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Billing code 67445: Orbital decompressionMedicare rate & RVUs

Report orbital bone removal for decompression when surgery enlarges the orbital space to relieve pressure associated with thyroid eye disease or other orbital conditions.

CMS RVU26DEffective Oct 1, 2026109 payment localities133 Medicare services in 2024

Medicare pays $1,311.65 for 67445 nationally in a facility.

Medicare rate · 67445

Orbital decompression

Swap in your local Medicare rate.

Work RVUs
18.64
Total RVUs
39.27
Global days
090

National rate · 2026

$1,311.65

Facility setting, before claim adjustments.

See every locality for 67445 → · 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 67445 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 67445 covers

This operation removes orbital bone to create additional space around the eye and relieve pressure on orbital contents. It is commonly performed by an ophthalmologist, often an oculoplastic or orbital surgeon, for proptosis or optic nerve compression associated with thyroid eye disease. The procedure is generally performed in an operating-room setting; CMS reported facility-setting utilization for this code in 2024.

Report 67445 when the operative service removes orbital bone for decompression, rather than exploring the orbit or removing a lesion. The operative report should identify the indication, side, bone removal, and decompressive purpose. The code has a 90-day global period, including the day-before preoperative visit and related postoperative care during that period. With multiple procedures in one session, the highest-valued procedure is paid in full and others at 50%. Bilateral reporting with modifier 50 is paid at 150%. Assistant-at-surgery payment may be available; co-surgeon payment requires supporting documentation, and team surgery is 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 67445 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

67445 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$1,209.21
Alaska*Unavailable$1,640.61
ArizonaUnavailable$1,284.33
ArkansasUnavailable$1,196.34
AtlantaUnavailable$1,334.31
AustinUnavailable$1,343.79
BakersfieldUnavailable$1,363.93
Baltimore/Surr. CntysUnavailable$1,380.57
BeaumontUnavailable$1,250.64
BrazoriaUnavailable$1,299.30

67445 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
67445 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 67445 rate is calculated

Each of 67445’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 · 67445

RVUs × geographic indexes × conversion factor

Swap in your local Medicare rate.

Work 18.64Practice expense 19.05Malpractice 1.58

39.2700 adjusted RVUs×$33.4009 conversion factor=$1,311.65

All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.

Payment rules and modifiers for 67445

67445 has a 90-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 67445

Orbital decompression

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)2Paid.
Co-surgeons (62)1Permitted with supporting documentation.
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 · 67445

Orbital decompression

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.

  • 24 Unrelated E/M visit by the same physician
  • 79 Unrelated procedure (starts its own global period)
  • 58 Staged, more extensive, or therapy procedure that was planned
  • 78 Unplanned 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

67445 without 50 · national facility

$1,311.65

Orbital decompression

67445-50 · Bilateral: 150%

$1,967.48

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

67445 compared with similar codes

Compare codes

67445 vs 67414 vs 67440 vs 67412: national Medicare rates

Swap in your local Medicare rate.

  • 67445
    Orbital decompression · 18.64 wRVU
    —
  • 67414
    Orbital decompression · 17.49 wRVU
    —
  • 67440
    Orbital drainage · 14.47 wRVU
    —
  • 67412
    Orbital surgery · 10.04 wRVU
    —

How to choose

67414Orbital decompression
Choose 67445 for orbital bone removal to decompress. Choose 67414 when the bone-flap or window orbitotomy is performed to remove an orbital lesion.
67440Orbital drainage
67440 describes lateral orbitotomy for exploration. 67445 is the decompression service involving orbital bone removal.
67412Orbital surgery
67412 is for orbitotomy with lesion removal through a non-bone-flap approach; 67445 is selected for decompression through bone removal.

Codes related to 67445

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

Codes related to 67445
CodeHow it relatesNational office range
Same family
67414Orbital decompressionOrbital bone-flap or window surgery directed at lesion removal rather than decompression.No office rate
67440Orbital drainageLateral orbitotomy for exploration, without the decompressive bone-removal purpose of 67445.No office rate
67412Orbital surgeryOrbitotomy for lesion removal using a non-bone-flap approach.No office rate
67400OrbitotomyOrbital exploration, with or without biopsy, rather than bone removal for decompression.No office rate

67445 billing questions

How is 67445 different from orbital exploration or lesion removal?

Use 67445 when orbital bone is removed to decompress the orbit. Exploration or removal of an orbital lesion describes a different operative purpose.

What should the operative report document?

Document the clinical reason for decompression, the side treated, the bone removal performed, and how the work relieved pressure in the orbit.

How is bilateral decompression reported?

When both orbits are treated, report modifier 50; CMS pays bilateral procedures at 150%.

How does the 90-day global period affect follow-up?

The day-before preoperative visit and 90 days of related postoperative care are included in the global period.

Can an assistant or co-surgeon be reported?

Assistant-at-surgery payment may be available. Co-surgeons are paid only when supporting documentation is provided.

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 67445PPRRVU2026_Oct_nonQPP.csv, line 7,477 (RVU26D)

Open CMS sourceHow we calculate rates

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