$863.31
Choose 21076 for the surgical obturator stage. Choose 21080 for the definitive obturator service.
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CMS RVU26D · Effective 2026-10-01
21080 Obturator prosthesis Medicare reimbursement rates in Wisconsin
Impression and preparation of a definitive obturator prosthesis to restore an acquired maxillary defect, commonly after resection and healing. Compare 21080 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 21080 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
$1628.27
1 of 1 localities have a supported rate.
Payment area: Wisconsin
One mapped payment locality.
Facility setting
$1085.27
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 21080: Definitive obturator prosthesis preparation
Impression and preparation of a definitive obturator prosthesis to restore an acquired maxillary defect, commonly after resection and healing.
This service covers taking an impression and preparing a definitive obturator prosthesis for a patient with an acquired maxillary or palatal defect, often following maxillectomy. The custom appliance closes the opening between the oral and nasal cavities and can support speech and swallowing. A maxillofacial prosthodontist or dentist with maxillofacial prosthetic expertise typically performs the work in a dental prosthetics clinic or hospital outpatient setting. The definitive stage is generally selected after the surgical defect has healed or stabilized, rather than for an appliance used immediately after surgery or during interim healing.
Report this code for the definitive obturator service, not the surgical or interim obturator stage. Documentation should identify the defect and clinical stage and describe the impression and preparation performed. CMS assigns a 90-day major-surgery global period, including 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 others at 50%. Bilateral adjustment is inappropriate; assistant-at-surgery payment is restricted, and co-surgeons and team surgery are not permitted.
CMS billing rules for 21080
- 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
- Statutory restriction: assistant at surgery is not paid.
- Co-surgeons
- Co-surgeons not permitted.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU24.43 · 47%
- Practice expense (office) RVU24.45 · 47%
- Malpractice RVU2.91 · 6%
521
Medicare services in 2024 · #3524 by national volume
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.
21080 compared with similar codes
Office rates for Wisconsin, from the same CMS release.
$1,432.98
21079 describes an interim obturator during healing; 21080 describes the definitive obturator stage.
$1,498.42
21081 concerns a prosthesis for a mandibular resection defect. This code is for a definitive obturator associated with a maxillary or palatal defect.
Compare 21080 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
$1628.27
Facility
$1085.27
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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 21080 in Wisconsin.
PPRRVU2026_Oct_nonQPP.csv
1,864
- Code
- 21080
- Physician work
- 24.43
- Practice expense
- 24.45
- Malpractice
- 2.91
GPCI2026.csv
111
- Locality
- Wisconsin
- Physician work
- 1.000
- Practice expense
- 0.958
- Malpractice
- 0.308
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 24.43 | × 1.000 | 24.4300 |
| Practice expense | 24.45 | × 0.958 | 23.4231 |
| Malpractice | 2.91 | × 0.308 | 0.8963 |
| Total RVUs | 48.7494 | ||
| Conversion factor | × 33.4009 | ||
Office / nonfacility rate, Wisconsin$1628.27
Explore RVUs, geographic factors and the full formula
Office / nonfacility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 24.43 | 1 |
| Practice expense | 24.45 | 0.958 |
| Malpractice | 2.91 | 0.308 |
(24.43 × 1 + 24.45 × 0.958 + 2.91 × 0.308) × $33.4009 = $1628.27
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 24.43 | 1 |
| Practice expense | 7.48 | 0.958 |
| Malpractice | 2.91 | 0.308 |
(24.43 × 1 + 7.48 × 0.958 + 2.91 × 0.308) × $33.4009 = $1085.27
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.
21080 billing questions
When should this code be chosen over 21079?
Use 21080 for the definitive obturator stage. Code 21079 describes an interim obturator used during the healing period.
How does 21080 differ from 21076?
21080 is for a definitive obturator; 21076 is for a surgical obturator used in the surgical stage.
What documentation supports reporting 21080?
Document the acquired maxillary or palatal defect, its clinical stage, and the impression and preparation work for the definitive appliance.
Can modifier 50 be used for bilateral obturator work?
No. CMS identifies bilateral adjustment as inappropriate for this code.
How does the global period affect related care?
The 90-day major-surgery global includes the day-before preoperative visit and related postoperative care through day 90.
What happens when another procedure is performed in the same session?
Under the standard multiple procedure reduction, the highest-valued procedure is paid in full and the other procedure is paid at 50%.
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.
1,86121076,,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
1,86621082,,Impres&prep paltl aug prosth,A,,20.32,22.14,,7.02,,2.40,44.86,29.74,0,090,0.10,0.69,0.21,2,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,86721083,,Impres&prep paltl lft prosth,A,,18.79,21.33,,6.49,,2.14,42.26,27.42,0,090,0.10,0.69,0.21,2,0,0,0,0,9,,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,,,,,,