{"id":179898,"date":"2026-08-14T08:34:03","date_gmt":"2026-08-14T08:34:03","guid":{"rendered":"https:\/\/pabau.com\/?p=179898"},"modified":"2026-08-14T08:34:07","modified_gmt":"2026-08-14T08:34:07","slug":"cpt-code-21280","status":"publish","type":"post","link":"https:\/\/pabau.com\/nl\/procedure-codes\/cpt-code-21280\/","title":{"rendered":"CPT code 21280: Medial canthopexy RVU values and reimbursement"},"content":{"rendered":"\n<script type=\"application\/ld+json\">{\"@context\":\"https:\/\/schema.org\",\"@type\":\"MedicalWebPage\",\"headline\":\"CPT code 21280: Medial canthopexy RVU values and reimbursement\",\"description\":\"Billing reference for CPT code 21280 (medial canthopexy). Covers the official descriptor, 2026 RVU values, Medicare payment, modifiers, ICD-10-CM pairings, and documentation requirements.\",\"url\":\"https:\/\/pabau.com\/procedure-codes\/cpt-code-21280\/\",\"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\":\"2026-08-10\",\"dateModified\":\"2026-08-14\"}<\/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 21280 reports medial canthopexy, the tightening or repositioning of the medial canthal tendon at the inner corner of the eyelid.<\/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 official descriptor is medial canthopexy, not a full-thickness eyelid repair. Eyelid laceration closure belongs to CPT 67930 and 67935.<\/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 descriptor carries a separate procedure designation, so bill 21280 on its own only when the canthopexy is a distinct service that day.<\/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>CPT 21280 carries 15.70 total RVUs in 2026, or roughly $524 nationally. CMS lists the same RVUs for office and 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>Practice management software like Pabau keeps procedure codes, operative notes, and claim status in one system instead of three.<\/p>\n                        <\/div>\n                                                <\/div>\n        <\/div>\n    \n\n\n<p class=\"wp-block-paragraph\">CPT code 21280 reports medial canthopexy, a repair that tightens or repositions the medial canthal tendon at the inner corner of the eyelid.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">The code sits in the musculoskeletal head section of CPT, alongside facial reconstruction codes. It is not an eyelid repair code, and that placement explains most of the miscoding around it.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Below you will find the official descriptor, 2026 RVU values and Medicare rates, modifiers, supporting ICD-10-CM codes, and the documentation payers ask for.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">It also settles a point that several reference pages publish incorrectly. CPT 21280 has no facility versus non-facility payment difference, and the RVU table below shows why.<\/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-what-cpt-code-21280-covers\" class=\"wp-block-heading\">What CPT code 21280 covers<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">The medial canthus is the inner corner of the eye, where the upper and lower eyelids meet. The medial canthal tendon anchors that junction to the lacrimal bone.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">When laxity, malposition, or trauma weakens that anchor, the lower lid drifts and the punctum lifts away from the eye surface. Tearing follows, and the patient reports a constantly watery eye. Medial canthopexy tightens or repositions the tendon to restore the normal anatomy.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">The code is maintained by 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> and falls in the Repair, Revision, and\/or Reconstruction subsection of the Head codes. Oculoplastic, orbital, and plastic surgeons at <a href=\"https:\/\/pabau.com\/blog\/plastic-surgery-practice-emr-software\/\">plastic surgery practices<\/a> report it, usually as a primary procedure.<\/p>\n\n\n\n<h2 id=\"h-official-descriptor-and-the-separate-procedure-designation\" class=\"wp-block-heading\">Official descriptor and the separate procedure designation<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">The official descriptor for CPT code 21280 reads: <strong>Medial canthopexy (separate procedure).<\/strong> That parenthetical is not incidental. It signals that the service is ordinarily a component of a larger procedure. Bill it independently only when it was performed as a distinct service.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">In practice, CPT 21280 stands alone when medial canthopexy is the sole surgical objective of the encounter. When it accompanies a wider periocular reconstruction, National Correct Coding Initiative (NCCI) edits may prevent separate payment unless a qualifying modifier is appended and documented.<\/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\">Field<\/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\">Detail<\/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\">CPT code<\/td>\n<td style=\"padding:12px 16px;color:#374151\">21280<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Official descriptor<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Medial canthopexy (separate procedure)<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">CPT section<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Musculoskeletal System, Head, Repair, Revision, and\/or Reconstruction<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Maintaining body<\/td>\n<td style=\"padding:12px 16px;color:#374151\">American Medical Association (AMA)<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Separate procedure<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Yes<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Global period<\/td>\n<td style=\"padding:12px 16px;color:#374151\">090 (major surgery)<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Total RVUs (2026)<\/td>\n<td style=\"padding:12px 16px;color:#374151\">15.70, identical in facility and non-facility 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\">National Medicare estimate (2026)<\/td>\n<td style=\"padding:12px 16px;color:#374151\">About $524.39 before geographic adjustment<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Paired code<\/td>\n<td style=\"padding:12px 16px;color:#374151\">CPT 21282 (lateral canthopexy)<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n\n\n<h2 id=\"h-codes-cpt-21280-is-confused-with\" class=\"wp-block-heading\">Codes CPT 21280 is confused with<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">A recurring error is treating 21280 as an eyelid repair code. The descriptor covers canthal tendon work only, and closing a lid laceration is reported from the ophthalmology section instead.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Read the operative note for what was actually done to the tendon. If the surgeon sutured a wound rather than repositioning the canthal anchor, 21280 is the wrong 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\">Descriptor<\/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 distinction from 21280<\/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\">21282<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Lateral canthopexy<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Same operation at the outer corner of the eye rather than the inner corner<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">67930<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Suture of recent wound, eyelid, involving lid margin, tarsus, and\/or palpebral conjunctiva, direct closure; partial thickness<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Wound closure of the lid itself, with no canthal tendon repositioning<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">67935<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Suture of recent wound, eyelid, involving lid margin, tarsus, and\/or palpebral conjunctiva, direct closure; full thickness<\/td>\n<td style=\"padding:12px 16px;color:#374151\">The full-thickness eyelid repair code, which 21280 is often mistaken for<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">67950<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Canthoplasty (reconstruction of canthus)<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Reconstruction of the canthal angle, not a tightening of an intact tendon<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">67917<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Repair of ectropion; extensive (for example, tarsal strip operations)<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Addresses lower lid laxity at the lateral side, a common alternative in the same patient<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n\n\n<p class=\"wp-block-paragraph\">Confirm every descriptor against the current CPT manual before you submit. Short descriptors published on reference sites drop the qualifying language that decides the code.<\/p>\n\n\n\n<h2 id=\"h-rvu-values-for-cpt-code-21280\" class=\"wp-block-heading\">RVU values for CPT code 21280<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Relative Value Units (RVUs) form the basis of Medicare&#8217;s payment formula. Three components combine into the total: Work RVU for physician effort, Practice Expense RVU for overhead, and Malpractice RVU for liability. The 2026 values published in the <a href=\"https:\/\/www.cms.gov\/medicare\/physician-fee-schedule\/search\/overview\" target=\"_blank\" rel=\"nofollow noopener\">CMS Physician Fee Schedule<\/a> are below.<\/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:center;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">2026 value (all settings)<\/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;text-align:center;color:#374151\">6.95<\/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)<\/td>\n<td style=\"padding:12px 16px;text-align:center;color:#374151\">8.04<\/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)<\/td>\n<td style=\"padding:12px 16px;text-align:center;color:#374151\">0.71<\/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;text-align:center;color:#374151\">15.70<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n\n\n<p class=\"wp-block-paragraph\">That table has one value column, and that is the detail worth flagging. CMS assigns CPT 21280 the same practice expense RVU in an office and in a facility, so there is a single total rather than two.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Reference pages that publish a reduced facility total for this code are quoting the general pattern for surgical codes rather than the current file. If your fee schedule shows two different totals for 21280, the schedule is wrong.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">The values also moved. The 2025 file listed 7.13 work, 9.87 practice expense, and 0.74 malpractice RVUs, for 17.74 total. Quoting last year&#8217;s number overstates the 2026 allowable by roughly 9%.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Confirm the current values with the CMS lookup tool or the <a href=\"https:\/\/fastrvu.com\/tools\/rvu-lookup\" target=\"_blank\" rel=\"nofollow noopener\">FastRVU RVU lookup<\/a>, then apply your locality&#8217;s geographic practice cost index. Practices billing this code through <a href=\"https:\/\/pabau.com\/blog\/aesthetic-emr-software\/\">aesthetic EMR software<\/a> can compare the published work RVU against actual payments to flag underpayments early.<\/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>Multiply the total RVU by the current conversion factor before you quote a patient a price. For 2026 that is 15.70 RVUs at $33.4009, or about $524 nationally for 21280. Locality adjustment can move the allowable by 10% to 20% in either direction, so check your MAC&#8217;s locality before putting a number in writing.<\/p>\n            <\/div>\n        <\/div>\n    \n\n\n<h2 id=\"h-medicare-reimbursement-for-medial-canthopexy\" class=\"wp-block-heading\">Medicare reimbursement for medial canthopexy<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Medicare pays CPT 21280 by multiplying the geographically adjusted RVUs by the annual conversion factor. At the 2026 factor of $33.4009, the national estimate is about $524.39.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Because the RVUs do not vary by setting, that figure holds in an office, a hospital, and an ambulatory surgery center. Place of service still belongs on the claim, but it does not change the physician allowable for this 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\">Item<\/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\">Value<\/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\">Total RVUs (2026)<\/td>\n<td style=\"padding:12px 16px;color:#374151\">15.70<\/td>\n<td style=\"padding:12px 16px;color:#374151\">One value only, with no facility or non-facility split for this code<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Conversion factor (2026)<\/td>\n<td style=\"padding:12px 16px;color:#374151\">$33.4009<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Set by CMS and updated every January<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">National estimate (2026)<\/td>\n<td style=\"padding:12px 16px;color:#374151\">About $524.39<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Before your locality&#8217;s GPCI adjustment is applied<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Prior year (2025)<\/td>\n<td style=\"padding:12px 16px;color:#374151\">About $573.83<\/td>\n<td style=\"padding:12px 16px;color:#374151\">17.74 total RVUs at the 2025 factor of $32.3465<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Place of service codes<\/td>\n<td style=\"padding:12px 16px;color:#374151\">11, 21, 22, 24<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Office, inpatient, outpatient, and ASC all pay the same allowable<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Global period<\/td>\n<td style=\"padding:12px 16px;color:#374151\">090<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Routine follow-up for 90 days is included in the payment<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n\n\n<p class=\"wp-block-paragraph\">Both the RVU file and the conversion factor change each January. Confirm the current-year figure for your MAC jurisdiction before you submit, and reprice any standing patient estimates at the same time.<\/p>\n\n\n\n<h2 id=\"h-modifiers-for-cpt-21280\" class=\"wp-block-heading\">Modifiers for CPT 21280<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Appending the wrong modifier, or omitting a required one, is among the most common reasons CPT 21280 claims are denied or reduced. The table below covers the modifiers most relevant to this 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\">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<\/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\">Reimbursement impact<\/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\">-51<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Multiple procedures<\/td>\n<td style=\"padding:12px 16px;color:#374151\">CPT 21280 billed alongside 21282 or another surgical code on the same date<\/td>\n<td style=\"padding:12px 16px;color:#374151\">The secondary procedure is typically paid at 50% of the fee schedule amount<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">-59<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Distinct procedural service<\/td>\n<td style=\"padding:12px 16px;color:#374151\">When an NCCI edit bundles 21280 with another code and the services were genuinely separate<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Overrides the bundling edit when the operative note supports it<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">-XS<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Separate structure<\/td>\n<td style=\"padding:12px 16px;color:#374151\">The more specific alternative to -59 when the second service involved a different structure<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Same effect as -59, and preferred by Medicare where a subset modifier fits<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">-RT<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Right side<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Procedure performed on the right medial canthus only<\/td>\n<td style=\"padding:12px 16px;color:#374151\">No reduction, and it documents laterality for audit purposes<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">-LT<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Left side<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Procedure performed on the left medial canthus only<\/td>\n<td style=\"padding:12px 16px;color:#374151\">No reduction, and it documents laterality for audit purposes<\/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\">Bilateral medial canthopexy in the same operative session<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Depends on the code&#8217;s CMS bilateral surgery indicator, so verify it before billing<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">-78 \/ -79<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Return to the operating room, or unrelated procedure<\/td>\n<td style=\"padding:12px 16px;color:#374151\">A second procedure inside the 90-day global period following 21280<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Keeps the later claim from being absorbed into the global package<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n\n\n<p class=\"wp-block-paragraph\">Modifier -59 requires supporting documentation. The operative note must establish that the procedures addressed different anatomical sites or different indications, or were performed through separate incisions. A generic operative report will not survive a payer audit.<\/p>\n\n\n\n<h2 id=\"h-cpt-21280-vs-cpt-21282-medial-vs-lateral-canthopexy\" class=\"wp-block-heading\">CPT 21280 vs. CPT 21282: Medial vs. lateral canthopexy<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">CPT 21280 and CPT 21282 are the paired canthopexy codes. Swapping them produces a denial and a corrected claim delay, and the distinction between them is purely anatomical.<\/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\">Feature<\/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\">CPT 21280<\/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\">CPT 21282<\/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\">Procedure<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Medial canthopexy<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Lateral canthopexy<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Anatomical site<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Inner corner of the eyelid<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Outer corner of the eyelid<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Tendon targeted<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Medial canthal tendon<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Lateral canthal tendon<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Work RVU (2026)<\/td>\n<td style=\"padding:12px 16px;color:#374151\">6.95<\/td>\n<td style=\"padding:12px 16px;color:#374151\">4.16<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Total RVU (2026)<\/td>\n<td style=\"padding:12px 16px;color:#374151\">15.70<\/td>\n<td style=\"padding:12px 16px;color:#374151\">11.06<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">National estimate (2026)<\/td>\n<td style=\"padding:12px 16px;color:#374151\">About $524.39<\/td>\n<td style=\"padding:12px 16px;color:#374151\">About $369.41<\/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\">090<\/td>\n<td style=\"padding:12px 16px;color:#374151\">090<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Billing both on the same date<\/td>\n<td style=\"padding:12px 16px;color:#374151\" colspan=\"2\">Possible when both canthi require repair. Modifier -51 goes on the secondary code, and NCCI edits should be checked first.<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n\n\n<p class=\"wp-block-paragraph\">When both procedures are performed in one session, the code with the higher work RVU is normally the primary one. That is 21280 at 6.95, so modifier -51 belongs on 21282. Check the current NCCI edit table for a column one and column two pairing before billing both.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Facial trauma can also pair a canthopexy with a fracture repair from the same CPT section, such as <a href=\"https:\/\/pabau.com\/procedure-codes\/cpt-code-21343\/\">CPT 21343<\/a>. Check the NCCI edits for that pairing before you put both codes on one claim.<\/p>\n\n\n\n<h2 id=\"h-icd-10-cm-codes-that-support-medical-necessity\" class=\"wp-block-heading\">ICD-10-CM codes that support medical necessity<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Every CPT 21280 claim needs a diagnosis that establishes functional impairment. A cosmetic request with no structural or functional diagnosis will not clear Medicare or most commercial payers.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Because the code is reported per side, the diagnosis laterality also has to match the modifier on the claim line. Trauma claims often carry a head injury diagnosis such as <a href=\"https:\/\/pabau.com\/diagnostic-codes\/icd-10-code-s066x1d\/\">ICD-10 S06.6X1D<\/a> as well. The examples below are the pairings that show up most often on medial canthopexy claims.<\/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 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\">Clinical context<\/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\">H04.221<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Epiphora due to insufficient drainage, right side<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Tearing from a punctum pulled away from the eye surface; pair with -RT<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">H04.222<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Epiphora due to insufficient drainage, left side<\/td>\n<td style=\"padding:12px 16px;color:#374151\">The left-side counterpart; pair with -LT<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">H02.102<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Unspecified ectropion of right lower eyelid<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Lower lid displacement from canthal tendon laxity; the left lower lid is H02.105<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">S01.111A<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Laceration without foreign body of right eyelid and periocular area, initial encounter<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Acute trauma involving the medial canthal region<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">S02.2XXA<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Fracture of nasal bones, initial encounter for closed fracture<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Naso-orbito-ethmoid injury patterns that detach the medial canthal tendon<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Q10.3<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Other congenital malformations of eyelid<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Congenital medial canthal malposition, including telecanthus presentations<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n\n\n<p class=\"wp-block-paragraph\">Code to the highest level of specificity your record supports, including laterality and the encounter character. Unspecified codes invite a request for records even when the surgery was clearly necessary.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Where the indication is purely aesthetic, there is no supporting diagnosis to find. Report Z41.1 for an encounter for cosmetic surgery and handle the case as a non-covered service.<\/p>\n\n\n\n<h2 id=\"h-billing-guidelines-and-documentation-requirements\" class=\"wp-block-heading\">Billing guidelines and documentation requirements<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Documentation quality is what separates a paid claim from a request for records that stalls payment by 30 days or more. The requirements below apply broadly across payers.<\/p>\n\n\n\n<h3 id=\"h-required-documentation-elements\" class=\"wp-block-heading\">Required documentation elements<\/h3>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Establish medical necessity in the operative note.<\/strong> State the presenting diagnosis, such as medial canthal tendon laxity, post-traumatic malposition, or epiphora from punctal displacement.<\/li>\n\n\n\n<li><strong>Record the functional impact.<\/strong> Note how the condition affects vision or ocular surface health, in the patient&#8217;s own reported terms where possible.<\/li>\n\n\n\n<li><strong>Document the surgical technique.<\/strong> Specify that a medial canthopexy was performed, the method used, and the anatomical landmarks addressed.<\/li>\n\n\n\n<li><strong>Support the separate procedure rule.<\/strong> If another surgical code is on the claim, explain why the canthopexy was distinct rather than an integral step.<\/li>\n\n\n\n<li><strong>Apply NCCI bundling awareness.<\/strong> Check the edit tables before every claim that pairs 21280 with eyelid reconstruction, entropion or ectropion repair, or orbital procedures.<\/li>\n\n\n\n<li><strong>Use laterality modifiers consistently.<\/strong> Append -RT or -LT to identify the side treated, and confirm the diagnosis laterality matches.<\/li>\n<\/ul>\n\n\n\n<h3 id=\"h-the-90-day-global-period\" class=\"wp-block-heading\">The 90-day global period<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">CPT 21280 carries a 090 global period, so routine post-operative visits for 90 days are already paid for in the surgical fee. Billing an office visit inside that window without a qualifying modifier produces a denial. <\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Those visits still belong in the record, and a standard <a href=\"https:\/\/pabau.com\/templates\/patient-discharge-form\/\">patient discharge form<\/a> keeps that documentation consistent.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">A return to the operating room for a related complication takes modifier -78. An unrelated procedure in the same window takes -79. Unrelated evaluation and management inside the window takes -24 on the visit code.<\/p>\n\n\n\n<h3 id=\"h-common-denial-reasons\" class=\"wp-block-heading\">Common denial reasons<\/h3>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>No functional diagnosis on the claim.<\/strong> The record describes an aesthetic concern, so the payer treats the surgery as cosmetic.<\/li>\n\n\n\n<li><strong>Bundling with a larger periocular repair.<\/strong> The separate procedure designation applies and no distinct-service modifier was appended.<\/li>\n\n\n\n<li><strong>Laterality mismatch.<\/strong> The modifier says right and the diagnosis code says left, or the modifier is missing entirely.<\/li>\n\n\n\n<li><strong>Post-operative visit billed inside the global period.<\/strong> Routine follow-up within 90 days is included in the surgical payment.<\/li>\n\n\n\n<li><strong>Missing prior authorization.<\/strong> Most commercial and Medicare Advantage plans require it for elective periocular surgery.<\/li>\n\n\n\n<li><strong>Stale fee schedule.<\/strong> The practice quoted 2025 rates, so the posted payment looks like an underpayment when it is not.<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">For practices building out <a href=\"https:\/\/pabau.com\/blog\/hipaa-compliance-software\/\">HIPAA-compliant documentation<\/a>, a structured operative note template covering these elements reduces variability between providers. <a href=\"https:\/\/pabau.com\/features\/patient-intake-software\/\">Digital consent and intake forms<\/a> capture the pre-operative functional complaints that support medical necessity later.<\/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-21280\/customizable-consent-and-intake-forms.webp\" alt=\"Customizable consent and intake forms\"\/><figcaption class=\"wp-element-caption\"><em>Customizable consent and intake forms record the tearing and functional complaints that support medical necessity on a CPT 21280 claim.<\/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\">Practices expanding into periocular surgery should also review the regulatory steps involved in <a href=\"https:\/\/pabau.com\/blog\/opening-a-cosmetic-surgery-clinic\/\">opening a cosmetic surgery clinic<\/a>. Credentialing and facility requirements both affect how surgical codes get billed.<\/p>\n\n\n\n<h2 id=\"h-is-medial-canthopexy-covered-by-insurance\" class=\"wp-block-heading\">Is medial canthopexy covered by insurance?<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Medicare and most commercial insurers cover medial canthopexy when the operative indication is functional, and exclude it when the indication is aesthetic. The medical record decides which category the case falls into.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Covered indications typically include canthal tendon laxity causing epiphora, punctal eversion that damages the ocular surface, and post-traumatic canthal displacement affecting visual function. Purely cosmetic improvement of the inner canthal angle is not covered.<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Functional coverage criteria.<\/strong> Documented canthal tendon laxity on exam, a measured lower lid laxity result, a functional complaint, and failure of conservative management where applicable.<\/li>\n\n\n\n<li><strong>Prior authorization.<\/strong> Required by most Medicare Advantage and commercial plans. Submit the operative plan, clinical photos, and exam findings that document functional impairment.<\/li>\n\n\n\n<li><strong>Cosmetic exclusion.<\/strong> Bill as a non-covered service and tell the patient their out-of-pocket responsibility before the procedure.<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">Submitting a functional case without prior authorization does not guarantee a denial, but it raises audit risk and slows resolution if one follows. <a href=\"https:\/\/pabau.com\/blog\/best-plastic-surgery-software\/\">Practice management tools for plastic surgery<\/a> can flag procedures needing authorization at the scheduling stage, before the patient arrives.<\/p>\n\n\n\n<h2 id=\"h-how-pabau-supports-cpt-21280-billing-workflows\" class=\"wp-block-heading\">How Pabau supports CPT 21280 billing workflows<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Reference sites tell you what CPT code 21280 means. They do not help you get it onto a claim, attached to the right patient record, with the correct modifier, on the day of service.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Pabau&#8217;s <a href=\"https:\/\/pabau.com\/features\/claims-management-software\/\">claims management software<\/a> links procedure codes to patient records and invoices inside the system your front desk and clinical team already use. When a surgeon finishes a medial canthopexy, the code, modifier, and supporting note are captured in one workflow.<\/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-21280\/automate-claims-through-healthcode.webp\" alt=\"Automate claims and billing with Pabau\"\/><figcaption class=\"wp-element-caption\"><em>Automated claim submission sends CPT 21280 out with its modifiers and supporting documentation already attached, so nothing is rekeyed.<\/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\">For <a href=\"https:\/\/pabau.com\/industry\/plastic-surgery-emr\/\">plastic surgery EMR<\/a> and oculoplastic practices, Pabau&#8217;s reporting lets you benchmark actual payments against the published Medicare rate. A consistent shortfall on 21280 shows up in the data instead of disappearing into year-end write-offs.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Groups that run <a href=\"https:\/\/pabau.com\/industry\/dermatology-emr-software\/\">dermatology<\/a> or <a href=\"https:\/\/pabau.com\/blog\/medical-spa-emr-software\/\">medical spa<\/a> service lines alongside surgery can manage all of them from one platform. Procedure code management stays consistent across service lines, with no duplicate data entry.<\/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>Build a CPT 21280 checklist into your pre-submission workflow. Confirm the laterality modifier is appended and verify NCCI edits when another surgical code shares the claim. Attach the operative note with a clear medical necessity statement. Catching these at submission is far faster than working a denial afterward.<\/p>\n            <\/div>\n        <\/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                    Manage surgical CPT codes inside your practice workflow                <\/h3>\n\n                <p class=\"description\">\n                    Pabau links CPT 21280 and every other procedure code directly to patient records, invoicing, and clinical documentation. No switching between a reference site and your practice management system.                <\/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 practice management dashboard showing procedure code billing workflows\"\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\">CPT code 21280 is a medial canthopexy code, not an eyelid repair code, and it pays one national rate regardless of setting. Getting both of those facts right removes two of the most common sources of error on these claims.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">What remains is documentation. The separate procedure designation, the NCCI edits, the 90-day global period, and the functional versus cosmetic question all turn on what the operative note says.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Pabau&#8217;s claim management and documentation tools keep that record inside your clinical workflow instead of across disconnected systems. <a href=\"https:\/\/pabau.com\/book-demo\/\">Book a demo<\/a> to see how Pabau handles surgical code management for oculoplastic practices.<\/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>Assessing a patient\u2019s eyes before periocular surgery?<\/strong> <a href=\"https:\/\/pabau.com\/blog\/neurological-eye-exam\/\">Neurological eye exam<\/a> sets out what the exam covers and what its findings point to.<\/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>Coding a foreign body removal from a trauma wound?<\/strong> <a href=\"https:\/\/pabau.com\/procedure-codes\/cpt-code-10121\/\">CPT 10121<\/a> walks through the complicated variant, its RVUs, and the documentation payers expect.<\/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 a code that no longer exists?<\/strong> <a href=\"https:\/\/pabau.com\/procedure-codes\/cpt-code-19324\/\">CPT 19324<\/a> explains what replaced the deleted mammaplasty code and how to report the work now.<\/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>Monitoring a head injury patient before facial repair?<\/strong> <a href=\"https:\/\/pabau.com\/blog\/neurological-vital-signs\/\">Neurological vital signs<\/a> covers assessment, GCS scoring, and when to escalate.<\/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-1786626504348\"><h3 class=\"schema-faq-question\">What is CPT code 21280 used for?<\/h3> <p class=\"schema-faq-answer\">CPT code 21280 reports medial canthopexy, a procedure that tightens or repositions the medial canthal tendon at the inner corner of the eyelid. Surgeons use it to correct canthal tendon laxity, punctal eversion, or post-traumatic canthal displacement causing tearing or functional impairment.<\/p> <\/div> <div class=\"schema-faq-section\" id=\"faq-question-1786626504349\"><h3 class=\"schema-faq-question\">Is CPT 21280 a full-thickness eyelid repair?<\/h3> <p class=\"schema-faq-answer\">No. The official descriptor for CPT 21280 is medial canthopexy, and the code sits in the musculoskeletal head section of CPT. Full-thickness closure of a recent eyelid wound is reported with CPT 67935 instead.<\/p> <\/div> <div class=\"schema-faq-section\" id=\"faq-question-1786626504350\"><h3 class=\"schema-faq-question\">What are the RVU values for CPT 21280?<\/h3> <p class=\"schema-faq-answer\">In the 2026 CMS Physician Fee Schedule, CPT 21280 carries a work RVU of 6.95 and a practice expense RVU of 8.04. The malpractice RVU is 0.71, for 15.70 total RVUs. CMS lists the same values in facility and office settings, so this code has no facility split.<\/p> <\/div> <div class=\"schema-faq-section\" id=\"faq-question-1786626504351\"><h3 class=\"schema-faq-question\">What is the Medicare reimbursement rate for CPT 21280?<\/h3> <p class=\"schema-faq-answer\">The 2026 Medicare national estimate for CPT 21280 is about $524.39. That is 15.70 total RVUs multiplied by the conversion factor of $33.4009. Geographic adjustment moves the final allowable up or down by locality.<\/p> <\/div> <div class=\"schema-faq-section\" id=\"faq-question-1786626504352\"><h3 class=\"schema-faq-question\">Does CPT 21280 pay differently in a facility and an office?<\/h3> <p class=\"schema-faq-answer\">No. CMS assigns CPT 21280 the same practice expense RVU in both settings, so the total RVUs and the payment are identical. Place of service still belongs on the claim, but it does not change the physician allowable.<\/p> <\/div> <div class=\"schema-faq-section\" id=\"faq-question-1786626504353\"><h3 class=\"schema-faq-question\">What modifiers apply to CPT code 21280?<\/h3> <p class=\"schema-faq-answer\">The modifiers used most often are -51 for multiple procedures, -59 or -XS for a distinct service, and -RT or -LT for laterality. Modifier -50 applies to bilateral cases, subject to the code&#8217;s CMS bilateral surgery indicator. Inside the 90-day global period, use -78 or -79.<\/p> <\/div> <div class=\"schema-faq-section\" id=\"faq-question-1786626504354\"><h3 class=\"schema-faq-question\">What does the separate procedure designation mean for CPT 21280?<\/h3> <p class=\"schema-faq-answer\">It means CPT 21280 is ordinarily a component of a more comprehensive service. Bill it independently only when the canthopexy was a distinct, unrelated procedure on that date. Reporting it inside a larger periocular reconstruction without a supporting modifier usually triggers a bundling denial.<\/p> <\/div> <div class=\"schema-faq-section\" id=\"faq-question-1786626504355\"><h3 class=\"schema-faq-question\">What is the difference between CPT 21280 and CPT 21282?<\/h3> <p class=\"schema-faq-answer\">CPT 21280 covers medial canthopexy at the inner corner of the eye. CPT 21282 covers lateral canthopexy at the outer corner. In 2026, 21280 carries 15.70 total RVUs and 21282 carries 11.06. When both are performed in one session, modifier -51 goes on the lower-valued code.<\/p> <\/div> <div class=\"schema-faq-section\" id=\"faq-question-1786626504356\"><h3 class=\"schema-faq-question\">Is medial canthopexy covered by insurance?<\/h3> <p class=\"schema-faq-answer\">Medicare and most commercial payers cover medial canthopexy when the record documents functional impairment. That means canthal tendon laxity causing epiphora, punctal eversion, or a measurable effect on vision. Purely cosmetic canthopexy is not covered. Most payers require prior authorization, so submit exam findings, clinical photos, and a medical necessity statement.<\/p> <\/div> <\/div>\n","protected":false},"excerpt":{"rendered":"<p>CPT code 21280 reports medial canthopexy, a repair that tightens or repositions the medial canthal tendon at the inner corner of the eyelid. The code sits in the musculoskeletal head section of CPT, alongside facial reconstruction codes. It is not an eyelid repair code, and that placement explains most of the miscoding around it. Below [&hellip;]<\/p>\n","protected":false},"author":83,"featured_media":179897,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_yoast_wpseo_linkdex":"91","_yoast_wpseo_content_score":"30","_yoast_wpseo_is_cornerstone":"","_yoast_wpseo_keywordsynonyms":"[\"\",\"\",\"\",\"\",\"\"]","_yoast_wpseo_focuskw_text_input":"","_seo_original_html":"","footnotes":""},"categories":[1433,1546],"tags":[4116,1543,1602,1236,4199],"class_list":["post-179898","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-billing-codes","category-cpt-codes","tag-billing-codes","tag-clinical-documentation","tag-cpt-modifiers","tag-medicare-reimbursement","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 21280: 2026 RVU values and Medicare payment<\/title>\n<meta name=\"description\" content=\"CPT 21280 (medial canthopexy) carries 15.70 total RVUs in 2026 and pays about $524, with no facility versus office split.\" \/>\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\/nl\/procedure-codes\/cpt-code-21280\/\" \/>\n<meta property=\"og:locale\" content=\"nl_NL\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"CPT code 21280: 2026 RVU values and Medicare payment\" \/>\n<meta property=\"og:description\" content=\"CPT 21280 (medial canthopexy) carries 15.70 total RVUs in 2026 and pays about $524, with no facility versus office split.\" \/>\n<meta property=\"og:url\" content=\"https:\/\/pabau.com\/nl\/procedure-codes\/cpt-code-21280\/\" \/>\n<meta property=\"og:site_name\" content=\"Pabau\" \/>\n<meta property=\"article:publisher\" 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Surgeons use it to correct canthal tendon laxity, punctal eversion, or post-traumatic canthal displacement causing tearing or functional impairment.\",\"inLanguage\":\"nl-NL\"},\"inLanguage\":\"nl-NL\"},{\"@type\":\"Question\",\"@id\":\"https:\\\/\\\/pabau.com\\\/nl\\\/procedure-codes\\\/cpt-code-21280\\\/#faq-question-1786626504349\",\"position\":2,\"url\":\"https:\\\/\\\/pabau.com\\\/nl\\\/procedure-codes\\\/cpt-code-21280\\\/#faq-question-1786626504349\",\"name\":\"Is CPT 21280 a full-thickness eyelid repair?\",\"answerCount\":1,\"acceptedAnswer\":{\"@type\":\"Answer\",\"text\":\"No. The official descriptor for CPT 21280 is medial canthopexy, and the code sits in the musculoskeletal head section of CPT. Full-thickness closure of a recent eyelid wound is reported with CPT 67935 instead.\",\"inLanguage\":\"nl-NL\"},\"inLanguage\":\"nl-NL\"},{\"@type\":\"Question\",\"@id\":\"https:\\\/\\\/pabau.com\\\/nl\\\/procedure-codes\\\/cpt-code-21280\\\/#faq-question-1786626504350\",\"position\":3,\"url\":\"https:\\\/\\\/pabau.com\\\/nl\\\/procedure-codes\\\/cpt-code-21280\\\/#faq-question-1786626504350\",\"name\":\"What are the RVU values for CPT 21280?\",\"answerCount\":1,\"acceptedAnswer\":{\"@type\":\"Answer\",\"text\":\"In the 2026 CMS Physician Fee Schedule, CPT 21280 carries a work RVU of 6.95 and a practice expense RVU of 8.04. The malpractice RVU is 0.71, for 15.70 total RVUs. CMS lists the same values in facility and office settings, so this code has no facility split.\",\"inLanguage\":\"nl-NL\"},\"inLanguage\":\"nl-NL\"},{\"@type\":\"Question\",\"@id\":\"https:\\\/\\\/pabau.com\\\/nl\\\/procedure-codes\\\/cpt-code-21280\\\/#faq-question-1786626504351\",\"position\":4,\"url\":\"https:\\\/\\\/pabau.com\\\/nl\\\/procedure-codes\\\/cpt-code-21280\\\/#faq-question-1786626504351\",\"name\":\"What is the Medicare reimbursement rate for CPT 21280?\",\"answerCount\":1,\"acceptedAnswer\":{\"@type\":\"Answer\",\"text\":\"The 2026 Medicare national estimate for CPT 21280 is about $524.39. That is 15.70 total RVUs multiplied by the conversion factor of $33.4009. Geographic adjustment moves the final allowable up or down by locality.\",\"inLanguage\":\"nl-NL\"},\"inLanguage\":\"nl-NL\"},{\"@type\":\"Question\",\"@id\":\"https:\\\/\\\/pabau.com\\\/nl\\\/procedure-codes\\\/cpt-code-21280\\\/#faq-question-1786626504352\",\"position\":5,\"url\":\"https:\\\/\\\/pabau.com\\\/nl\\\/procedure-codes\\\/cpt-code-21280\\\/#faq-question-1786626504352\",\"name\":\"Does CPT 21280 pay differently in a facility and an office?\",\"answerCount\":1,\"acceptedAnswer\":{\"@type\":\"Answer\",\"text\":\"No. CMS assigns CPT 21280 the same practice expense RVU in both settings, so the total RVUs and the payment are identical. Place of service still belongs on the claim, but it does not change the physician allowable.\",\"inLanguage\":\"nl-NL\"},\"inLanguage\":\"nl-NL\"},{\"@type\":\"Question\",\"@id\":\"https:\\\/\\\/pabau.com\\\/nl\\\/procedure-codes\\\/cpt-code-21280\\\/#faq-question-1786626504353\",\"position\":6,\"url\":\"https:\\\/\\\/pabau.com\\\/nl\\\/procedure-codes\\\/cpt-code-21280\\\/#faq-question-1786626504353\",\"name\":\"What modifiers apply to CPT code 21280?\",\"answerCount\":1,\"acceptedAnswer\":{\"@type\":\"Answer\",\"text\":\"The modifiers used most often are -51 for multiple procedures, -59 or -XS for a distinct service, and -RT or -LT for laterality. Modifier -50 applies to bilateral cases, subject to the code's CMS bilateral surgery indicator. Inside the 90-day global period, use -78 or -79.\",\"inLanguage\":\"nl-NL\"},\"inLanguage\":\"nl-NL\"},{\"@type\":\"Question\",\"@id\":\"https:\\\/\\\/pabau.com\\\/nl\\\/procedure-codes\\\/cpt-code-21280\\\/#faq-question-1786626504354\",\"position\":7,\"url\":\"https:\\\/\\\/pabau.com\\\/nl\\\/procedure-codes\\\/cpt-code-21280\\\/#faq-question-1786626504354\",\"name\":\"What does the separate procedure designation mean for CPT 21280?\",\"answerCount\":1,\"acceptedAnswer\":{\"@type\":\"Answer\",\"text\":\"It means CPT 21280 is ordinarily a component of a more comprehensive service. Bill it independently only when the canthopexy was a distinct, unrelated procedure on that date. Reporting it inside a larger periocular reconstruction without a supporting modifier usually triggers a bundling denial.\",\"inLanguage\":\"nl-NL\"},\"inLanguage\":\"nl-NL\"},{\"@type\":\"Question\",\"@id\":\"https:\\\/\\\/pabau.com\\\/nl\\\/procedure-codes\\\/cpt-code-21280\\\/#faq-question-1786626504355\",\"position\":8,\"url\":\"https:\\\/\\\/pabau.com\\\/nl\\\/procedure-codes\\\/cpt-code-21280\\\/#faq-question-1786626504355\",\"name\":\"What is the difference between CPT 21280 and CPT 21282?\",\"answerCount\":1,\"acceptedAnswer\":{\"@type\":\"Answer\",\"text\":\"CPT 21280 covers medial canthopexy at the inner corner of the eye. CPT 21282 covers lateral canthopexy at the outer corner. In 2026, 21280 carries 15.70 total RVUs and 21282 carries 11.06. When both are performed in one session, modifier -51 goes on the lower-valued code.\",\"inLanguage\":\"nl-NL\"},\"inLanguage\":\"nl-NL\"},{\"@type\":\"Question\",\"@id\":\"https:\\\/\\\/pabau.com\\\/nl\\\/procedure-codes\\\/cpt-code-21280\\\/#faq-question-1786626504356\",\"position\":9,\"url\":\"https:\\\/\\\/pabau.com\\\/nl\\\/procedure-codes\\\/cpt-code-21280\\\/#faq-question-1786626504356\",\"name\":\"Is medial canthopexy covered by insurance?\",\"answerCount\":1,\"acceptedAnswer\":{\"@type\":\"Answer\",\"text\":\"Medicare and most commercial payers cover medial canthopexy when the record documents functional impairment. That means canthal tendon laxity causing epiphora, punctal eversion, or a measurable effect on vision. Purely cosmetic canthopexy is not covered. Most payers require prior authorization, so submit exam findings, clinical photos, and a medical necessity statement.\",\"inLanguage\":\"nl-NL\"},\"inLanguage\":\"nl-NL\"}]}<\/script>\n<!-- \/ Yoast SEO Premium plugin. -->","yoast_head_json":{"title":"CPT code 21280: 2026 RVU values and Medicare payment","description":"CPT 21280 (medial canthopexy) carries 15.70 total RVUs in 2026 and pays about $524, with no facility versus office split.","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\/nl\/procedure-codes\/cpt-code-21280\/","og_locale":"nl_NL","og_type":"article","og_title":"CPT code 21280: 2026 RVU values and Medicare payment","og_description":"CPT 21280 (medial canthopexy) carries 15.70 total RVUs in 2026 and pays about $524, with no facility versus office 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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\/nl\/#\/schema\/person\/f2e43b25ed02313e8781f0f4507398b9","name":"Anja Dodevska","image":{"@type":"ImageObject","inLanguage":"nl-NL","@id":"https:\/\/pabau.com\/wp-content\/uploads\/2026\/06\/cropped-CE0C072E-91B7-4BB7-BD27-D1E3B38ED0CA-scaled-1-96x96.jpg","url":"https:\/\/pabau.com\/wp-content\/uploads\/2026\/06\/cropped-CE0C072E-91B7-4BB7-BD27-D1E3B38ED0CA-scaled-1-96x96.jpg","contentUrl":"https:\/\/pabau.com\/wp-content\/uploads\/2026\/06\/cropped-CE0C072E-91B7-4BB7-BD27-D1E3B38ED0CA-scaled-1-96x96.jpg","caption":"Anja Dodevska"},"description":"Anja Dodevska writes about healthcare, dermatology, and the day-to-day realities of running a medical practice for Pabau. She enjoys breaking down complex topics into clear, accessible content and has a soft spot for the often-overlooked aspects of clinic life. When she's not writing, she's exploring cafes, walking her dog, or spending time with friends and family.","url":"https:\/\/pabau.com\/nl\/blog\/author\/anja-dodevska\/"},{"@type":"Question","@id":"https:\/\/pabau.com\/nl\/procedure-codes\/cpt-code-21280\/#faq-question-1786626504348","position":1,"url":"https:\/\/pabau.com\/nl\/procedure-codes\/cpt-code-21280\/#faq-question-1786626504348","name":"What is CPT code 21280 used for?","answerCount":1,"acceptedAnswer":{"@type":"Answer","text":"CPT code 21280 reports medial canthopexy, a procedure that tightens or repositions the medial canthal tendon at the inner corner of the eyelid. Surgeons use it to correct canthal tendon laxity, punctal eversion, or post-traumatic canthal displacement causing tearing or functional impairment.","inLanguage":"nl-NL"},"inLanguage":"nl-NL"},{"@type":"Question","@id":"https:\/\/pabau.com\/nl\/procedure-codes\/cpt-code-21280\/#faq-question-1786626504349","position":2,"url":"https:\/\/pabau.com\/nl\/procedure-codes\/cpt-code-21280\/#faq-question-1786626504349","name":"Is CPT 21280 a full-thickness eyelid repair?","answerCount":1,"acceptedAnswer":{"@type":"Answer","text":"No. The official descriptor for CPT 21280 is medial canthopexy, and the code sits in the musculoskeletal head section of CPT. Full-thickness closure of a recent eyelid wound is reported with CPT 67935 instead.","inLanguage":"nl-NL"},"inLanguage":"nl-NL"},{"@type":"Question","@id":"https:\/\/pabau.com\/nl\/procedure-codes\/cpt-code-21280\/#faq-question-1786626504350","position":3,"url":"https:\/\/pabau.com\/nl\/procedure-codes\/cpt-code-21280\/#faq-question-1786626504350","name":"What are the RVU values for CPT 21280?","answerCount":1,"acceptedAnswer":{"@type":"Answer","text":"In the 2026 CMS Physician Fee Schedule, CPT 21280 carries a work RVU of 6.95 and a practice expense RVU of 8.04. The malpractice RVU is 0.71, for 15.70 total RVUs. CMS lists the same values in facility and office settings, so this code has no facility split.","inLanguage":"nl-NL"},"inLanguage":"nl-NL"},{"@type":"Question","@id":"https:\/\/pabau.com\/nl\/procedure-codes\/cpt-code-21280\/#faq-question-1786626504351","position":4,"url":"https:\/\/pabau.com\/nl\/procedure-codes\/cpt-code-21280\/#faq-question-1786626504351","name":"What is the Medicare reimbursement rate for CPT 21280?","answerCount":1,"acceptedAnswer":{"@type":"Answer","text":"The 2026 Medicare national estimate for CPT 21280 is about $524.39. That is 15.70 total RVUs multiplied by the conversion factor of $33.4009. Geographic adjustment moves the final allowable up or down by locality.","inLanguage":"nl-NL"},"inLanguage":"nl-NL"},{"@type":"Question","@id":"https:\/\/pabau.com\/nl\/procedure-codes\/cpt-code-21280\/#faq-question-1786626504352","position":5,"url":"https:\/\/pabau.com\/nl\/procedure-codes\/cpt-code-21280\/#faq-question-1786626504352","name":"Does CPT 21280 pay differently in a facility and an office?","answerCount":1,"acceptedAnswer":{"@type":"Answer","text":"No. CMS assigns CPT 21280 the same practice expense RVU in both settings, so the total RVUs and the payment are identical. Place of service still belongs on the claim, but it does not change the physician allowable.","inLanguage":"nl-NL"},"inLanguage":"nl-NL"},{"@type":"Question","@id":"https:\/\/pabau.com\/nl\/procedure-codes\/cpt-code-21280\/#faq-question-1786626504353","position":6,"url":"https:\/\/pabau.com\/nl\/procedure-codes\/cpt-code-21280\/#faq-question-1786626504353","name":"What modifiers apply to CPT code 21280?","answerCount":1,"acceptedAnswer":{"@type":"Answer","text":"The modifiers used most often are -51 for multiple procedures, -59 or -XS for a distinct service, and -RT or -LT for laterality. Modifier -50 applies to bilateral cases, subject to the code's CMS bilateral surgery indicator. Inside the 90-day global period, use -78 or -79.","inLanguage":"nl-NL"},"inLanguage":"nl-NL"},{"@type":"Question","@id":"https:\/\/pabau.com\/nl\/procedure-codes\/cpt-code-21280\/#faq-question-1786626504354","position":7,"url":"https:\/\/pabau.com\/nl\/procedure-codes\/cpt-code-21280\/#faq-question-1786626504354","name":"What does the separate procedure designation mean for CPT 21280?","answerCount":1,"acceptedAnswer":{"@type":"Answer","text":"It means CPT 21280 is ordinarily a component of a more comprehensive service. Bill it independently only when the canthopexy was a distinct, unrelated procedure on that date. Reporting it inside a larger periocular reconstruction without a supporting modifier usually triggers a bundling denial.","inLanguage":"nl-NL"},"inLanguage":"nl-NL"},{"@type":"Question","@id":"https:\/\/pabau.com\/nl\/procedure-codes\/cpt-code-21280\/#faq-question-1786626504355","position":8,"url":"https:\/\/pabau.com\/nl\/procedure-codes\/cpt-code-21280\/#faq-question-1786626504355","name":"What is the difference between CPT 21280 and CPT 21282?","answerCount":1,"acceptedAnswer":{"@type":"Answer","text":"CPT 21280 covers medial canthopexy at the inner corner of the eye. CPT 21282 covers lateral canthopexy at the outer corner. In 2026, 21280 carries 15.70 total RVUs and 21282 carries 11.06. When both are performed in one session, modifier -51 goes on the lower-valued code.","inLanguage":"nl-NL"},"inLanguage":"nl-NL"},{"@type":"Question","@id":"https:\/\/pabau.com\/nl\/procedure-codes\/cpt-code-21280\/#faq-question-1786626504356","position":9,"url":"https:\/\/pabau.com\/nl\/procedure-codes\/cpt-code-21280\/#faq-question-1786626504356","name":"Is medial canthopexy covered by insurance?","answerCount":1,"acceptedAnswer":{"@type":"Answer","text":"Medicare and most commercial payers cover medial canthopexy when the record documents functional impairment. That means canthal tendon laxity causing epiphora, punctal eversion, or a measurable effect on vision. Purely cosmetic canthopexy is not covered. Most payers require prior authorization, so submit exam findings, clinical photos, and a medical necessity statement.","inLanguage":"nl-NL"},"inLanguage":"nl-NL"}]}},"yoast":{"focus_keyword":"CPT code 21280","seo_title":"CPT code 21280: %%currentyear%% RVU values and Medicare payment","meta_description":"CPT 21280 (medial canthopexy) carries 15.70 total RVUs in %%currentyear%% and pays about $524, with no facility versus office split.","content_score":"30","is_cornerstone":"","related_keyphrases":[{"keyword":"CPT 21280 RVU values","score":61},{"keyword":"CPT 21280 modifiers","score":61},{"keyword":"medial canthopexy billing","score":61},{"keyword":"oculoplastic CPT codes","score":61}]},"_links":{"self":[{"href":"https:\/\/pabau.com\/nl\/wp-json\/wp\/v2\/posts\/179898","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/pabau.com\/nl\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/pabau.com\/nl\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/pabau.com\/nl\/wp-json\/wp\/v2\/users\/83"}],"replies":[{"embeddable":true,"href":"https:\/\/pabau.com\/nl\/wp-json\/wp\/v2\/comments?post=179898"}],"version-history":[{"count":4,"href":"https:\/\/pabau.com\/nl\/wp-json\/wp\/v2\/posts\/179898\/revisions"}],"predecessor-version":[{"id":180243,"href":"https:\/\/pabau.com\/nl\/wp-json\/wp\/v2\/posts\/179898\/revisions\/180243"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/pabau.com\/nl\/wp-json\/wp\/v2\/media\/179897"}],"wp:attachment":[{"href":"https:\/\/pabau.com\/nl\/wp-json\/wp\/v2\/media?parent=179898"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/pabau.com\/nl\/wp-json\/wp\/v2\/categories?post=179898"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/pabau.com\/nl\/wp-json\/wp\/v2\/tags?post=179898"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}