{"id":175532,"date":"2026-08-11T12:18:00","date_gmt":"2026-08-11T12:18:00","guid":{"rendered":"https:\/\/pabau.com\/?p=175532"},"modified":"2026-08-11T14:34:49","modified_gmt":"2026-08-11T14:34:49","slug":"cpt-code-21407","status":"publish","type":"post","link":"https:\/\/pabau.com\/es\/procedure-codes\/cpt-code-21407\/","title":{"rendered":"CPT code 21407: Open treatment of orbital fracture with implant"},"content":{"rendered":"\n<script type=\"application\/ld+json\">{\"@context\":\"https:\/\/schema.org\",\"@type\":\"MedicalWebPage\",\"headline\":\"CPT code 21407: Open treatment of orbital fracture with implant\",\"description\":\"Complete reference for CPT code 21407 (open treatment of fracture of orbit, except blowout, with implant): 2026 RVU values, Medicare reimbursement, modifiers, ICD-10 pairings, and billing guidelines.\",\"url\":\"https:\/\/pabau.com\/procedure-codes\/cpt-code-21407\/\",\"audience\":{\"@type\":\"MedicalAudience\",\"audienceType\":\"Clinician\"},\"reviewedBy\":{\"@type\":\"Person\",\"name\":\"Dr Vanja Kitanova\",\"jobTitle\":\"Medical Reviewer\",\"affiliation\":{\"@type\":\"Organization\",\"name\":\"Pabau\"},\"knowsAbout\":[\"Medical Coding\",\"Clinical Documentation\",\"Healthcare Billing\",\"Clinical Safety\"],\"sameAs\":\"https:\/\/pabau.com\/blog\/author\/vanja\/\"},\"datePublished\":\"2026-08-07\",\"dateModified\":\"2026-08-11\"}<\/script>\n\n\n        <div id=\"key_takeaways\">\n            <div class=\"header\">\n                                    <img decoding=\"async\" src=\"https:\/\/pabau.com\/wp-content\/uploads\/2025\/12\/Key-Takeaways-Icon.svg\" alt=\"Key takeaways\" height=\"42\" width=\"42\">\n                                <h3>Key takeaways<\/h3>\n            <\/div>\n            <div class=\"list\">\n                                                            <div class=\"item\">\n                            <div>\n                                <svg width=\"20\" height=\"27\" viewBox=\"0 0 20 27\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                                    <path\n                                        d=\"M18.6223 14.3857C19.1246 13.8975 19.1246 13.1045 18.6223 12.6162L12.1938 6.36621C11.6915 5.87793 10.8759 5.87793 10.3737 6.36621C9.87143 6.85449 9.87143 7.64746 10.3737 8.13574L14.6125 12.2529H2.28571C1.57455 12.2529 1 12.8115 1 13.5029C1 14.1943 1.57455 14.7529 2.28571 14.7529H14.6085L10.3777 18.8701C9.87545 19.3584 9.87545 20.1514 10.3777 20.6396C10.8799 21.1279 11.6955 21.1279 12.1978 20.6396L18.6263 14.3896L18.6223 14.3857Z\"\n                                        fill=\"#3D3D46\" \/>\n                                <\/svg>\n                            <\/div>\n                            <p>CPT code 21407 covers open treatment of an orbital fracture, excluding blowout, when the surgeon places an implant.<\/p>\n                        <\/div>\n                                                                                <div class=\"item\">\n                            <div>\n                                <svg width=\"20\" height=\"27\" viewBox=\"0 0 20 27\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                                    <path\n                                        d=\"M18.6223 14.3857C19.1246 13.8975 19.1246 13.1045 18.6223 12.6162L12.1938 6.36621C11.6915 5.87793 10.8759 5.87793 10.3737 6.36621C9.87143 6.85449 9.87143 7.64746 10.3737 8.13574L14.6125 12.2529H2.28571C1.57455 12.2529 1 12.8115 1 13.5029C1 14.1943 1.57455 14.7529 2.28571 14.7529H14.6085L10.3777 18.8701C9.87545 19.3584 9.87545 20.1514 10.3777 20.6396C10.8799 21.1279 11.6955 21.1279 12.1978 20.6396L18.6263 14.3896L18.6223 14.3857Z\"\n                                        fill=\"#3D3D46\" \/>\n                                <\/svg>\n                            <\/div>\n                            <p>The implant is the deciding factor: 21406 applies with no implant, 21407 with an implant, and 21408 with a bone graft.<\/p>\n                        <\/div>\n                                                                                <div class=\"item\">\n                            <div>\n                                <svg width=\"20\" height=\"27\" viewBox=\"0 0 20 27\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                                    <path\n                                        d=\"M18.6223 14.3857C19.1246 13.8975 19.1246 13.1045 18.6223 12.6162L12.1938 6.36621C11.6915 5.87793 10.8759 5.87793 10.3737 6.36621C9.87143 6.85449 9.87143 7.64746 10.3737 8.13574L14.6125 12.2529H2.28571C1.57455 12.2529 1 12.8115 1 13.5029C1 14.1943 1.57455 14.7529 2.28571 14.7529H14.6085L10.3777 18.8701C9.87545 19.3584 9.87545 20.1514 10.3777 20.6396C10.8799 21.1279 11.6955 21.1279 12.1978 20.6396L18.6263 14.3896L18.6223 14.3857Z\"\n                                        fill=\"#3D3D46\" \/>\n                                <\/svg>\n                            <\/div>\n                            <p>Under the 2026 fee schedule, 21407 carries 17.29 total RVUs in both facility and non-facility settings.<\/p>\n                        <\/div>\n                                                                                <div class=\"item\">\n                            <div>\n                                <svg width=\"20\" height=\"27\" viewBox=\"0 0 20 27\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                                    <path\n                                        d=\"M18.6223 14.3857C19.1246 13.8975 19.1246 13.1045 18.6223 12.6162L12.1938 6.36621C11.6915 5.87793 10.8759 5.87793 10.3737 6.36621C9.87143 6.85449 9.87143 7.64746 10.3737 8.13574L14.6125 12.2529H2.28571C1.57455 12.2529 1 12.8115 1 13.5029C1 14.1943 1.57455 14.7529 2.28571 14.7529H14.6085L10.3777 18.8701C9.87545 19.3584 9.87545 20.1514 10.3777 20.6396C10.8799 21.1279 11.6955 21.1279 12.1978 20.6396L18.6263 14.3896L18.6223 14.3857Z\"\n                                        fill=\"#3D3D46\" \/>\n                                <\/svg>\n                            <\/div>\n                            <p>S02.3XXA was deleted in 2016, so orbital floor claims now need a laterality-specific code such as S02.31XA or S02.32XA.<\/p>\n                        <\/div>\n                                                                                <div class=\"item\">\n                            <div>\n                                <svg width=\"20\" height=\"27\" viewBox=\"0 0 20 27\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                                    <path\n                                        d=\"M18.6223 14.3857C19.1246 13.8975 19.1246 13.1045 18.6223 12.6162L12.1938 6.36621C11.6915 5.87793 10.8759 5.87793 10.3737 6.36621C9.87143 6.85449 9.87143 7.64746 10.3737 8.13574L14.6125 12.2529H2.28571C1.57455 12.2529 1 12.8115 1 13.5029C1 14.1943 1.57455 14.7529 2.28571 14.7529H14.6085L10.3777 18.8701C9.87545 19.3584 9.87545 20.1514 10.3777 20.6396C10.8799 21.1279 11.6955 21.1279 12.1978 20.6396L18.6263 14.3896L18.6223 14.3857Z\"\n                                        fill=\"#3D3D46\" \/>\n                                <\/svg>\n                            <\/div>\n                            <p>Pabau&#8217;s claims management software validates CPT and ICD-10 pairings and attaches operative notes before an orbital fracture claim goes out.<\/p>\n                        <\/div>\n                                                <\/div>\n        <\/div>\n    \n\n\n<p class=\"wp-block-paragraph\">CPT code 21407 covers open treatment of an orbital fracture, excluding blowout, when the surgeon places an implant. The implant restores orbital anatomy, and its presence in the operative note is what separates 21407 from 21406. The code sits in the musculoskeletal section of the CPT code set, under fracture and dislocation procedures on the head.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">The <a href=\"https:\/\/www.ama-assn.org\/practice-management\/cpt\/cpt-code-set-overview\" target=\"_blank\" rel=\"nofollow noopener\">American Medical Association (AMA)<\/a> maintains the CPT code set and keeps 21407 separate from the blowout fracture codes, 21385 through 21395. Those cover a different mechanism and a different surgical approach. Sorting the two families out is the first decision on any orbital claim.<\/p>\n\n\n\n<figure class=\"wp-block-embed is-type-video is-provider-youtube wp-block-embed-youtube wp-embed-aspect-16-9 wp-has-aspect-ratio\"><div class=\"wp-block-embed__wrapper\">\n<iframe title=\"CPT Coding Pitfalls Every Medical Practice Faces\" width=\"800\" height=\"450\" src=\"https:\/\/www.youtube.com\/embed\/vbvV5okdXKg?feature=oembed\" frameborder=\"0\" allow=\"accelerometer; autoplay; clipboard-write; encrypted-media; gyroscope; picture-in-picture; web-share\" referrerpolicy=\"strict-origin-when-cross-origin\" allowfullscreen><\/iframe>\n<\/div><\/figure>\n\n\n\n<h2 id=\"h-cpt-code-21407-vs-21406-vs-21408-key-differences\" class=\"wp-block-heading\">CPT code 21407 vs. 21406 vs. 21408: Key differences<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">The 214XX orbital fracture codes are separated by what the surgeon places in the orbit. Picking the wrong one is among the most common billing errors in craniofacial and oculoplastic surgery. The table below shows the differentiating factor for each code.<\/p>\n\n\n\n<table style=\"width:100%;border-collapse:separate;border-spacing:0;border-radius:12px;overflow:hidden;font-size:15px;line-height:1.5;margin:1.5em 0 2em;box-shadow:0 2px 12px rgba(0,0,0,0.08)\">\n<thead>\n<tr>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">CPT code<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Description<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Key differentiator<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Typical use case<\/th>\n<\/tr>\n<\/thead>\n<tbody>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">21406<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Open treatment of orbital fracture, except blowout, without implant<\/td>\n<td style=\"padding:12px 16px;color:#374151\">No implant placed<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Fracture reduced and stabilized surgically without hardware<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">21407<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Open treatment of orbital fracture, except blowout, with implant<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Implant placed to restore anatomy<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Orbital floor or wall fracture needing an implant for structural support<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">21408<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Open treatment of orbital fracture, except blowout, with bone graft<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Autologous or allograft bone used<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Complex reconstruction where a synthetic implant alone is not enough<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n\n\n<p class=\"wp-block-paragraph\">The blowout exclusion applies to all three codes. Blowout fractures have their own range, 21385 through 21395, because the mechanism and the surgical approach differ from the fractures 21407 covers.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Adjacent head fracture codes follow the same logic. Percutaneous treatment of a malar area fracture is <a href=\"https:\/\/pabau.com\/procedure-codes\/cpt-code-21355\/\">21355<\/a>, and reconstruction of the orbital walls is <a href=\"https:\/\/pabau.com\/procedure-codes\/cpt-code-21184\/\">21184<\/a>. The <a href=\"https:\/\/www.aapc.com\/codify\/icd-10-crosswalk.aspx\" target=\"_blank\" rel=\"nofollow noopener\">AAPC CPT-to-ICD-10 crosswalk<\/a> confirms which diagnoses support each one.<\/p>\n\n\n        <div id=\"pro_tip\">\n            <div class=\"img\">\n                <svg width=\"42\" height=\"42\" viewBox=\"0 0 42 42\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                    <path fill-rule=\"evenodd\" clip-rule=\"evenodd\"\n                        d=\"M12.6383 19.5238C12.6632 21.2071 12.8734 22.9926 12.0685 24.5523C11.0341 26.8917 8.45076 28.169 7.56292 30.5918C6.63082 33.1061 7.19505 36.185 9.31371 37.9786C10.929 39.5678 13.4183 39.9873 15.6061 39.5463C17.4592 39.073 19.1049 37.8388 19.9706 36.1608C20.781 34.7141 20.7866 32.9904 20.5293 31.3985C20.1006 29.3092 18.3775 27.8705 16.9807 26.362C14.8814 24.1005 14.6684 20.6854 15.595 17.8915C16.4331 15.4768 19.0026 14.2344 20.0425 11.9461C20.7202 10.6769 20.7506 9.20327 20.6068 7.81304C20.1864 5.40098 18.3139 3.23631 15.8716 2.56674C13.9742 2.03969 11.8224 2.30052 10.1739 3.37614C8.70522 4.34688 7.5878 5.86618 7.28356 7.58178C6.76081 9.82981 7.53525 12.2822 9.20307 13.9118C10.7658 15.4741 12.4806 17.2273 12.6383 19.5238Z\"\n                        fill=\"#2BADD4\" \/>\n                    <path fill-rule=\"evenodd\" clip-rule=\"evenodd\"\n                        d=\"M22.7048 19.8387C22.6822 22.3279 24.4507 24.6234 26.7493 25.4682C28.0531 25.961 29.4725 25.9183 30.7989 25.5487C32.0575 24.9955 33.301 24.2237 34.0069 23.0092C34.8384 21.5811 35.2982 19.8286 34.7832 18.2094C34.3611 16.2507 32.8739 14.6541 31.0275 13.9426C28.6736 12.9595 25.8073 13.7942 24.1719 15.7001C23.2022 16.8366 22.6143 18.3326 22.7048 19.8387Z\"\n                        fill=\"#2BADD4\" \/>\n                <\/svg>\n            <\/div>\n            <div class=\"text\">\n                <h3>Pro Tip<\/h3>\n                <p>When the operative note describes both an implant and a bone graft for the same orbital fracture, do not bill 21407 and 21408 together. Check National Correct Coding Initiative (NCCI) edits for bundling rules first. Then confirm the local coverage determination from your Medicare Administrative Contractor (MAC) before you choose the higher-complexity code.<\/p>\n            <\/div>\n        <\/div>\n    \n\n\n<h2 id=\"h-rvu-values-under-the-2026-fee-schedule\" class=\"wp-block-heading\">RVU values under the 2026 fee schedule<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Relative value units (RVUs) drive what Medicare pays for 21407. The Centers for Medicare and Medicaid Services (CMS) sets them each year through the Medicare Physician Fee Schedule (MPFS). The table below shows the 2026 national values. Check the <a href=\"https:\/\/www.cms.gov\/medicare\/physician-fee-schedule\/search\/overview\" target=\"_blank\" rel=\"nofollow noopener\">CMS fee schedule lookup tool<\/a> for your own locality.<\/p>\n\n\n\n<table style=\"width:100%;border-collapse:separate;border-spacing:0;border-radius:12px;overflow:hidden;font-size:15px;line-height:1.5;margin:1.5em 0 2em;box-shadow:0 2px 12px rgba(0,0,0,0.08)\">\n<thead>\n<tr>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">RVU component<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Facility setting<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Non-facility setting<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Notes<\/th>\n<\/tr>\n<\/thead>\n<tbody>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Work RVU (wRVU)<\/td>\n<td style=\"padding:12px 16px;color:#374151\">8.79<\/td>\n<td style=\"padding:12px 16px;color:#374151\">8.79<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Physician effort component, identical across settings<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Practice expense RVU (PE RVU)<\/td>\n<td style=\"padding:12px 16px;color:#374151\">7.29<\/td>\n<td style=\"padding:12px 16px;color:#374151\">7.29<\/td>\n<td style=\"padding:12px 16px;color:#374151\">CMS gives 21407 the same practice expense value in both settings<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Malpractice RVU (MP RVU)<\/td>\n<td style=\"padding:12px 16px;color:#374151\">1.21<\/td>\n<td style=\"padding:12px 16px;color:#374151\">1.21<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Risk component, consistent across settings<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Total RVU<\/td>\n<td style=\"padding:12px 16px;color:#374151\">17.29<\/td>\n<td style=\"padding:12px 16px;color:#374151\">17.29<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Work plus practice expense plus malpractice, before GPCI adjustment<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n\n\n<p class=\"wp-block-paragraph\">That last row is worth a second look. Plenty of surgical codes pay more in a non-facility setting because the physician carries the overhead. 21407 is not one of them. The site of service leaves the RVU total untouched, so a hospital case and an office-based case start from the same number.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Figures shift with each year&#8217;s fee schedule and with the Geographic Practice Cost Index (GPCI), which adjusts payment for your location. The <a href=\"https:\/\/fastrvu.com\/tools\/rvu-lookup\" target=\"_blank\" rel=\"nofollow noopener\">FastRVU lookup tool<\/a> returns current, locality-adjusted values for 21407.<\/p>\n\n\n\n<h2 id=\"h-how-medicare-payment-is-calculated\" class=\"wp-block-heading\">How Medicare payment is calculated<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Medicare payment for 21407 is the total RVU multiplied by the annual conversion factor (CF), adjusted by the GPCI for your locality. At the 2026 conversion factor of $33.4009, 17.29 RVUs comes to roughly $578 before that adjustment. The conversion factor changes every January 1, so any dollar figure is year-specific.<\/p>\n\n\n\n<table style=\"width:100%;border-collapse:separate;border-spacing:0;border-radius:12px;overflow:hidden;font-size:15px;line-height:1.5;margin:1.5em 0 2em;box-shadow:0 2px 12px rgba(0,0,0,0.08)\">\n<thead>\n<tr>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Factor<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Details<\/th>\n<\/tr>\n<\/thead>\n<tbody>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Conversion factor<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Set annually by CMS in dollars per RVU. The 2026 figure is $33.4009.<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">GPCI adjustment<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Varies by locality. Rural areas typically receive lower payments than urban markets.<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Facility setting<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Total RVU of 17.29. The hospital or surgery center bills separately for its own overhead.<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Non-facility setting<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Also 17.29 for this code, so an office-based case starts from the same total.<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Global period<\/td>\n<td style=\"padding:12px 16px;color:#374151\">90 days. Related follow-up care is bundled into the single payment.<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n\n\n<p class=\"wp-block-paragraph\">Each MAC publishes local coverage determinations (LCDs) that define medical necessity for orbital fracture repair. Your MAC may ask for documentation beyond the national standard. Confirm the active LCDs for your region before you bill Medicare.<\/p>\n\n\n\n<h2 id=\"h-modifiers-that-apply-to-21407\" class=\"wp-block-heading\">Modifiers that apply to 21407<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">The modifier decides whether a claim pays in full, downcodes, or denies. These are the ones that come up most often in orbital fracture repair.<\/p>\n\n\n\n<table style=\"width:100%;border-collapse:separate;border-spacing:0;border-radius:12px;overflow:hidden;font-size:15px;line-height:1.5;margin:1.5em 0 2em;box-shadow:0 2px 12px rgba(0,0,0,0.08)\">\n<thead>\n<tr>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Modifier<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Name<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">When to use it with 21407<\/th>\n<\/tr>\n<\/thead>\n<tbody>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">-22<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Increased procedural services<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Operative time or complexity well beyond the typical case. Needs detailed operative note support.<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">-50<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Bilateral procedure<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Both orbits treated in the same session. Check payer bilateral rules before applying it.<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">-51<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Multiple procedures<\/td>\n<td style=\"padding:12px 16px;color:#374151\">21407 performed alongside another separate procedure. The secondary procedure is reduced by 50%.<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">-52<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Reduced services<\/td>\n<td style=\"padding:12px 16px;color:#374151\">The procedure was less extensive than described, such as an abbreviated implant placement.<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">-62<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Two surgeons<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Two surgeons of different specialties each perform a distinct part of the procedure.<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">-80<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Assistant surgeon<\/td>\n<td style=\"padding:12px 16px;color:#374151\">A second physician assists. Medicare pays the assistant 16% of the primary fee.<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n\n\n<p class=\"wp-block-paragraph\">Commercial payers often handle modifier -50 differently from Medicare. Some want two line items, 21407-RT and 21407-LT, instead of the single bilateral modifier. Confirm the rule with the payer before you submit a bilateral repair.<\/p>\n\n\n\n<h2 id=\"h-icd-10-codes-paired-with-21407\" class=\"wp-block-heading\">ICD-10 codes paired with 21407<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Every 21407 claim needs an ICD-10-CM diagnosis code that establishes medical necessity. The diagnosis has to carry the fracture site, the side, and the encounter type. Initial encounters use the seventh character A for a closed fracture and B for an open one, as in <a href=\"https:\/\/pabau.com\/diagnostic-codes\/icd-10-code-s02121b\/\">S02.32XB<\/a>.<\/p>\n\n\n\n<table style=\"width:100%;border-collapse:separate;border-spacing:0;border-radius:12px;overflow:hidden;font-size:15px;line-height:1.5;margin:1.5em 0 2em;box-shadow:0 2px 12px rgba(0,0,0,0.08)\">\n<thead>\n<tr>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">ICD-10-CM codes<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Description<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Notes<\/th>\n<\/tr>\n<\/thead>\n<tbody>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">S02.30XA, S02.31XA, S02.32XA<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Fracture of orbital floor: unspecified side, right side, left side<\/td>\n<td style=\"padding:12px 16px;color:#374151\">The most common pairing for 21407. Code the side named in the operative note.<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">S02.839A, S02.831A, S02.832A<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Fracture of medial orbital wall: unspecified side, right side, left side<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Lamina papyracea fractures, coded separately from the floor<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">S02.121A, S02.122A<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Fracture of orbital roof, right side and left side<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Use when the note documents the roof rather than the floor<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">S02.841A, S02.842A<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Fracture of lateral orbital wall, right side and left side<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Often part of a zygomaticomaxillary complex injury<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">S02.400A, S02.401A<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Malar fracture and maxillary fracture, unspecified side<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Use when the injury extends into the malar complex<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">S02.411A, S02.412A, S02.413A<\/td>\n<td style=\"padding:12px 16px;color:#374151\">LeFort I, LeFort II, and LeFort III fracture<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Complex facial fractures may involve the orbit. Verify the anatomy documented.<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n\n\n<p class=\"wp-block-paragraph\">S02.3XXA still turns up on orbital claims, and it was deleted in 2016. Payers reject it. Orbital floor fractures now carry laterality, so the correct choice is S02.30XA, S02.31XA, or S02.32XA.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">The medial orbital wall works the same way, so S02.83XA becomes S02.831A, S02.832A, or S02.839A. LeFort patterns are coded S02.411A, S02.412A, and S02.413A. A LeFort injury usually moves the procedure into a different CPT family, starting with <a href=\"https:\/\/pabau.com\/procedure-codes\/cpt-code-21422\/\">21422<\/a> and <a href=\"https:\/\/pabau.com\/procedure-codes\/cpt-code-21346\/\">21346<\/a>.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Blowout fractures also code to the S02.3 family, so the diagnosis alone will not tell a payer which CPT code belongs on the claim. Only the operative note does that. Billing 21407 for a pure blowout repair is a common upcoding error that draws audits.<\/p>\n\n\n\n<h2 id=\"h-documentation-the-operative-note-must-carry\" class=\"wp-block-heading\">Documentation the operative note must carry<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">The operative note is the billing record for 21407. CMS Article A52767 on fracture care billing requires documentation that supports the level of service billed, including the surgical approach and the implant. Records also have to stay <a href=\"https:\/\/pabau.com\/blog\/hipaa-compliance-for-medical-offices\/\">HIPAA compliant<\/a>, since payers can request the note at any point.<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Diagnosis confirmation:<\/strong> Reference the preoperative CT scan in the note, confirming the fracture type and ruling out a blowout mechanism.<\/li>\n\n\n\n<li><strong>Surgical approach:<\/strong> Document the incision location, whether subciliary, transconjunctival, or coronal, plus the exposure method and landmarks accessed.<\/li>\n\n\n\n<li><strong>Implant details:<\/strong> Record the manufacturer, material, size, and placement method. This is the clinical element that separates 21407 from 21406.<\/li>\n\n\n\n<li><strong>Fracture complexity:<\/strong> Describe comminution, degree of displacement, and any involvement of adjacent orbital walls. This is what supports modifier -22.<\/li>\n\n\n\n<li><strong>Surgeon identity:<\/strong> If you bill modifier -62 or -80, both surgeons have to document their own contribution to the procedure.<\/li>\n\n\n\n<li><strong>Postoperative plan:<\/strong> Include planned follow-up, global period management, and any complications encountered during the operation.<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">The global surgery period for 21407 is 90 days under Medicare. Related follow-up visits, dressing changes, and suture removal inside that window are bundled. They cannot be billed separately without a modifier showing the service was unrelated.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Referrals often arrive from emergency departments or <a href=\"https:\/\/pabau.com\/industry\/sports-medicine-software\/\">sports medicine practices<\/a>, so the preoperative imaging report may sit outside your own records. <a href=\"https:\/\/pabau.com\/features\/patient-intake-software\/\">Digital forms<\/a> that capture implant type, approach, and fracture detail keep every piece together before the claim goes out.<\/p>\n\n\n\n<figure class=\"wp-block-image size-large\"><img decoding=\"async\" src=\"https:\/\/cdn.pabau.com\/cdn\/attachments\/pulse\/content-engine\/billing_codes\/cpt-code-21407\/digital-forms.webp\" alt=\"Pabau digital forms builder\"\/><figcaption class=\"wp-element-caption\"><em>Pabau&#8217;s digital forms capture implant type, approach, and fracture detail as structured fields, so the operative record is complete before billing.<\/em><\/figcaption><\/figure>\n\n\n\n<div style=\"height:35px;width:800px\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div>\n\n\n\n<h2 id=\"h-common-billing-errors-and-how-to-avoid-them\" class=\"wp-block-heading\">Common billing errors and how to avoid them<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">A handful of errors drive most 21407 denials. Each one has a pre-submission check that catches it.<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Code family confusion:<\/strong> Coding 21407 when no implant was placed, or 21406 when one was, are both audit triggers. The note needs an explicit implant reference to support 21407. If it reads \u00abreduced and approximated without hardware,\u00bb 21406 applies.<\/li>\n\n\n\n<li><strong>Blowout fracture miscoding:<\/strong> Billing 21407 for a pure blowout repair is a frequent error. Confirm the note rules out the blowout definition before you send the claim.<\/li>\n\n\n\n<li><strong>Global period bundling:<\/strong> Billing an evaluation and management (E\/M) visit inside the 90-day window without modifier -24 or -25 denies automatically.<\/li>\n\n\n\n<li><strong>Modifier -22 without support:<\/strong> Asking for more money through -22 with no note explaining the unusual complexity invites a records request and a downward adjustment.<\/li>\n\n\n\n<li><strong>Unspecified laterality:<\/strong> Sending S02.30XA when the note names the right or left orbit creates a medical necessity mismatch. Use S02.31XA or S02.32XA instead.<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">Coding accuracy is one half of <a href=\"https:\/\/pabau.com\/blog\/what-is-medical-billing\/\">medical billing<\/a>. The review step before submission is the other half. Many practices add a second-level review for surgical codes with 90-day global periods, where bundling risk is highest. Tracking denials by code shows which part of the workflow needs attention.<\/p>\n\n\n        <div id=\"pro_tip\">\n            <div class=\"img\">\n                <svg width=\"42\" height=\"42\" viewBox=\"0 0 42 42\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                    <path fill-rule=\"evenodd\" clip-rule=\"evenodd\"\n                        d=\"M12.6383 19.5238C12.6632 21.2071 12.8734 22.9926 12.0685 24.5523C11.0341 26.8917 8.45076 28.169 7.56292 30.5918C6.63082 33.1061 7.19505 36.185 9.31371 37.9786C10.929 39.5678 13.4183 39.9873 15.6061 39.5463C17.4592 39.073 19.1049 37.8388 19.9706 36.1608C20.781 34.7141 20.7866 32.9904 20.5293 31.3985C20.1006 29.3092 18.3775 27.8705 16.9807 26.362C14.8814 24.1005 14.6684 20.6854 15.595 17.8915C16.4331 15.4768 19.0026 14.2344 20.0425 11.9461C20.7202 10.6769 20.7506 9.20327 20.6068 7.81304C20.1864 5.40098 18.3139 3.23631 15.8716 2.56674C13.9742 2.03969 11.8224 2.30052 10.1739 3.37614C8.70522 4.34688 7.5878 5.86618 7.28356 7.58178C6.76081 9.82981 7.53525 12.2822 9.20307 13.9118C10.7658 15.4741 12.4806 17.2273 12.6383 19.5238Z\"\n                        fill=\"#2BADD4\" \/>\n                    <path fill-rule=\"evenodd\" clip-rule=\"evenodd\"\n                        d=\"M22.7048 19.8387C22.6822 22.3279 24.4507 24.6234 26.7493 25.4682C28.0531 25.961 29.4725 25.9183 30.7989 25.5487C32.0575 24.9955 33.301 24.2237 34.0069 23.0092C34.8384 21.5811 35.2982 19.8286 34.7832 18.2094C34.3611 16.2507 32.8739 14.6541 31.0275 13.9426C28.6736 12.9595 25.8073 13.7942 24.1719 15.7001C23.2022 16.8366 22.6143 18.3326 22.7048 19.8387Z\"\n                        fill=\"#2BADD4\" \/>\n                <\/svg>\n            <\/div>\n            <div class=\"text\">\n                <h3>Pro Tip<\/h3>\n                <p>Set up a claim review rule for the 21406-21407-21408 family. Flag any 21407 claim where the attached operative note has no keyword match for &#8216;implant&#8217; or &#8216;implant placement.&#8217; That single rule catches the most common upcoding error before submission.<\/p>\n            <\/div>\n        <\/div>\n    \n\n\n<h2 id=\"h-how-pabau-supports-orbital-fracture-billing\" class=\"wp-block-heading\">How Pabau supports orbital fracture billing<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Surgical billing for a code like 21407 creates more documentation touchpoints than routine office coding. <a href=\"https:\/\/pabau.com\/industry\/plastic-surgery-emr\/\">Plastic surgery practices<\/a> handling orbital repairs alongside other head and neck work need three things. Operative notes have to link to claims, ICD-10 pairings need checking, and the global period has to be tracked.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><a href=\"https:\/\/pabau.com\/blog\/practice-management-software\/\">Practice management software<\/a> like Pabau handles that workflow in one place. Its <a href=\"https:\/\/pabau.com\/features\/claims-management-software\/\">claims management<\/a> tools capture structured operative data, attach it to the claim, and validate the CPT and ICD-10 pair before submission. The checklist confirms implant details and surgical approach are filled in first.<\/p>\n\n\n\n<figure class=\"wp-block-image size-large\"><img decoding=\"async\" src=\"https:\/\/cdn.pabau.com\/cdn\/attachments\/pulse\/content-engine\/billing_codes\/cpt-code-21407\/automate-claims-through-healthcode.webp\" alt=\"Automate claims and billing with Pabau\"\/><figcaption class=\"wp-element-caption\"><em>Pabau&#8217;s claims tools submit and track a 21407 claim, so you see a rejection the day it lands instead of a month later.<\/em><\/figcaption><\/figure>\n\n\n\n<div style=\"height:35px;width:800px\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div>\n\n\n\n<p class=\"wp-block-paragraph\">The 90-day global period tracker flags a follow-up visit that falls inside the window, which cuts inadvertent bundling errors. For a fracture care program running several surgeons, <a href=\"https:\/\/pabau.com\/features\/medical-records-management\/\">structured clinical records<\/a> keep implant documentation, modifier justification, and follow-up notes together at claim review.<\/p>\n\n\n\n<figure class=\"wp-block-image size-large\"><img decoding=\"async\" src=\"https:\/\/cdn.pabau.com\/cdn\/attachments\/pulse\/content-engine\/billing_codes\/cpt-code-21407\/detailed-client-records-in-pabau.webp\" alt=\"Detailed client records in Pabau\"\/><figcaption class=\"wp-element-caption\"><em>Pabau&#8217;s client records hold implant details, modifier notes, and follow-up visits in one place, so a global period review takes minutes.<\/em><\/figcaption><\/figure>\n\n\n\n<div style=\"height:35px;width:800px\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div>\n\n\n        <div id=\"book_a_demo\">\n            <div class=\"left-side\">\n                <div class=\"logo\">\n                    <img decoding=\"async\"\n                        src=\"https:\/\/pabau.com\/wp-content\/uploads\/2026\/01\/Logo.svg\"\n                        alt=\"Logo\"\n                        loading=\"lazy\"\n                    \/>\n                <\/div>\n\n                <h3 class=\"heading\">\n                    Send orbital fracture claims with the documentation attached                <\/h3>\n\n                <p class=\"description\">\n                    Pabau&#8217;s claims management software attaches the operative note to the claim and checks the CPT and ICD-10 pairing before you submit. Your team spends less time reworking denials.                <\/p>\n\n                <div class=\"button-group\">\n                    <a href=\"\/book-demo\/\" class=\"btn btn-scale-effect btn-cta-color btn-md\">\n                        <span class=\"btn-text\">Book a demo<\/span>\n                        <div class=\"btn-icon btn-icon-right\" aria-hidden=\"true\">\n                            <svg\n                                width=\"14\"\n                                height=\"12\"\n                                viewBox=\"0 0 14 12\"\n                                fill=\"none\"\n                                xmlns=\"http:\/\/www.w3.org\/2000\/svg\"\n                            >\n                                <path\n                                    d=\"M0.75 4.77295C0.335786 4.77295 0 5.10874 0 5.52295C0 5.93716 0.335786 6.27295 0.75 6.27295V5.52295V4.77295ZM13.2803 6.05328C13.5732 5.76039 13.5732 5.28551 13.2803 4.99262L8.50736 0.219648C8.21447 -0.073245 7.73959 -0.073245 7.4467 0.219648C7.15381 0.512542 7.15381 0.987415 7.4467 1.28031L11.6893 5.52295L7.4467 9.76559C7.15381 10.0585 7.15381 10.5334 7.4467 10.8263C7.73959 11.1191 8.21447 11.1191 8.50736 10.8263L13.2803 6.05328ZM0.75 5.52295V6.27295L12.75 6.27295V5.52295V4.77295L0.75 4.77295V5.52295Z\"\n                                    fill=\"currentColor\"\n                                ><\/path>\n                            <\/svg>\n                        <\/div>\n                    <\/a>\n                <\/div>\n            <\/div>\n\n            <div class=\"right-side\">\n                <img decoding=\"async\"\n                    src=\"https:\/\/pabau.com\/wp-content\/uploads\/2026\/01\/Home-Page-Concept-4.webp\"\n                    alt=\"Pabau claims management dashboard\"\n                    loading=\"lazy\"\n                \/>\n            <\/div>\n        <\/div>\n        \n\n\n<h2 id=\"h-conclusion\" class=\"wp-block-heading\">Conclusion<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">The implant line in the operative note is what makes 21407 the right code, and it is the first thing a payer looks for. If that line is vague, the claim downcodes to 21406 no matter how complex the case was.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Site of service will not change what Medicare pays here. The leverage sits in the operative note, the ICD-10 laterality, and the 90-day global period.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Build the pre-submission review around those three and the denials thin out quickly. <a href=\"https:\/\/pabau.com\/book-demo\/\">Book a demo<\/a> to see how Pabau keeps operative detail attached to surgical claims.<\/p>\n\n\n        <div id=\"expert_picks\">\n            <div class=\"header\">\n                                    <img decoding=\"async\" src=\"https:\/\/pabau.com\/wp-content\/uploads\/2025\/11\/Expert-Picks.svg\" alt=\"Continue your research\" height=\"42\" width=\"42\">\n                                <h3>Continue your research<\/h3>\n            <\/div>\n            <div class=\"content\">\n                                                            <div class=\"item\">\n                            <div>\n                                <svg width=\"20\" height=\"27\" viewBox=\"0 0 20 27\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                                    <path\n                                        d=\"M18.6223 14.3857C19.1246 13.8975 19.1246 13.1045 18.6223 12.6162L12.1938 6.36621C11.6915 5.87793 10.8759 5.87793 10.3737 6.36621C9.87143 6.85449 9.87143 7.64746 10.3737 8.13574L14.6125 12.2529H2.28571C1.57455 12.2529 1 12.8115 1 13.5029C1 14.1943 1.57455 14.7529 2.28571 14.7529H14.6085L10.3777 18.8701C9.87545 19.3584 9.87545 20.1514 10.3777 20.6396C10.8799 21.1279 11.6955 21.1279 12.1978 20.6396L18.6263 14.3896L18.6223 14.3857Z\"\n                                        fill=\"#54B2D3\" \/>\n                                <\/svg>\n                            <\/div>\n                            <p><strong>Coding another head fracture repair?<\/strong> <a href=\"https:\/\/pabau.com\/procedure-codes\/cpt-code-21470\/\">21470<\/a> covers open treatment of a complicated mandibular fracture, with the same documentation demands.<\/p>\n                        <\/div>\n                                                                                <div class=\"item\">\n                            <div>\n                                <svg width=\"20\" height=\"27\" viewBox=\"0 0 20 27\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                                    <path\n                                        d=\"M18.6223 14.3857C19.1246 13.8975 19.1246 13.1045 18.6223 12.6162L12.1938 6.36621C11.6915 5.87793 10.8759 5.87793 10.3737 6.36621C9.87143 6.85449 9.87143 7.64746 10.3737 8.13574L14.6125 12.2529H2.28571C1.57455 12.2529 1 12.8115 1 13.5029C1 14.1943 1.57455 14.7529 2.28571 14.7529H14.6085L10.3777 18.8701C9.87545 19.3584 9.87545 20.1514 10.3777 20.6396C10.8799 21.1279 11.6955 21.1279 12.1978 20.6396L18.6263 14.3896L18.6223 14.3857Z\"\n                                        fill=\"#54B2D3\" \/>\n                                <\/svg>\n                            <\/div>\n                            <p><strong>Working a LeFort I case?<\/strong> <a href=\"https:\/\/pabau.com\/procedure-codes\/cpt-code-21422\/\">21422<\/a> walks through open treatment of a palatal or maxillary fracture.<\/p>\n                        <\/div>\n                                                                                <div class=\"item\">\n                            <div>\n                                <svg width=\"20\" height=\"27\" viewBox=\"0 0 20 27\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                                    <path\n                                        d=\"M18.6223 14.3857C19.1246 13.8975 19.1246 13.1045 18.6223 12.6162L12.1938 6.36621C11.6915 5.87793 10.8759 5.87793 10.3737 6.36621C9.87143 6.85449 9.87143 7.64746 10.3737 8.13574L14.6125 12.2529H2.28571C1.57455 12.2529 1 12.8115 1 13.5029C1 14.1943 1.57455 14.7529 2.28571 14.7529H14.6085L10.3777 18.8701C9.87545 19.3584 9.87545 20.1514 10.3777 20.6396C10.8799 21.1279 11.6955 21.1279 12.1978 20.6396L18.6263 14.3896L18.6223 14.3857Z\"\n                                        fill=\"#54B2D3\" \/>\n                                <\/svg>\n                            <\/div>\n                            <p><strong>Reconstructing the zygomatic arch?<\/strong> <a href=\"https:\/\/pabau.com\/procedure-codes\/cpt-code-21255\/\">21255<\/a> covers the bone graft reconstruction and the modifiers that go with it.<\/p>\n                        <\/div>\n                                                                                <div class=\"item\">\n                            <div>\n                                <svg width=\"20\" height=\"27\" viewBox=\"0 0 20 27\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                                    <path\n                                        d=\"M18.6223 14.3857C19.1246 13.8975 19.1246 13.1045 18.6223 12.6162L12.1938 6.36621C11.6915 5.87793 10.8759 5.87793 10.3737 6.36621C9.87143 6.85449 9.87143 7.64746 10.3737 8.13574L14.6125 12.2529H2.28571C1.57455 12.2529 1 12.8115 1 13.5029C1 14.1943 1.57455 14.7529 2.28571 14.7529H14.6085L10.3777 18.8701C9.87545 19.3584 9.87545 20.1514 10.3777 20.6396C10.8799 21.1279 11.6955 21.1279 12.1978 20.6396L18.6263 14.3896L18.6223 14.3857Z\"\n                                        fill=\"#54B2D3\" \/>\n                                <\/svg>\n                            <\/div>\n                            <p><strong>Billing interdental fixation on its own?<\/strong> <a href=\"https:\/\/pabau.com\/procedure-codes\/cpt-code-21110\/\">21110<\/a> explains when the device application is separately reportable.<\/p>\n                        <\/div>\n                                                                                <div class=\"item\">\n                            <div>\n                                <svg width=\"20\" height=\"27\" viewBox=\"0 0 20 27\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                                    <path\n                                        d=\"M18.6223 14.3857C19.1246 13.8975 19.1246 13.1045 18.6223 12.6162L12.1938 6.36621C11.6915 5.87793 10.8759 5.87793 10.3737 6.36621C9.87143 6.85449 9.87143 7.64746 10.3737 8.13574L14.6125 12.2529H2.28571C1.57455 12.2529 1 12.8115 1 13.5029C1 14.1943 1.57455 14.7529 2.28571 14.7529H14.6085L10.3777 18.8701C9.87545 19.3584 9.87545 20.1514 10.3777 20.6396C10.8799 21.1279 11.6955 21.1279 12.1978 20.6396L18.6263 14.3896L18.6223 14.3857Z\"\n                                        fill=\"#54B2D3\" \/>\n                                <\/svg>\n                            <\/div>\n                            <p><strong>Facing a panfacial injury?<\/strong> <a href=\"https:\/\/pabau.com\/procedure-codes\/cpt-code-21433\/\">21433<\/a> covers open treatment of craniofacial separation and what the note has to show.<\/p>\n                        <\/div>\n                                                <\/div>\n        <\/div>\n    \n\n\n<h2 id=\"h-frequently-asked-questions\" class=\"wp-block-heading\">Frequently asked questions<\/h2>\n\n\n\n<div class=\"schema-faq wp-block-yoast-faq-block\"><div class=\"schema-faq-section\" id=\"faq-question-1786435243829\"><h3 class=\"schema-faq-question\">What does CPT code 21407 mean?<\/h3> <p class=\"schema-faq-answer\">CPT code 21407 is the procedure code for open treatment of an orbital fracture, excluding blowout fractures, with placement of an implant. It sits in the musculoskeletal section of the CPT code set, under fracture and dislocation procedures on the head.<\/p> <\/div> <div class=\"schema-faq-section\" id=\"faq-question-1786435243830\"><h3 class=\"schema-faq-question\">What is the difference between CPT codes 21406, 21407, and 21408?<\/h3> <p class=\"schema-faq-answer\">21406 covers open treatment without an implant, 21407 covers open treatment with an implant, and 21408 covers open treatment with a bone graft. The operative note must document implant placement to support 21407. Without it, 21406 applies regardless of surgical complexity.<\/p> <\/div> <div class=\"schema-faq-section\" id=\"faq-question-1786435243831\"><h3 class=\"schema-faq-question\">What modifiers apply to CPT code 21407?<\/h3> <p class=\"schema-faq-answer\">The common ones are -22 for increased complexity, -50 for a bilateral procedure, and -51 for multiple procedures. Others include -52 for reduced services, -62 for two surgeons, and -80 for an assistant surgeon. Modifier -22 needs a detailed operative note to justify the increase.<\/p> <\/div> <div class=\"schema-faq-section\" id=\"faq-question-1786435243832\"><h3 class=\"schema-faq-question\">What ICD-10 codes are paired with CPT 21407?<\/h3> <p class=\"schema-faq-answer\">Orbital floor fractures use S02.30XA, S02.31XA, or S02.32XA, depending on the side documented. Medial orbital wall fractures use S02.839A, S02.831A, or S02.832A. LeFort patterns use S02.411A, S02.412A, and S02.413A. S02.3XXA was deleted in 2016 and will be rejected.<\/p> <\/div> <div class=\"schema-faq-section\" id=\"faq-question-1786435243835\"><h3 class=\"schema-faq-question\">Does the setting change what Medicare pays for 21407?<\/h3> <p class=\"schema-faq-answer\">No. CMS gives 21407 the same practice expense RVU in both settings, so the total stays at 17.29 either way. Many surgical codes pay more in a non-facility setting, but this one does not.<\/p> <\/div> <div class=\"schema-faq-section\" id=\"faq-question-1786435243833\"><h3 class=\"schema-faq-question\">Does Medicare cover CPT code 21407?<\/h3> <p class=\"schema-faq-answer\">Yes. Medicare covers 21407 when medical necessity is documented and the claim meets CMS criteria under the Medicare Physician Fee Schedule. Coverage is subject to local coverage determinations from your Medicare Administrative Contractor (MAC), which may add requirements. Check the active LCDs for your region first.<\/p> <\/div> <div class=\"schema-faq-section\" id=\"faq-question-1786435243834\"><h3 class=\"schema-faq-question\">What documentation is required for CPT code 21407?<\/h3> <p class=\"schema-faq-answer\">The operative note needs preoperative imaging confirming the fracture, the surgical approach and incision type, and the implant manufacturer and material. It also needs the fracture complexity and the postoperative plan. Missing implant details are the most common reason a 21407 claim downcodes to 21406.<\/p> <\/div> <\/div>\n\n","protected":false},"excerpt":{"rendered":"<p>CPT code 21407 covers open treatment of an orbital fracture, excluding blowout, when the surgeon places an implant. The implant restores orbital anatomy, and its presence in the operative note is what separates 21407 from 21406. The code sits in the musculoskeletal section of the CPT code set, under fracture and dislocation procedures on the [&hellip;]<\/p>\n","protected":false},"author":82,"featured_media":175531,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_yoast_wpseo_linkdex":"80","_yoast_wpseo_content_score":"60","_yoast_wpseo_is_cornerstone":"","_yoast_wpseo_keywordsynonyms":"[\"\",\"\",\"\",\"\"]","_yoast_wpseo_focuskw_text_input":"","_seo_original_html":"","footnotes":""},"categories":[1433,1546],"tags":[1162,3539,2653,2668,4199],"class_list":["post-175532","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-billing-codes","category-cpt-codes","tag-cpt-codes","tag-initial-encounter-coding","tag-laterality-coding","tag-musculoskeletal-coding","tag-plastic-surgery-billing"],"yoast_head":"<!-- This site is optimized with the Yoast SEO Premium plugin v28.2 (Yoast SEO v28.2) - https:\/\/yoast.com\/product\/yoast-seo-premium-wordpress\/ -->\n<title>CPT code 21407: RVUs, modifiers, and ICD-10 pairings (2026)<\/title>\n<meta name=\"description\" content=\"CPT 21407 covers open orbital fracture repair with an implant: 17.29 total RVUs in both settings, plus the ICD-10 laterality codes.\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/pabau.com\/es\/procedure-codes\/cpt-code-21407\/\" \/>\n<meta property=\"og:locale\" content=\"es_ES\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"CPT code 21407: RVUs, modifiers, and ICD-10 pairings (2026)\" \/>\n<meta property=\"og:description\" content=\"CPT 21407 covers open orbital fracture repair with an implant: 17.29 total RVUs in both settings, plus the ICD-10 laterality codes.\" \/>\n<meta property=\"og:url\" content=\"https:\/\/pabau.com\/es\/procedure-codes\/cpt-code-21407\/\" \/>\n<meta property=\"og:site_name\" content=\"Pabau\" \/>\n<meta property=\"article:publisher\" content=\"https:\/\/www.facebook.com\/Pabau\/\" \/>\n<meta property=\"article:published_time\" content=\"2026-08-11T12:18:00+00:00\" \/>\n<meta property=\"article:modified_time\" content=\"2026-08-11T14:34:49+00:00\" \/>\n<meta property=\"og:image\" content=\"https:\/\/pabau.com\/wp-content\/uploads\/2026\/08\/cpt-code-21407.webp\" \/>\n\t<meta property=\"og:image:width\" content=\"1200\" \/>\n\t<meta property=\"og:image:height\" content=\"630\" \/>\n\t<meta property=\"og:image:type\" content=\"image\/webp\" \/>\n<meta name=\"author\" content=\"Maja Popovska\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:creator\" content=\"@pabaucrm\" \/>\n<meta name=\"twitter:site\" content=\"@pabaucrm\" \/>\n<meta name=\"twitter:label1\" content=\"Escrito por\" \/>\n\t<meta name=\"twitter:data1\" content=\"Maja Popovska\" \/>\n\t<meta name=\"twitter:label2\" content=\"Tiempo de lectura\" \/>\n\t<meta name=\"twitter:data2\" content=\"11 minutos\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\\\/\\\/schema.org\",\"@graph\":[{\"@type\":\"Article\",\"@id\":\"https:\\\/\\\/pabau.com\\\/es\\\/procedure-codes\\\/cpt-code-21407\\\/#article\",\"isPartOf\":{\"@id\":\"https:\\\/\\\/pabau.com\\\/es\\\/procedure-codes\\\/cpt-code-21407\\\/\"},\"author\":{\"name\":\"Maja Popovska\",\"@id\":\"https:\\\/\\\/pabau.com\\\/es\\\/#\\\/schema\\\/person\\\/b00aec1dd379f0ddcf6137d78e2a21db\"},\"headline\":\"CPT code 21407: Open treatment of orbital fracture with implant\",\"datePublished\":\"2026-08-11T12:18:00+00:00\",\"dateModified\":\"2026-08-11T14:34:49+00:00\",\"mainEntityOfPage\":{\"@id\":\"https:\\\/\\\/pabau.com\\\/es\\\/procedure-codes\\\/cpt-code-21407\\\/\"},\"wordCount\":2206,\"publisher\":{\"@id\":\"https:\\\/\\\/pabau.com\\\/es\\\/#organization\"},\"image\":{\"@id\":\"https:\\\/\\\/pabau.com\\\/es\\\/procedure-codes\\\/cpt-code-21407\\\/#primaryimage\"},\"thumbnailUrl\":\"https:\\\/\\\/pabau.com\\\/wp-content\\\/uploads\\\/2026\\\/08\\\/cpt-code-21407.webp\",\"keywords\":[\"CPT Codes\",\"Initial encounter coding\",\"Laterality coding\",\"Musculoskeletal coding\",\"plastic surgery billing\"],\"articleSection\":[\"Billing Codes\",\"CPT Codes\"],\"inLanguage\":\"es\"},{\"@type\":[\"WebPage\",\"FAQPage\"],\"@id\":\"https:\\\/\\\/pabau.com\\\/es\\\/procedure-codes\\\/cpt-code-21407\\\/\",\"url\":\"https:\\\/\\\/pabau.com\\\/es\\\/procedure-codes\\\/cpt-code-21407\\\/\",\"name\":\"CPT code 21407: RVUs, modifiers, and ICD-10 pairings (2026)\",\"isPartOf\":{\"@id\":\"https:\\\/\\\/pabau.com\\\/es\\\/#website\"},\"primaryImageOfPage\":{\"@id\":\"https:\\\/\\\/pabau.com\\\/es\\\/procedure-codes\\\/cpt-code-21407\\\/#primaryimage\"},\"image\":{\"@id\":\"https:\\\/\\\/pabau.com\\\/es\\\/procedure-codes\\\/cpt-code-21407\\\/#primaryimage\"},\"thumbnailUrl\":\"https:\\\/\\\/pabau.com\\\/wp-content\\\/uploads\\\/2026\\\/08\\\/cpt-code-21407.webp\",\"datePublished\":\"2026-08-11T12:18:00+00:00\",\"dateModified\":\"2026-08-11T14:34:49+00:00\",\"description\":\"CPT 21407 covers open orbital fracture repair with an implant: 17.29 total RVUs in both settings, plus the ICD-10 laterality codes.\",\"mainEntity\":[{\"@id\":\"https:\\\/\\\/pabau.com\\\/es\\\/procedure-codes\\\/cpt-code-21407\\\/#faq-question-1786435243829\"},{\"@id\":\"https:\\\/\\\/pabau.com\\\/es\\\/procedure-codes\\\/cpt-code-21407\\\/#faq-question-1786435243830\"},{\"@id\":\"https:\\\/\\\/pabau.com\\\/es\\\/procedure-codes\\\/cpt-code-21407\\\/#faq-question-1786435243831\"},{\"@id\":\"https:\\\/\\\/pabau.com\\\/es\\\/procedure-codes\\\/cpt-code-21407\\\/#faq-question-1786435243832\"},{\"@id\":\"https:\\\/\\\/pabau.com\\\/es\\\/procedure-codes\\\/cpt-code-21407\\\/#faq-question-1786435243835\"},{\"@id\":\"https:\\\/\\\/pabau.com\\\/es\\\/procedure-codes\\\/cpt-code-21407\\\/#faq-question-1786435243833\"},{\"@id\":\"https:\\\/\\\/pabau.com\\\/es\\\/procedure-codes\\\/cpt-code-21407\\\/#faq-question-1786435243834\"}],\"inLanguage\":\"es\",\"potentialAction\":[{\"@type\":\"ReadAction\",\"target\":[\"https:\\\/\\\/pabau.com\\\/es\\\/procedure-codes\\\/cpt-code-21407\\\/\"]}]},{\"@type\":\"ImageObject\",\"inLanguage\":\"es\",\"@id\":\"https:\\\/\\\/pabau.com\\\/es\\\/procedure-codes\\\/cpt-code-21407\\\/#primaryimage\",\"url\":\"https:\\\/\\\/pabau.com\\\/wp-content\\\/uploads\\\/2026\\\/08\\\/cpt-code-21407.webp\",\"contentUrl\":\"https:\\\/\\\/pabau.com\\\/wp-content\\\/uploads\\\/2026\\\/08\\\/cpt-code-21407.webp\",\"width\":1200,\"height\":630},{\"@type\":\"WebSite\",\"@id\":\"https:\\\/\\\/pabau.com\\\/es\\\/#website\",\"url\":\"https:\\\/\\\/pabau.com\\\/es\\\/\",\"name\":\"Pabau\",\"description\":\"Clinic Software for your Business | Go Paperless Today\",\"publisher\":{\"@id\":\"https:\\\/\\\/pabau.com\\\/es\\\/#organization\"},\"potentialAction\":[{\"@type\":\"SearchAction\",\"target\":{\"@type\":\"EntryPoint\",\"urlTemplate\":\"https:\\\/\\\/pabau.com\\\/es\\\/?s={search_term_string}\"},\"query-input\":{\"@type\":\"PropertyValueSpecification\",\"valueRequired\":true,\"valueName\":\"search_term_string\"}}],\"inLanguage\":\"es\"},{\"@type\":\"Organization\",\"@id\":\"https:\\\/\\\/pabau.com\\\/es\\\/#organization\",\"name\":\"Pabau\",\"url\":\"https:\\\/\\\/pabau.com\\\/es\\\/\",\"logo\":{\"@type\":\"ImageObject\",\"inLanguage\":\"es\",\"@id\":\"https:\\\/\\\/pabau.com\\\/es\\\/#\\\/schema\\\/logo\\\/image\\\/\",\"url\":\"https:\\\/\\\/pabau.com\\\/wp-content\\\/uploads\\\/2022\\\/05\\\/Logo-4-e1654525062364.png\",\"contentUrl\":\"https:\\\/\\\/pabau.com\\\/wp-content\\\/uploads\\\/2022\\\/05\\\/Logo-4-e1654525062364.png\",\"width\":736,\"height\":195,\"caption\":\"Pabau\"},\"image\":{\"@id\":\"https:\\\/\\\/pabau.com\\\/es\\\/#\\\/schema\\\/logo\\\/image\\\/\"},\"sameAs\":[\"https:\\\/\\\/www.facebook.com\\\/Pabau\\\/\",\"https:\\\/\\\/x.com\\\/pabaucrm\",\"https:\\\/\\\/www.linkedin.com\\\/company\\\/pabau-ltd\\\/\",\"https:\\\/\\\/www.instagram.com\\\/pabausoftware\\\/\"],\"description\":\"Pabau is an all-in-one healthcare practice management software platform designed for clinics, medspas, therapists, and medical professionals. It combines scheduling, electronic health records, clinical forms, payments, marketing automation, reporting, and patient engagement tools into one secure cloud system to help practices streamline operations and grow their business.\",\"foundingDate\":\"2011-10-20\",\"numberOfEmployees\":{\"@type\":\"QuantitativeValue\",\"minValue\":\"201\",\"maxValue\":\"500\"}},{\"@type\":\"Person\",\"@id\":\"https:\\\/\\\/pabau.com\\\/es\\\/#\\\/schema\\\/person\\\/b00aec1dd379f0ddcf6137d78e2a21db\",\"name\":\"Maja Popovska\",\"image\":{\"@type\":\"ImageObject\",\"inLanguage\":\"es\",\"@id\":\"https:\\\/\\\/pabau.com\\\/wp-content\\\/uploads\\\/2026\\\/06\\\/cropped-Maja-Popovska_WP-1-96x96.jpeg\",\"url\":\"https:\\\/\\\/pabau.com\\\/wp-content\\\/uploads\\\/2026\\\/06\\\/cropped-Maja-Popovska_WP-1-96x96.jpeg\",\"contentUrl\":\"https:\\\/\\\/pabau.com\\\/wp-content\\\/uploads\\\/2026\\\/06\\\/cropped-Maja-Popovska_WP-1-96x96.jpeg\",\"caption\":\"Maja Popovska\"},\"description\":\"Maja is a Senior Content Writer at Pabau, where she covers everything from practice management and compliance to medical aesthetics and patient experience. Off the clock: binging true crime docuseries, baking and dreaming about travel.\",\"url\":\"https:\\\/\\\/pabau.com\\\/es\\\/blog\\\/author\\\/maja-popovska\\\/\"},{\"@type\":\"Question\",\"@id\":\"https:\\\/\\\/pabau.com\\\/es\\\/procedure-codes\\\/cpt-code-21407\\\/#faq-question-1786435243829\",\"position\":1,\"url\":\"https:\\\/\\\/pabau.com\\\/es\\\/procedure-codes\\\/cpt-code-21407\\\/#faq-question-1786435243829\",\"name\":\"What does CPT code 21407 mean?\",\"answerCount\":1,\"acceptedAnswer\":{\"@type\":\"Answer\",\"text\":\"CPT code 21407 is the procedure code for open treatment of an orbital fracture, excluding blowout fractures, with placement of an implant. It sits in the musculoskeletal section of the CPT code set, under fracture and dislocation procedures on the head.\",\"inLanguage\":\"es\"},\"inLanguage\":\"es\"},{\"@type\":\"Question\",\"@id\":\"https:\\\/\\\/pabau.com\\\/es\\\/procedure-codes\\\/cpt-code-21407\\\/#faq-question-1786435243830\",\"position\":2,\"url\":\"https:\\\/\\\/pabau.com\\\/es\\\/procedure-codes\\\/cpt-code-21407\\\/#faq-question-1786435243830\",\"name\":\"What is the difference between CPT codes 21406, 21407, and 21408?\",\"answerCount\":1,\"acceptedAnswer\":{\"@type\":\"Answer\",\"text\":\"21406 covers open treatment without an implant, 21407 covers open treatment with an implant, and 21408 covers open treatment with a bone graft. The operative note must document implant placement to support 21407. Without it, 21406 applies regardless of surgical complexity.\",\"inLanguage\":\"es\"},\"inLanguage\":\"es\"},{\"@type\":\"Question\",\"@id\":\"https:\\\/\\\/pabau.com\\\/es\\\/procedure-codes\\\/cpt-code-21407\\\/#faq-question-1786435243831\",\"position\":3,\"url\":\"https:\\\/\\\/pabau.com\\\/es\\\/procedure-codes\\\/cpt-code-21407\\\/#faq-question-1786435243831\",\"name\":\"What modifiers apply to CPT code 21407?\",\"answerCount\":1,\"acceptedAnswer\":{\"@type\":\"Answer\",\"text\":\"The common ones are -22 for increased complexity, -50 for a bilateral procedure, and -51 for multiple procedures. Others include -52 for reduced services, -62 for two surgeons, and -80 for an assistant surgeon. Modifier -22 needs a detailed operative note to justify the increase.\",\"inLanguage\":\"es\"},\"inLanguage\":\"es\"},{\"@type\":\"Question\",\"@id\":\"https:\\\/\\\/pabau.com\\\/es\\\/procedure-codes\\\/cpt-code-21407\\\/#faq-question-1786435243832\",\"position\":4,\"url\":\"https:\\\/\\\/pabau.com\\\/es\\\/procedure-codes\\\/cpt-code-21407\\\/#faq-question-1786435243832\",\"name\":\"What ICD-10 codes are paired with CPT 21407?\",\"answerCount\":1,\"acceptedAnswer\":{\"@type\":\"Answer\",\"text\":\"Orbital floor fractures use S02.30XA, S02.31XA, or S02.32XA, depending on the side documented. Medial orbital wall fractures use S02.839A, S02.831A, or S02.832A. LeFort patterns use S02.411A, S02.412A, and S02.413A. S02.3XXA was deleted in 2016 and will be rejected.\",\"inLanguage\":\"es\"},\"inLanguage\":\"es\"},{\"@type\":\"Question\",\"@id\":\"https:\\\/\\\/pabau.com\\\/es\\\/procedure-codes\\\/cpt-code-21407\\\/#faq-question-1786435243835\",\"position\":5,\"url\":\"https:\\\/\\\/pabau.com\\\/es\\\/procedure-codes\\\/cpt-code-21407\\\/#faq-question-1786435243835\",\"name\":\"Does the setting change what Medicare pays for 21407?\",\"answerCount\":1,\"acceptedAnswer\":{\"@type\":\"Answer\",\"text\":\"No. CMS gives 21407 the same practice expense RVU in both settings, so the total stays at 17.29 either way. Many surgical codes pay more in a non-facility setting, but this one does not.\",\"inLanguage\":\"es\"},\"inLanguage\":\"es\"},{\"@type\":\"Question\",\"@id\":\"https:\\\/\\\/pabau.com\\\/es\\\/procedure-codes\\\/cpt-code-21407\\\/#faq-question-1786435243833\",\"position\":6,\"url\":\"https:\\\/\\\/pabau.com\\\/es\\\/procedure-codes\\\/cpt-code-21407\\\/#faq-question-1786435243833\",\"name\":\"Does Medicare cover CPT code 21407?\",\"answerCount\":1,\"acceptedAnswer\":{\"@type\":\"Answer\",\"text\":\"Yes. Medicare covers 21407 when medical necessity is documented and the claim meets CMS criteria under the Medicare Physician Fee Schedule. Coverage is subject to local coverage determinations from your Medicare Administrative Contractor (MAC), which may add requirements. Check the active LCDs for your region first.\",\"inLanguage\":\"es\"},\"inLanguage\":\"es\"},{\"@type\":\"Question\",\"@id\":\"https:\\\/\\\/pabau.com\\\/es\\\/procedure-codes\\\/cpt-code-21407\\\/#faq-question-1786435243834\",\"position\":7,\"url\":\"https:\\\/\\\/pabau.com\\\/es\\\/procedure-codes\\\/cpt-code-21407\\\/#faq-question-1786435243834\",\"name\":\"What documentation is required for CPT code 21407?\",\"answerCount\":1,\"acceptedAnswer\":{\"@type\":\"Answer\",\"text\":\"The operative note needs preoperative imaging confirming the fracture, the surgical approach and incision type, and the implant manufacturer and material. It also needs the fracture complexity and the postoperative plan. Missing implant details are the most common reason a 21407 claim downcodes to 21406.\",\"inLanguage\":\"es\"},\"inLanguage\":\"es\"}]}<\/script>\n<!-- \/ Yoast SEO Premium plugin. -->","yoast_head_json":{"title":"CPT code 21407: RVUs, modifiers, and ICD-10 pairings (2026)","description":"CPT 21407 covers open orbital fracture repair with an implant: 17.29 total RVUs in both settings, plus the ICD-10 laterality codes.","robots":{"index":"index","follow":"follow","max-snippet":"max-snippet:-1","max-image-preview":"max-image-preview:large","max-video-preview":"max-video-preview:-1"},"canonical":"https:\/\/pabau.com\/es\/procedure-codes\/cpt-code-21407\/","og_locale":"es_ES","og_type":"article","og_title":"CPT code 21407: RVUs, modifiers, and ICD-10 pairings (2026)","og_description":"CPT 21407 covers open orbital fracture repair with an implant: 17.29 total RVUs in both settings, plus the ICD-10 laterality codes.","og_url":"https:\/\/pabau.com\/es\/procedure-codes\/cpt-code-21407\/","og_site_name":"Pabau","article_publisher":"https:\/\/www.facebook.com\/Pabau\/","article_published_time":"2026-08-11T12:18:00+00:00","article_modified_time":"2026-08-11T14:34:49+00:00","og_image":[{"width":1200,"height":630,"url":"https:\/\/pabau.com\/wp-content\/uploads\/2026\/08\/cpt-code-21407.webp","type":"image\/webp"}],"author":"Maja Popovska","twitter_card":"summary_large_image","twitter_creator":"@pabaucrm","twitter_site":"@pabaucrm","twitter_misc":{"Escrito por":"Maja Popovska","Tiempo de lectura":"11 minutos"},"schema":{"@context":"https:\/\/schema.org","@graph":[{"@type":"Article","@id":"https:\/\/pabau.com\/es\/procedure-codes\/cpt-code-21407\/#article","isPartOf":{"@id":"https:\/\/pabau.com\/es\/procedure-codes\/cpt-code-21407\/"},"author":{"name":"Maja Popovska","@id":"https:\/\/pabau.com\/es\/#\/schema\/person\/b00aec1dd379f0ddcf6137d78e2a21db"},"headline":"CPT code 21407: Open treatment of orbital fracture with implant","datePublished":"2026-08-11T12:18:00+00:00","dateModified":"2026-08-11T14:34:49+00:00","mainEntityOfPage":{"@id":"https:\/\/pabau.com\/es\/procedure-codes\/cpt-code-21407\/"},"wordCount":2206,"publisher":{"@id":"https:\/\/pabau.com\/es\/#organization"},"image":{"@id":"https:\/\/pabau.com\/es\/procedure-codes\/cpt-code-21407\/#primaryimage"},"thumbnailUrl":"https:\/\/pabau.com\/wp-content\/uploads\/2026\/08\/cpt-code-21407.webp","keywords":["CPT Codes","Initial encounter coding","Laterality coding","Musculoskeletal coding","plastic surgery billing"],"articleSection":["Billing Codes","CPT Codes"],"inLanguage":"es"},{"@type":["WebPage","FAQPage"],"@id":"https:\/\/pabau.com\/es\/procedure-codes\/cpt-code-21407\/","url":"https:\/\/pabau.com\/es\/procedure-codes\/cpt-code-21407\/","name":"CPT code 21407: RVUs, modifiers, and ICD-10 pairings (2026)","isPartOf":{"@id":"https:\/\/pabau.com\/es\/#website"},"primaryImageOfPage":{"@id":"https:\/\/pabau.com\/es\/procedure-codes\/cpt-code-21407\/#primaryimage"},"image":{"@id":"https:\/\/pabau.com\/es\/procedure-codes\/cpt-code-21407\/#primaryimage"},"thumbnailUrl":"https:\/\/pabau.com\/wp-content\/uploads\/2026\/08\/cpt-code-21407.webp","datePublished":"2026-08-11T12:18:00+00:00","dateModified":"2026-08-11T14:34:49+00:00","description":"CPT 21407 covers open orbital fracture repair with an implant: 17.29 total RVUs in both settings, plus the ICD-10 laterality codes.","mainEntity":[{"@id":"https:\/\/pabau.com\/es\/procedure-codes\/cpt-code-21407\/#faq-question-1786435243829"},{"@id":"https:\/\/pabau.com\/es\/procedure-codes\/cpt-code-21407\/#faq-question-1786435243830"},{"@id":"https:\/\/pabau.com\/es\/procedure-codes\/cpt-code-21407\/#faq-question-1786435243831"},{"@id":"https:\/\/pabau.com\/es\/procedure-codes\/cpt-code-21407\/#faq-question-1786435243832"},{"@id":"https:\/\/pabau.com\/es\/procedure-codes\/cpt-code-21407\/#faq-question-1786435243835"},{"@id":"https:\/\/pabau.com\/es\/procedure-codes\/cpt-code-21407\/#faq-question-1786435243833"},{"@id":"https:\/\/pabau.com\/es\/procedure-codes\/cpt-code-21407\/#faq-question-1786435243834"}],"inLanguage":"es","potentialAction":[{"@type":"ReadAction","target":["https:\/\/pabau.com\/es\/procedure-codes\/cpt-code-21407\/"]}]},{"@type":"ImageObject","inLanguage":"es","@id":"https:\/\/pabau.com\/es\/procedure-codes\/cpt-code-21407\/#primaryimage","url":"https:\/\/pabau.com\/wp-content\/uploads\/2026\/08\/cpt-code-21407.webp","contentUrl":"https:\/\/pabau.com\/wp-content\/uploads\/2026\/08\/cpt-code-21407.webp","width":1200,"height":630},{"@type":"WebSite","@id":"https:\/\/pabau.com\/es\/#website","url":"https:\/\/pabau.com\/es\/","name":"Pabau","description":"Clinic Software for your Business | Go Paperless Today","publisher":{"@id":"https:\/\/pabau.com\/es\/#organization"},"potentialAction":[{"@type":"SearchAction","target":{"@type":"EntryPoint","urlTemplate":"https:\/\/pabau.com\/es\/?s={search_term_string}"},"query-input":{"@type":"PropertyValueSpecification","valueRequired":true,"valueName":"search_term_string"}}],"inLanguage":"es"},{"@type":"Organization","@id":"https:\/\/pabau.com\/es\/#organization","name":"Pabau","url":"https:\/\/pabau.com\/es\/","logo":{"@type":"ImageObject","inLanguage":"es","@id":"https:\/\/pabau.com\/es\/#\/schema\/logo\/image\/","url":"https:\/\/pabau.com\/wp-content\/uploads\/2022\/05\/Logo-4-e1654525062364.png","contentUrl":"https:\/\/pabau.com\/wp-content\/uploads\/2022\/05\/Logo-4-e1654525062364.png","width":736,"height":195,"caption":"Pabau"},"image":{"@id":"https:\/\/pabau.com\/es\/#\/schema\/logo\/image\/"},"sameAs":["https:\/\/www.facebook.com\/Pabau\/","https:\/\/x.com\/pabaucrm","https:\/\/www.linkedin.com\/company\/pabau-ltd\/","https:\/\/www.instagram.com\/pabausoftware\/"],"description":"Pabau is an all-in-one healthcare practice management software platform designed for clinics, medspas, therapists, and medical professionals. It combines scheduling, electronic health records, clinical forms, payments, marketing automation, reporting, and patient engagement tools into one secure cloud system to help practices streamline operations and grow their business.","foundingDate":"2011-10-20","numberOfEmployees":{"@type":"QuantitativeValue","minValue":"201","maxValue":"500"}},{"@type":"Person","@id":"https:\/\/pabau.com\/es\/#\/schema\/person\/b00aec1dd379f0ddcf6137d78e2a21db","name":"Maja Popovska","image":{"@type":"ImageObject","inLanguage":"es","@id":"https:\/\/pabau.com\/wp-content\/uploads\/2026\/06\/cropped-Maja-Popovska_WP-1-96x96.jpeg","url":"https:\/\/pabau.com\/wp-content\/uploads\/2026\/06\/cropped-Maja-Popovska_WP-1-96x96.jpeg","contentUrl":"https:\/\/pabau.com\/wp-content\/uploads\/2026\/06\/cropped-Maja-Popovska_WP-1-96x96.jpeg","caption":"Maja Popovska"},"description":"Maja is a Senior Content Writer at Pabau, where she covers everything from practice management and compliance to medical aesthetics and patient experience. Off the clock: binging true crime docuseries, baking and dreaming about travel.","url":"https:\/\/pabau.com\/es\/blog\/author\/maja-popovska\/"},{"@type":"Question","@id":"https:\/\/pabau.com\/es\/procedure-codes\/cpt-code-21407\/#faq-question-1786435243829","position":1,"url":"https:\/\/pabau.com\/es\/procedure-codes\/cpt-code-21407\/#faq-question-1786435243829","name":"What does CPT code 21407 mean?","answerCount":1,"acceptedAnswer":{"@type":"Answer","text":"CPT code 21407 is the procedure code for open treatment of an orbital fracture, excluding blowout fractures, with placement of an implant. It sits in the musculoskeletal section of the CPT code set, under fracture and dislocation procedures on the head.","inLanguage":"es"},"inLanguage":"es"},{"@type":"Question","@id":"https:\/\/pabau.com\/es\/procedure-codes\/cpt-code-21407\/#faq-question-1786435243830","position":2,"url":"https:\/\/pabau.com\/es\/procedure-codes\/cpt-code-21407\/#faq-question-1786435243830","name":"What is the difference between CPT codes 21406, 21407, and 21408?","answerCount":1,"acceptedAnswer":{"@type":"Answer","text":"21406 covers open treatment without an implant, 21407 covers open treatment with an implant, and 21408 covers open treatment with a bone graft. The operative note must document implant placement to support 21407. Without it, 21406 applies regardless of surgical complexity.","inLanguage":"es"},"inLanguage":"es"},{"@type":"Question","@id":"https:\/\/pabau.com\/es\/procedure-codes\/cpt-code-21407\/#faq-question-1786435243831","position":3,"url":"https:\/\/pabau.com\/es\/procedure-codes\/cpt-code-21407\/#faq-question-1786435243831","name":"What modifiers apply to CPT code 21407?","answerCount":1,"acceptedAnswer":{"@type":"Answer","text":"The common ones are -22 for increased complexity, -50 for a bilateral procedure, and -51 for multiple procedures. Others include -52 for reduced services, -62 for two surgeons, and -80 for an assistant surgeon. Modifier -22 needs a detailed operative note to justify the increase.","inLanguage":"es"},"inLanguage":"es"},{"@type":"Question","@id":"https:\/\/pabau.com\/es\/procedure-codes\/cpt-code-21407\/#faq-question-1786435243832","position":4,"url":"https:\/\/pabau.com\/es\/procedure-codes\/cpt-code-21407\/#faq-question-1786435243832","name":"What ICD-10 codes are paired with CPT 21407?","answerCount":1,"acceptedAnswer":{"@type":"Answer","text":"Orbital floor fractures use S02.30XA, S02.31XA, or S02.32XA, depending on the side documented. Medial orbital wall fractures use S02.839A, S02.831A, or S02.832A. LeFort patterns use S02.411A, S02.412A, and S02.413A. S02.3XXA was deleted in 2016 and will be rejected.","inLanguage":"es"},"inLanguage":"es"},{"@type":"Question","@id":"https:\/\/pabau.com\/es\/procedure-codes\/cpt-code-21407\/#faq-question-1786435243835","position":5,"url":"https:\/\/pabau.com\/es\/procedure-codes\/cpt-code-21407\/#faq-question-1786435243835","name":"Does the setting change what Medicare pays for 21407?","answerCount":1,"acceptedAnswer":{"@type":"Answer","text":"No. CMS gives 21407 the same practice expense RVU in both settings, so the total stays at 17.29 either way. Many surgical codes pay more in a non-facility setting, but this one does not.","inLanguage":"es"},"inLanguage":"es"},{"@type":"Question","@id":"https:\/\/pabau.com\/es\/procedure-codes\/cpt-code-21407\/#faq-question-1786435243833","position":6,"url":"https:\/\/pabau.com\/es\/procedure-codes\/cpt-code-21407\/#faq-question-1786435243833","name":"Does Medicare cover CPT code 21407?","answerCount":1,"acceptedAnswer":{"@type":"Answer","text":"Yes. Medicare covers 21407 when medical necessity is documented and the claim meets CMS criteria under the Medicare Physician Fee Schedule. Coverage is subject to local coverage determinations from your Medicare Administrative Contractor (MAC), which may add requirements. Check the active LCDs for your region first.","inLanguage":"es"},"inLanguage":"es"},{"@type":"Question","@id":"https:\/\/pabau.com\/es\/procedure-codes\/cpt-code-21407\/#faq-question-1786435243834","position":7,"url":"https:\/\/pabau.com\/es\/procedure-codes\/cpt-code-21407\/#faq-question-1786435243834","name":"What documentation is required for CPT code 21407?","answerCount":1,"acceptedAnswer":{"@type":"Answer","text":"The operative note needs preoperative imaging confirming the fracture, the surgical approach and incision type, and the implant manufacturer and material. It also needs the fracture complexity and the postoperative plan. Missing implant details are the most common reason a 21407 claim downcodes to 21406.","inLanguage":"es"},"inLanguage":"es"}]}},"yoast":{"focus_keyword":"CPT code 21407","seo_title":"CPT code 21407: RVUs, modifiers, and ICD-10 pairings (2026)","meta_description":"CPT 21407 covers open orbital fracture repair with an implant: 17.29 total RVUs in both settings, plus the ICD-10 laterality codes.","content_score":"60","is_cornerstone":"","related_keyphrases":[{"keyword":"orbital fracture repair billing","score":72},{"keyword":"fracture care CPT codes","score":61},{"keyword":"open treatment orbital fracture","score":72}]},"_links":{"self":[{"href":"https:\/\/pabau.com\/es\/wp-json\/wp\/v2\/posts\/175532","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/pabau.com\/es\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/pabau.com\/es\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/pabau.com\/es\/wp-json\/wp\/v2\/users\/82"}],"replies":[{"embeddable":true,"href":"https:\/\/pabau.com\/es\/wp-json\/wp\/v2\/comments?post=175532"}],"version-history":[{"count":4,"href":"https:\/\/pabau.com\/es\/wp-json\/wp\/v2\/posts\/175532\/revisions"}],"predecessor-version":[{"id":176120,"href":"https:\/\/pabau.com\/es\/wp-json\/wp\/v2\/posts\/175532\/revisions\/176120"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/pabau.com\/es\/wp-json\/wp\/v2\/media\/175531"}],"wp:attachment":[{"href":"https:\/\/pabau.com\/es\/wp-json\/wp\/v2\/media?parent=175532"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/pabau.com\/es\/wp-json\/wp\/v2\/categories?post=175532"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/pabau.com\/es\/wp-json\/wp\/v2\/tags?post=175532"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}