxillofacial surgeons may perform this work in a hospital or other surgical setting. The operative report should identify the bones revised and explain the deformity and corrective work performed.
Report the code when the documented operation is a revision of the orbitofacial bony framework, not simply a separately defined orbital reconstruction or soft-tissue procedure. It has 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 subject to the standard 50% multiple-procedure reduction. Modifier 50 is inappropriate under the CMS bilateral rule. Assistant-at-surgery payment may be made; co-surgeon payment requires supporting documentation, and team surgery is not permitted.
CMS billing rules for 21275
- 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 may be paid.
- Co-surgeons
- Co-surgeons paid only with supporting documentation.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU11.47 · 50%
- Practice expense (office) RVU9.28 · 41%
- Malpractice RVU2.13 · 9%
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.
21275 compared with similar codes
Office rates for Utah, from the same CMS release.
No office rate
21260 is a separately defined eye-socket revision code. Choose between it and 21275 based on which code describes the actual operative scope.
No office rate
21268 is another specific eye-socket revision option; 21275 describes revision of orbitofacial bones. Match the code to the documented procedure.
Compare 21275 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
Utah →
Office / nonfacility
Unavailable
Facility
$738.36
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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 21275 in Utah.
PPRRVU2026_Oct_nonQPP.csv
1,937
- Code
- 21275
- Physician work
- 11.47
- Practice expense
- 9.28
- Malpractice
- 2.13
GPCI2026.csv
104
- Locality
- Utah
- Physician work
- 1.000
- Practice expense
- 0.940
- Malpractice
- 0.898
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 11.47 | × 1.000 | 11.4700 |
| Practice expense | 9.28 | × 0.940 | 8.7232 |
| Malpractice | 2.13 | × 0.898 | 1.9127 |
| Total RVUs | 22.1059 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Utah$738.36
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 11.47 | 1 |
| Practice expense | 9.28 | 0.94 |
| Malpractice | 2.13 | 0.898 |
(11.47 × 1 + 9.28 × 0.94 + 2.13 × 0.898) × $33.4009 = $738.36
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.
21275 billing questions
When should this code be chosen over an orbital reconstruction code?
Use this code for revision of orbitofacial bones. A code for reconstruction of the orbit, such as 21256, describes that separately defined service rather than the broader revision work.
Can modifier 50 be used when both sides are treated?
No. CMS identifies bilateral adjustment as inapplicable and modifier 50 as inappropriate for this code.
What documentation supports reporting this revision?
Document the bony deformity, the orbitofacial bones revised, the corrective work performed, and the relationship to any prior surgery or injury.
How does the 90-day global period affect follow-up visits?
The day-before preoperative visit and 90 days of related postoperative care are included in the global period.
Can an assistant or co-surgeon be reported?
Assistant-at-surgery payment may be made. Co-surgeon payment requires supporting documentation; team surgery is not permitted.
What happens when this is performed with another procedure in the same session?
The highest-valued procedure is paid in full, and other procedures are subject to the standard multiple-procedure reduction.
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.
1,93421267,,Revise eye sockets,A,,20.17,19.99,NA,19.99,,3.75,43.91,43.91,0,090,0.10,0.69,0.21,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,93521268,,Revise eye sockets,A,,26.39,23.25,NA,23.25,,4.89,54.53,54.53,0,090,0.10,0.69,0.21,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,93621270,,Augmentation cheek bone,A,,10.36,20.78,,7.94,,1.92,33.06,20.22,0,090,0.10,0.69,0.21,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,93721275,,Revision orbitofacial bones,A,,11.47,9.28,NA,9.28,,2.13,22.88,22.88,0,090,0.10,0.69,0.21,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,93821280,,Medial canthopexy,A,,6.95,8.04,NA,8.04,,0.71,15.70,15.70,0,090,0.10,0.69,0.21,2,1,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,93921282,,Lateral canthopexy,A,,4.16,6.39,NA,6.39,,0.51,11.06,11.06,0,090,0.10,0.69,0.21,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,94021295,,Revision of jaw muscle/bone,A,,1.85,3.43,NA,3.43,,0.26,5.54,5.54,0,090,0.10,0.69,0.21,2,1,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
10104412,TX,15,GALVESTON,1.008,0.993,0.828
10204412,TX,18,HOUSTON,1.008,0.993,1.376
10304412,TX,99,REST OF TEXAS,1.000,0.949,0.903
10403502,UT,09,UTAH,1.000,0.940,0.898
10514512,VT,50,VERMONT,1.000,0.990,0.506
10611302,VA,00,VIRGINIA,1.000,0.983,0.706
10709202,VI,50,VIRGIN ISLANDS,1.000,1.011,0.985