21386 Orbital fracture repair Medicare reimbursement rates in Virginia

Code 21386 describes open repair of an orbital floor blowout fracture reached through a periorbital route, typically through an incision in the eyelid area. The surgeon exposes the fractured floor, addresses displaced bone and any orbital tissue caught at the defect, and restores support as needed. Ophthalmic or oculoplastic, facial plastic, otolaryngology, and oral and maxillofacial surgeons may perform this repair in an operating room, often for traumatic fractures associated with double vision, restricted eye movement, or a change in globe position.

Choose this code based on the documented periorbital approach, not merely the presence of an orbital fracture; transantral and combined approaches have different codes, as do repairs involving an implant or bone graft. The operative report should identify the fracture location, surgical route, findings such as tissue entrapment, and reconstruction performed. CMS assigns a 90-day global period, including the day-before preoperative visit and related postoperative care through day 90. In a session with multiple procedures, the highest-valued procedure is paid in full and others at 50%. Bilateral reporting with modifier 50 is paid at 150%. Assistant-at-surgery payment may be made; co-surgeons and team surgery are not permitted.