Billing code 67450: Orbital explorationMedicare rate & RVUs

Medicare pays $1,218.13 for 67450 nationally in a facility.

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

What 67450 covers

This service involves surgically opening the orbit through a bone flap or window to inspect orbital tissues, with biopsy when needed. It is typically performed by an ophthalmologist with orbital or oculoplastic expertise in a hospital or other surgical facility. A clinical situation may involve evaluating an orbital mass or unexplained orbital findings when direct operative access is needed to obtain tissue or inspect the space.

Report the code when the operative work is exploration, with or without biopsy, rather than drainage, lesion removal, or decompression. The operative report should support the approach, the structures explored, and whether tissue was sampled. CMS assigns a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. For multiple procedures in the same session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% reduction. Bilateral reporting with modifier 50 is paid at 150%. An assistant at surgery may be paid; 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 67450 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

67450 rates by state

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

How the 67450 rate is calculated

Each of 67450’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 67450

67450 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

67450 compared with similar codes

How to choose

67400Orbitotomy

Both can involve orbital exploration and biopsy. Use 67450 when the surgeon uses a bone flap or window; use 67400 for exploration without a bone flap.

67405Orbital drainage

67405 is for orbital drainage. Use 67450 when the operative purpose is exploration, with or without biopsy, rather than drainage.

67415Orbital aspiration

67415 describes aspiration or injection of orbital contents. It is not the open exploration and biopsy service represented by 67450.

67445Orbital decompression

67445 is orbital decompression involving bone removal. Use 67450 when the documented service is exploration, with or without biopsy.

Codes related to 67450

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