Billing code 65426: Pterygium removalMedicare rate & RVUs

Medicare pays $670.69 for 65426 nationally in the office and $413.17 in a hospital or facility. Local office rates run $598.62–$887.79.

Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.

What 65426 covers

An ophthalmologist removes or repositions a pterygium, a fibrovascular growth that advances from the conjunctiva onto the cornea, and places a graft over the resulting surface defect. The procedure is typically performed in an operating room or ambulatory surgery center when the growth causes symptoms, threatens vision, or warrants surgical treatment. The graft distinguishes this service from pterygium surgery without a graft.

Choose this code when the operative report supports both pterygium excision or transposition and graft placement. Document the treated eye, the pterygium and its corneal involvement, the surgical method, and the graft. Medicare assigns a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. When multiple procedures are performed in one session, the highest-valued procedure is paid in full and others at 50%. For bilateral surgery reported with modifier 50, payment is 150%. Medicare does not pay an assistant at surgery; co-surgeons and team surgery are not permitted.

This summary was written with AI assistance from CMS physician fee schedule data and checked against the CMS billing rules shown here. Rates on this page come directly from CMS files.

Where 65426 pays more and less

The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.

109 of 109 payment localities

65426 rates by state

Office rate range in each state. Select a state to see its payment localities.

How the 65426 rate is calculated

Each of 65426’s three RVUs is multiplied by a geographic index (GPCI) for the payment locality, added up, and multiplied by the conversion factor. Drag the indexes or enter a ZIP to see what moves the rate.

Payment rules and modifiers for 65426

65426 has a 90-day global period: related visits in that window are included in the surgery payment.

What modifiers do to the payment

When to use modifier 50

65426 compared with similar codes

How to choose

65420Pterygium removal

Both codes describe pterygium surgery; report 65426 when the surgeon places a graft and 65420 when surgery is performed without one.

65400Corneal excision

This code is for pterygium excision or transposition with a graft. Code 65400 addresses excision of a corneal lesion rather than pterygium surgery.

65410Corneal biopsy

Code 65410 represents corneal biopsy for tissue diagnosis. Use 65426 when the procedure is pterygium removal or transposition with graft placement.

Codes related to 65426

Related codes aren’t interchangeable: bill the code that matches the service performed.

Where these rates come from

FeeBase calculates base physician payments from CMS work, practice-expense and malpractice RVUs, adjusted by each locality’s geographic indexes and the conversion factor. Services without a published rate are labeled, never given a made-up amount. Amounts are Medicare allowed amounts before claim adjustments: not a patient’s bill or a commercial rate.

CMS RVU26D · effective Oct 1, 2026 through the day before Jan 1, 2027

Open CMS sourceHow we calculate rates