Billing code 21400: Orbital fracture treatmentMedicare rate & RVUs in Washington
Closed treatment of an orbital fracture without manipulation, reported when the clinician manages the fracture without repositioning the fractured bones.
Medicare pays $246.73–$280.56 for 21400 in the office in Washington, from Rest Of Washington to Seattle (King Cnty). 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 21400 covers
This service covers closed management of an orbital fracture when the clinician does not manipulate or reposition the fracture. Orbital floor, medial wall, or rim fractures may be managed this way when the treatment plan does not call for manual realignment. Ophthalmologists, facial plastic or otolaryngologic surgeons, and oral and maxillofacial surgeons may provide this care in an office or facility setting. The service represents fracture treatment, not simply an examination that identifies the injury.
Choose this code when the record supports active closed treatment without manipulation; document the fracture site, treatment plan, and whether the fracture was manipulated. If the clinician manipulates the fracture, consider 21401; open repair belongs to the applicable open-treatment code. CMS assigns a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. For multiple procedures in one session, the highest-valued procedure is paid in full and other procedures at 50%. Bilateral reporting with modifier 50 is paid at 150%. Assistant-at-surgery payment requires documented medical necessity; 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.
Where 21400 pays more and less in Washington
| Payment locality | Office | Facility |
|---|---|---|
| Rest Of Washington | $246.73 | $178.15 |
| Seattle (King Cnty) | $280.56 | $200.65 |
How the 21400 rate is calculated
Each of 21400’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 · 21400
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 1.46Practice expense 5.43Malpractice 0.25
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 21400
21400 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 21400
Orbital fracture treatment
| 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) | 0 | Not paid without supporting documentation. |
| 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 · 21400
Orbital fracture treatment
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
21400 without 50 · national office
$238.48
Orbital fracture treatment
21400-50 · Bilateral: 150%
$357.72
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).
21400 compared with similar codes
Compare codes
21400 vs 21401 vs 21406 vs 21407 vs 21408: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 21401Orbital fracture treatment
- Both codes describe closed orbital fracture treatment. Choose 21400 when treatment does not involve manipulation and 21401 when the fracture is manipulated.
- 21406Orbital fracture repair
- This code is for closed treatment without manipulation. 21406 describes open treatment of an orbital fracture without an implant.
- 21407Orbital repair
- Use 21400 for closed treatment without manipulation. 21407 is for open treatment with an implant.
- 21408Orbital fracture repair
- This code covers closed treatment without manipulation; 21408 applies to open orbital fracture treatment involving bone grafting.
21400 billing questions
How do I distinguish this code from 21401?
Use 21400 when the orbital fracture is treated without manipulation. When the clinician manipulates the fracture, 21401 is the related code to consider.
Can I report an office visit with the fracture treatment?
Related postoperative care is included in the 90-day global period. The documentation should distinguish any separately reported service from routine care related to this fracture treatment.
How is bilateral treatment reported?
For bilateral treatment, report modifier 50; CMS pays the bilateral procedure at 150%.
How does CMS handle another procedure performed in the same session?
The highest-valued procedure is paid in full, and other procedures in that session are paid at 50%.
Can an assistant or co-surgeon be reported?
Assistant-at-surgery payment requires documentation of medical necessity. Co-surgeons and team surgery are not permitted 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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