Summary & Overview
CPT 21387: Orbital Floor Repair for Blowout Fracture
CPT code 21387 denotes surgical repair of the orbital floor to restore anatomy and function after a blowout fracture from blunt trauma. This procedure addresses orbital floor defects that can impair ocular movement, cause enophthalmos, or disrupt facial appearance. Nationally, orbital fracture repairs are an important component of facial trauma care delivered across emergency, inpatient, and ambulatory surgical settings, with implications for surgical resource use and posttrauma functional outcomes. Key payers included in analyses of coverage and reimbursement typically comprise Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of the clinical context for orbital floor repair, typical sites of service, and commonly associated billing practices. The publication summarizes benchmark measures where available, highlights pertinent policy and coverage considerations affecting access to timely surgical repair, and outlines coding relationships relevant to procedural documentation. It also provides clinical context that helps billing and clinical teams align operative notes with reporting requirements. Data not available in the input will be noted where applicable.
Billing Code Overview
CPT code 21387 describes surgical repair of the orbital floor (the bony structure beneath the eye) to restore facial appearance and ocular function after a blowout fracture caused by blunt force trauma. The procedure involves exposure of the orbital floor through one or more incisions and reconstruction or repair of the bony defect.
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Service type: Surgical repair / facial trauma surgery
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Typical site of service: Operative setting, commonly performed in the hospital operating room or an ambulatory surgical center depending on clinical complexity and patient stability.
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Clinical & Coding Specifications
Clinical Context
A 28-year-old male presents to the emergency department after an assault with blunt facial trauma. He reports double vision on upward gaze and numbness of the left cheek. Facial CT demonstrates a displaced left orbital floor (blowout) fracture with herniation of orbital fat into the maxillary sinus. The otolaryngology or maxillofacial surgical team evaluates the patient, documents diplopia and restricted upward gaze on clinical exam, and confirms imaging findings that correlate with entrapment and loss of orbital support.
Surgical planning includes preoperative ophthalmology assessment, consent, and imaging review. In the operating room under general anesthesia, the surgeon approaches the orbital floor through transconjunctival and/or subciliary incisions, reduces herniated contents, and repairs the bony defect using an alloplastic implant or autogenous graft to restore orbital volume and ocular alignment. Postoperative workflow includes ophthalmology recheck for ocular motility and vision, wound care, pain control, and discharge with follow-up for implant position and functional recovery. Typical sites of service are the operating room in an acute hospital setting or ambulatory surgery center depending on patient stability and complexity of injury.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | Reserved/Not commonly used for Medicare reporting | Use only if payer-specific requirements designate this value (rare). |