Summary & Overview
CPT 21407: Open Reduction, Internal Fixation of Orbital Fracture
CPT code 21407 covers open reduction and internal fixation of an orbital fracture that is not categorized as a blowout fracture. This surgical procedure addresses fractures of the bony orbit that support the eye, typically resulting from blunt facial trauma. Proper coding of orbital fracture repairs matters nationally because these procedures involve specialized surgical teams, implants, and facility resources, and they affect hospital and surgeon reimbursement, case mix, and quality reporting.
Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise clinical context for the procedure, typical sites of service, and an overview of what to expect when preparing claims for orbital fracture repair. The publication also outlines common billing modifiers and related administrative considerations where available, and highlights benchmarking and policy topics relevant to payers and providers.
This summary equips clinicians, billing professionals, and policy analysts with the essential framing for CPT code 21407: what the procedure is, why accurate coding matters, and what content the full publication will cover, including coding benchmarks, payer-specific policy notes, and clinical documentation considerations. Data not available in the input will be identified within the detailed sections of the full publication.
Billing Code Overview
CPT code 21407 describes surgical assessment and open treatment of an orbital fracture that does not qualify as a blowout fracture. The procedure typically involves an incision directly over the fracture site and placement of an implant to reduce and stabilize the fractured orbital bones.
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Service type: Surgical repair of orbital fracture (open reduction with internal fixation)
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Typical site of service: Hospital operating room or ambulatory surgical center where facial trauma surgery is performed
Clinical & Coding Specifications
Clinical Context
A 34-year-old male presents to the emergency department after an assault with blunt facial trauma and periorbital swelling, diplopia on upward gaze, and localized tenderness over the orbital rim. Facial CT demonstrates a displaced orbital rim fracture without full orbital blowout involvement. The patient is evaluated by an oral and maxillofacial surgeon or an otolaryngologist with facial trauma expertise. After informed consent, the patient is taken to the operating room for open reduction and internal fixation of the orbital fracture under general anesthesia. The surgeon makes a targeted incision over the fracture site, reduces the bone fragments, and places an appropriate implant (e.g., titanium plate and screws or orbital mesh) to stabilize the bony orbit. Intraoperative fluoroscopy or imaging confirms alignment. Postoperative care includes short inpatient observation or same-day discharge depending on airway, ocular status, and comorbidities, with outpatient follow-up to monitor wound healing, ocular function, and hardware position.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | Use when billing only the physician’s professional component separate from technical services (rare for this surgical service). |
50 |