Surgical fixation of the medial canthus (inner corner of the eye) to restore or tighten its anatomic position

Verified May 8, 2026 · 7 sources ↓

Medicare: $524.39
Work RVU: 6.95
Global, days: 90
Region: Other

Drawn from CMSAAPCEyesEmednyMdclarity

Documentation requirements

What must appear in the operative or office note to support the claim.

Source · Editorial brief grounded in 7 cited references ↓

Specify medial versus lateral canthus explicitly — 'canthopexy' alone does not distinguish 21280 from 21282
Document the indication: telecanthus, post-traumatic canthal drift, epiphora, or lacrimal drainage obstruction
Describe the fixation technique: transnasal wiring, suture to periosteum, or anchor system used
Note laterality (left, right, or bilateral) in both the preoperative diagnosis and operative report
If performed with other craniofacial or orbital procedures, clearly establish that medial canthopexy was a distinct, separately identifiable surgical step
Photograph or imaging documentation supporting medial canthal laxity or displacement strengthens medical necessity

Applicable modifiers

Modifiers commonly billed with this code.

Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual

22 Increased complexity 24 Unrelated E/M during global 25 Significant separate E/M 50 Bilateral procedure 51 Multiple procedures 52 Reduced services 58 Staged or related 59 Distinct service 76 Repeat, same physician 78 Unplanned return — related 79 Unrelated during global 80 Assistant surgeon LT Left side RT Right side XS Separate structure

What this code covers

Source · Editorial summary grounded in 7 cited references ↓

CPT 21280 covers surgical repositioning and fixation of the medial canthal tendon — the fibrous structure anchoring the inner corner of the eyelids to the medial orbital wall. Surgeons perform this to correct telecanthus, post-traumatic medial canthal drift, or lacrimal drainage compromise. It is listed as a separate procedure, meaning it can be reported independently when performed as a standalone surgery but may be bundled when performed as a component of a broader craniofacial or orbital reconstruction.

The 90-day global period applies. All routine follow-up, wound checks, and suture removal through day 90 are included in the surgical payment. Any medically necessary E/M visit for an unrelated condition during the global window requires modifier 24. If a distinct, separately identifiable E/M occurs the same day as the procedure, append modifier 25.

Do not confuse 21280 with 21282 (lateral canthopexy) — they describe anatomically distinct anchor points. Billing the wrong code based on operative side is a frequent audit flag. When both medial and lateral canthopexy are performed on the same eye during the same session, report each separately with modifier 51 on the lower-valued code. Bilateral medial canthopexy requires modifier 50.

RVU & reimbursement

Component RVUs and Medicare national rate. Actual payment varies by GPCI locality.

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU vs. total RVU

The work RVU (6.95) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (15.7) adds practice overhead and malpractice, and is what drives the Medicare payment below.

Work RVU	6.95
Practice expense RVU	8.04
Malpractice RVU	0.71
Total RVU	15.7
Medicare national rate	$524.39
Global period	90 days

Payment by site of service

Medicare pays different rates by setting. HOPD typically pays substantially more than ASC for the same procedure.

Source · CMS OPPS Addendum B·ASC HCPCS payment rates·2026

Setting	Medicare rate (national)
Office (PFS non-facility) Procedure performed in physician's office	$524.39
HOPD (APC 5164) Hospital outpatient department	$3,387.27
ASC (PI A2) Ambulatory surgical center (freestanding)	$1,480.50

Common denial reasons

The recurring reasons claims for CPT 21280 get rejected.

Source · Editorial brief grounded in CMS NCCI edits, AAOS coding appeals, and cited references ↓

Wrong code selected — 21282 (lateral) billed when operative note documents medial canthal fixation, or vice versa
Bundling denial when payer considers 21280 inclusive of a concurrent orbital or craniofacial reconstruction without modifier 59 or XS to establish distinct anatomic service
Medical necessity denial for cosmetic presentation without documented functional deficit (e.g., epiphora, visual field obstruction, post-traumatic deformity)
Global period conflict — post-op E/M billed without modifier 24 when patient is still within the 90-day global of a prior procedure by the same surgeon
Missing laterality modifier when payer requires LT or RT for unilateral reporting

Frequently asked questions

Source · Generated from the editorial pipeline, verified against 7 cited references ↓

01What is the difference between CPT 21280 and CPT 21282?

21280 is medial canthopexy — fixation of the inner canthal tendon to the medial orbital wall. 21282 is lateral canthopexy — fixation of the outer canthal tendon. The anatomic site determines the code. Billing the wrong one based on operative report ambiguity is a common audit finding.

02Can 21280 and 21282 be billed together on the same operative session?

Yes, when both the medial and lateral canthus of the same eye are surgically fixed during one session, report both codes. Append modifier 51 to the lower-valued code. Document each as a distinct surgical step in the operative note.

03Does 21280 require a modifier for bilateral procedures?

Yes. Bilateral medial canthopexy performed in the same session is reported with modifier 50 appended to 21280. Some payers instead want LT and RT on two line items — verify payer preference before submitting.

04What ICD-10 diagnoses support medical necessity for 21280?

Common supporting diagnoses include traumatic telecanthus (S00-S09 range with appropriate specificity), medial canthal tendon laxity, nasolacrimal drainage obstruction, and post-surgical canthal malposition. Cosmetic-only presentations without a functional diagnosis will trigger medical necessity denials from most payers.

05What is the global period for 21280 and what does it cover?

21280 carries a 90-day global. That includes the day before surgery, the operative day, and all routine post-op care through day 90. E/M visits for unrelated conditions in that window need modifier 24. A new problem on the same day as the procedure needs modifier 25 on the E/M.

06Is 21280 ever bundled into larger craniofacial reconstruction codes?

It can be. When medial canthopexy is performed as a component of a more comprehensive orbital or craniofacial procedure, payers may bundle it. If the canthopexy was a distinct, additional surgical step at a separate anatomic site, use modifier 59 or XS with documentation supporting the separate service.

Sources & references

Editorial content was developed using the following public sources. Last verified May 8, 2026.

Mira Scribe

Mira's AI scribe captures the specific anatomic site (medial vs. lateral canthus), the clinical indication (post-traumatic drift, telecanthus, lacrimal compromise), the fixation method, and laterality directly from the surgeon's dictation. This prevents the most common audit flag for 21280 — operative notes that document a generic 'canthopexy' without specifying medial, leaving coders to guess between 21280 and 21282.

See how Mira captures CPT 21280 documentation