$1,533.06
Use 21086 for an auricular prosthesis replacing external ear structures; 21077 is for an orbital defect.
On this page
CMS RVU26D · Effective 2026-10-01
21077 Orbital prosthesis Medicare reimbursement rates in Wisconsin
Reports the impression and custom preparation of an orbital prosthesis for a patient with loss or absence of orbital structures. Compare 21077 office and facility rates across CMS payment localities in Wisconsin.
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 21077 in Wisconsin?
Wisconsin 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
$2066.32
1 of 1 localities have a supported rate.
Payment area: Wisconsin
One mapped payment locality.
Facility setting
$1428.91
1 of 1 localities have a supported rate.
Payment area: Wisconsin
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.
Maxillofacial prosthetics
About 21077: Custom orbital prosthesis impression and preparation
Reports the impression and custom preparation of an orbital prosthesis for a patient with loss or absence of orbital structures.
This service captures the patient’s orbital defect and prepares a custom prosthesis to restore the external appearance of the eye and surrounding orbital area. It is typically performed by a maxillofacial prosthodontist or other clinician with specialized facial prosthetic training, often after orbital exenteration for cancer or after traumatic loss. The prosthesis is distinct from a replacement for the globe alone because it addresses the broader orbital defect.
Report 21077 for the orbital prosthesis impression and custom preparation, supported by documentation of the defect and the patient-specific prosthetic work. CMS assigns a 90-day global period, which includes the day-before preoperative visit and related postoperative care through day 90. When multiple procedures occur in the same session, the highest-valued procedure is paid in full and other procedures are reduced to 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.
CMS billing rules for 21077
- 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 is paid only with documentation of medical necessity.
- Co-surgeons
- Co-surgeons not permitted.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU32.86 · 50%
- Practice expense (office) RVU29.07 · 44%
- Malpractice RVU3.75 · 6%
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.
21077 compared with similar codes
Office rates for Wisconsin, from the same CMS release.
$1,533.06
Use 21087 for a nasal prosthesis. 21077 applies when the prosthetic site is the orbit.
21088
No office rateImpres&prep facial prosth
Use 21088 for a facial prosthesis when the site is not specifically orbital; 21077 identifies the orbital prosthesis service.
$863.31
21076 is for a surgical obturator, used in relation to a surgical defect of the palate or maxilla, not an orbital prosthesis.
Compare 21077 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
Wisconsin →
Office / nonfacility
$2066.32
Facility
$1428.91
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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 21077 in Wisconsin.
PPRRVU2026_Oct_nonQPP.csv
1,862
- Code
- 21077
- Physician work
- 32.86
- Practice expense
- 29.07
- Malpractice
- 3.75
GPCI2026.csv
111
- Locality
- Wisconsin
- Physician work
- 1.000
- Practice expense
- 0.958
- Malpractice
- 0.308
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 32.86 | × 1.000 | 32.8600 |
| Practice expense | 29.07 | × 0.958 | 27.8491 |
| Malpractice | 3.75 | × 0.308 | 1.1550 |
| Total RVUs | 61.8641 | ||
| Conversion factor | × 33.4009 | ||
Office / nonfacility rate, Wisconsin$2066.32
Explore RVUs, geographic factors and the full formula
Office / nonfacility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 32.86 | 1 |
| Practice expense | 29.07 | 0.958 |
| Malpractice | 3.75 | 0.308 |
(32.86 × 1 + 29.07 × 0.958 + 3.75 × 0.308) × $33.4009 = $2066.32
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 32.86 | 1 |
| Practice expense | 9.15 | 0.958 |
| Malpractice | 3.75 | 0.308 |
(32.86 × 1 + 9.15 × 0.958 + 3.75 × 0.308) × $33.4009 = $1428.91
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.
21077 billing questions
When should 21077 be chosen instead of an ocular prosthesis service?
Use 21077 for a custom prosthesis addressing an orbital defect, including surrounding external structures. A prosthesis replacing only the eye itself is not the orbital prosthesis described by this code.
How does 21077 differ from 21088?
21077 is specific to an orbital prosthesis. 21088 is for a facial prosthesis when the prosthetic site is facial rather than orbital.
Does the 90-day global period include related postoperative care?
Yes. The CMS global period includes the day-before preoperative visit and 90 days of related postoperative care.
How is bilateral 21077 reported?
For bilateral orbital prostheses, report modifier 50; CMS pays the bilateral procedure at 150%.
Can an assistant surgeon or co-surgeon be reported?
Assistant-at-surgery payment is allowed only when medical necessity is documented. Co-surgeons and team surgery are not permitted.
What happens when 21077 is performed with another procedure in the same session?
The highest-valued procedure is paid in full, and other procedures in that session are subject to the standard 50% 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.
1,85921070,,Remove coronoid process,A,,8.40,6.54,NA,6.54,,1.23,16.17,16.17,0,090,0.10,0.69,0.21,2,1,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,86021073,,Mnpj of tmj w/anesth,A,,3.36,9.03,,2.85,,0.48,12.87,6.69,0,090,0.10,0.69,0.21,2,1,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,86121076,,Impres&prep surg obt prosth,A,,13.07,12.80,,4.07,,1.67,27.54,18.81,0,010,0.10,0.80,0.10,2,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,86221077,,Impres&prep orbital prosth,A,,32.86,29.07,,9.15,,3.75,65.68,45.76,0,090,0.10,0.69,0.21,2,1,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,86321079,,Impres&prep intrm obt prosth,A,,21.75,21.26,,6.72,,2.55,45.56,31.02,0,090,0.10,0.69,0.21,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,86421080,,Impres&prep def obt prosth,A,,24.43,24.45,,7.48,,2.91,51.79,34.82,0,090,0.10,0.69,0.21,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,86521081,,Impres&prep mndbl res prosth,A,,22.28,22.71,,6.95,,2.68,47.67,31.91,0,090,0.10,0.69,0.21,2,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
10802402,WA,02,SEATTLE (KING CNTY),1.050,1.227,0.817
10902402,WA,99,REST OF WASHINGTON,1.013,1.053,0.761
11011402,WV,16,WEST VIRGINIA,1.000,0.869,1.431
11106302,WI,00,WISCONSIN,1.000,0.958,0.308
11203602,WY,21,WYOMING**,1.000,1.000,0.740
113"MAC Assignments as of November 22, 2023",,,,,,
114,,,,,,