$236.31
Both describe closed orbital fracture treatment, but 21401 includes manipulation to reduce the fracture; 21400 is for treatment without manipulation.
On this page
CMS RVU26D · Effective 2026-10-01
21401 Orbital fracture treatment Medicare reimbursement rates in Wyoming
Closed reduction of an orbital fracture with manipulation is reported when the surgeon restores fracture alignment without open exposure. Compare 21401 office and facility rates across CMS payment localities in Wyoming.
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 21401 in Wyoming?
Wyoming 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
$546.39
1 of 1 localities have a supported rate.
Payment area: Wyoming**
One mapped payment locality.
Facility setting
$309.91
1 of 1 localities have a supported rate.
Payment area: Wyoming**
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.
Facial fracture treatment
About 21401: Closed orbital fracture reduction with manipulation
Closed reduction of an orbital fracture with manipulation is reported when the surgeon restores fracture alignment without open exposure.
This service covers closed management of an orbital fracture in which the surgeon manipulates the fracture to restore alignment rather than exposing it through an incision. Orbital fractures may involve the rim or walls of the orbit after facial trauma. The operative record should identify the fracture and describe the reduction maneuver. Ophthalmologists, oculoplastic surgeons, and facial trauma or oral and maxillofacial surgeons may perform this treatment in a hospital or ambulatory surgical setting.
Choose 21401 when closed treatment includes manipulation; 21400 describes closed treatment without manipulation. When the fracture is treated through open exposure, select the applicable open-treatment code instead. Document the fracture, laterality, operative details, and the manipulation performed. CMS assigns a 90-day major-surgery global period, including the day-before preoperative visit and 90 days of related postoperative care. In a same-session multiple-procedure claim, 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 may be made; co-surgeons and team surgery are not permitted.
CMS billing rules for 21401
- 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 may be paid.
- Co-surgeons
- Co-surgeons not permitted.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU3.59 · 22%
- Practice expense (office) RVU12.28 · 74%
- Malpractice RVU0.66 · 4%
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.
21401 compared with similar codes
Office rates for Wyoming, from the same CMS release.
No office rate
21406 is for open treatment of an orbital fracture without an implant. 21401 describes closed treatment with manipulation.
No office rate
21407 describes open orbital fracture treatment with an implant; 21401 is the closed-treatment option when manipulation is performed.
Compare 21401 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
Wyoming** →
Office / nonfacility
$546.39
Facility
$309.91
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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 21401 in Wyoming**.
PPRRVU2026_Oct_nonQPP.csv
1,970
- Code
- 21401
- Physician work
- 3.59
- Practice expense
- 12.28
- Malpractice
- 0.66
GPCI2026.csv
112
- Locality
- Wyoming**
- Physician work
- 1.000
- Practice expense
- 1.000
- Malpractice
- 0.740
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 3.59 | × 1.000 | 3.5900 |
| Practice expense | 12.28 | × 1.000 | 12.2800 |
| Malpractice | 0.66 | × 0.740 | 0.4884 |
| Total RVUs | 16.3584 | ||
| Conversion factor | × 33.4009 | ||
Office / nonfacility rate, Wyoming**$546.39
Explore RVUs, geographic factors and the full formula
Office / nonfacility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 3.59 | 1 |
| Practice expense | 12.28 | 1 |
| Malpractice | 0.66 | 0.74 |
(3.59 × 1 + 12.28 × 1 + 0.66 × 0.74) × $33.4009 = $546.39
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 3.59 | 1 |
| Practice expense | 5.2 | 1 |
| Malpractice | 0.66 | 0.74 |
(3.59 × 1 + 5.2 × 1 + 0.66 × 0.74) × $33.4009 = $309.91
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.
21401 billing questions
How does 21401 differ from 21400?
Use 21401 when the closed reduction involves manipulation of the fracture. Use 21400 for closed treatment without manipulation.
When is an open-treatment code more appropriate?
When the surgeon exposes the fracture for treatment, report the applicable open-treatment code rather than 21401. Codes 21406, 21407, and 21408 distinguish open orbital fracture treatment by the procedure performed.
What documentation supports 21401?
The operative record should identify the orbital fracture and laterality and describe the closed manipulation used to reduce it.
How is bilateral treatment reported under the CMS payment rule?
For a bilateral procedure reported with modifier 50, CMS pays 150% under the rule supplied for this code.
What postoperative care is included?
The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care.
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.
1,96721390,,Opn tx orbit periorbtl implt,A,,10.95,8.79,NA,8.79,,1.47,21.21,21.21,0,090,0.10,0.69,0.21,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,96821395,,Opn tx orbit periorbt w/grft,A,,14.33,9.87,NA,9.87,,2.65,26.85,26.85,0,090,0.10,0.69,0.21,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,96921400,,Closed tx orbit w/o manipulj,A,,1.46,5.43,,3.48,,0.25,7.14,5.19,0,090,0.10,0.69,0.21,2,1,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,97021401,,Closed tx orbit w/manipulj,A,,3.59,12.28,,5.20,,0.66,16.53,9.45,0,090,0.10,0.69,0.21,2,1,2,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,97121406,,Opn tx orbit fx w/o implant,A,,7.23,7.68,NA,7.68,,1.33,16.24,16.24,0,090,0.10,0.69,0.21,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,97221407,,Opn tx orbit fx w/implant,A,,8.79,7.29,NA,7.29,,1.21,17.29,17.29,0,090,0.10,0.69,0.21,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,97321408,,Opn tx orbit fx w/bone grft,A,,12.46,9.60,NA,9.60,,2.32,24.38,24.38,0,090,0.10,0.69,0.21,2,1,2,2,0,9,,33.4009,09,0,99,0.00,0.00,0.00
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,,,,,,
115*Work GPCI reflects a 1.5 floor in Alaska established by the MIPPA.,,,,,,