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Billing code 67405: Orbital drainageMedicare rate & RVUs

Reports open orbital drainage through an orbitotomy without a bone flap, such as drainage of an orbital abscess when drainage is the operative objective.

CMS RVU26DEffective Oct 1, 2026109 payment localities90 Medicare services in 2024

Medicare pays $801.62 for 67405 nationally in a facility.

Medicare rate · 67405

Orbital drainage

Work RVUs
8.97
Total RVUs
24.00
Global days
090

National rate · 2026

$801.62

Facility setting, before claim adjustments.

See every locality for 67405 →Billed by an NP, PA or therapist? →

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

On this page 10 sections
  1. Medicare rate
  2. What 67405 covers
  3. By payment locality
  4. Rate map
  5. How it’s calculated
  6. Payment rules
  7. Similar codes
  8. Related codes
  9. Billing questions
  10. Sources

What 67405 covers

An ophthalmic or oculoplastic surgeon uses an orbitotomy without a bone flap to reach and drain an orbital collection, commonly an abscess. The service is generally performed in an operating room, often in a hospital facility, when operative access and drainage are needed rather than needle aspiration alone. The drainage is the defining purpose; exploration may provide access, but removal of a lesion or foreign body is a different operative objective.

Report 67405 when the operative documentation supports orbital drainage without a bone flap and identifies the site and collection treated. The 90-day global period includes the day-before preoperative visit and related postoperative care during the 90 days after surgery. When other procedures are performed in the same session, the highest-valued procedure is paid in full and other procedures are subject to the standard multiple-procedure reduction. For bilateral surgery reported with modifier 50, CMS pays 150%. Assistant-at-surgery payment is restricted; 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 67405 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

67405 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$731.54
Alaska*Unavailable$971.87
ArizonaUnavailable$783.38
ArkansasUnavailable$722.68
AtlantaUnavailable$814.94
AustinUnavailable$827.26
BakersfieldUnavailable$843.96
Baltimore/Surr. CntysUnavailable$846.95
BeaumontUnavailable$756.89
BrazoriaUnavailable$794.50

67405 rates by state

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

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Local rates. Clear comparisons.

Hover or focus a tile to see its rate range. Select it to open the state’s fee schedule.

View every state and territory as a table
67405 office rate range by state
State / territoryOffice rate rangeLocalities
AKNo published base rate1
ALNo published base rate1
ARNo published base rate1
AZNo published base rate1
CANo published base rate29
CONo published base rate1
CTNo published base rate1
DCNo published base rate1
DENo published base rate1
FLNo published base rate3
GANo published base rate2
GUNo published base rate1
HINo published base rate1
IANo published base rate1
IDNo published base rate1
ILNo published base rate4
INNo published base rate1
KSNo published base rate1
KYNo published base rate1
LANo published base rate2
MANo published base rate2
MDNo published base rate3
MENo published base rate2
MINo published base rate2
MNNo published base rate1
MONo published base rate3
MSNo published base rate1
MTNo published base rate1
NCNo published base rate1
NDNo published base rate1
NENo published base rate1
NHNo published base rate1
NJNo published base rate2
NMNo published base rate1
NVNo published base rate1
NYNo published base rate5
OHNo published base rate1
OKNo published base rate1
ORNo published base rate2
PANo published base rate2
PRNo published base rate1
RINo published base rate1
SCNo published base rate1
SDNo published base rate1
TNNo published base rate1
TXNo published base rate8
UTNo published base rate1
VANo published base rate2
VINo published base rate1
VTNo published base rate1
WANo published base rate2
WINo published base rate1
WVNo published base rate1
WYNo published base rate1

How the 67405 rate is calculated

Each of 67405’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.

How the rate is built · 67405

RVUs × geographic indexes × conversion factor

Work8.97

8.97 RVUs× 1.000 GPCI

Practice expense14.32

14.32 RVUs× 1.000 GPCI

Malpractice0.71

0.71 RVUs× 1.000 GPCI

Adjusted RVUs

24.0000

Conversion factor

$33.4009

Medicare rate

$801.62

Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.

Payment rules and modifiers for 67405

67405 has a 90-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 67405

Orbital drainage

RuleCMS valueWhat it means
Global period090Major surgery: the day before, the day of, and 90 days after are included.
Multiple procedures2Standard reduction: highest-valued procedure at 100%, others at 50%.
Bilateral (modifier 50)1Bilateral with modifier 50 pays 150% of the fee schedule amount.
Assistant at surgery (80/81/82/AS)1Not paid (statutory restriction).
Co-surgeons (62)0Not permitted.
Team surgery (66)0Not permitted.
Professional/technical0Physician service: no professional/technical split.
Split (54/55/56)0.10/0.70/0.20Share of the payment for pre-op, the procedure itself, and post-op care.

Global surgery period · 67405

Orbital drainage

90-day global period ends

Dec 30, 2026

Covers Sep 30, 2026 through Dec 30, 2026 (92 days, including the day before surgery).

Visit on Oct 31, 2026

Day 30 of the 90-day post-op period: related follow-up care is included in the surgical payment.

  • 24Unrelated E/M visit by the same physician
  • 79Unrelated procedure (starts its own global period)
  • 58Staged, more extensive, or therapy procedure that was planned
  • 78Unplanned return to the operating room for a related complication
SurgeryVisit
Sep 23, 2026Jan 10, 2027

Pre-op dayGlobal period

What modifiers do to the payment

Modifier 50 · payment effect

With and without the modifier

67405 without 50 · national facility

$801.62

Orbital drainage

67405-50 · Bilateral: 150%

$1,202.43

Both sides on one line with modifier 50 are paid at 150% of the fee schedule amount (subject to multiple-procedure rules with other procedures).

When to use modifier 50

67405 compared with similar codes

Compare codes · National

5 codes, side by side

  • 67405

    Orbital drainage8.97 wRVU

    Not priced

  • 67400

    Orbitotomy10.92 wRVU

    Not priced

  • 67440

    Orbital drainage14.47 wRVU

    Not priced

  • 67415

    Orbital aspiration1.72 wRVU

    Not priced

  • 67412

    Orbital surgery10.04 wRVU

    Not priced

How to choose

67400Orbitotomy
Choose 67405 when the orbitotomy is performed to drain an orbital collection. Choose 67400 for exploration, with or without biopsy, when drainage is not the service performed.
67440Orbital drainage
Both describe orbital drainage, but 67440 uses a bone flap or window through a lateral approach; 67405 is drainage without a bone flap.
67415Orbital aspiration
67415 describes aspiration of orbital contents. 67405 describes open drainage through an orbitotomy.
67412Orbital surgery
67412 is used when orbitotomy treatment includes removal of a lesion. 67405 is for drainage as the operative objective.

Codes related to 67405

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

Codes related to 67405
CodeHow it relatesNational office range
Same family
67400OrbitotomyOrbitotomy without a bone flap for exploration, with or without biopsy, rather than drainage.No office rate
Used instead
67440Orbital drainageOrbital drainage using a bone flap or window through a lateral approach.No office rate
67415Orbital aspirationAspiration of orbital contents rather than open drainage through an orbitotomy.No office rate
67412Orbital surgeryOrbitotomy for treatment involving lesion removal, not drainage as the operative objective.No office rate

67405 billing questions

When is 67405 appropriate instead of orbital aspiration?

Use 67405 for operative drainage through an orbitotomy without a bone flap. Orbital-content aspiration, rather than open surgical drainage, is described by 67415.

How does 67405 differ from 67400?

67405 identifies drainage as the operative objective. 67400 describes orbitotomy for exploration, with or without biopsy, when drainage is not the service performed.

Can 67405 be reported when a lesion is removed?

67405 is for drainage only. If the operative objective is removal of an orbital lesion, select the code that describes that procedure rather than reporting drainage for the same work.

What documentation supports 67405?

Document the orbital collection and its location, the orbitotomy approach, and the drainage performed. The operative report should make clear that drainage, rather than aspiration or lesion removal, was the objective.

How are bilateral procedures and other same-session procedures paid?

CMS pays bilateral surgery reported with modifier 50 at 150%. For multiple procedures in the same session, the highest-valued procedure is paid in full and the others are subject to the standard reduction.

Is postoperative care separately reported during the global period?

The 90-day global period includes the day-before preoperative visit and related postoperative care through 90 days after surgery.

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

Show the CMS file lines behind this rate
RVUs for 67405PPRRVU2026_Oct_nonQPP.csv, line 7,469 (RVU26D)

Open CMS sourceHow we calculate rates

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