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CMS RVU26D · Effective 2026-10-01

65426 in Redding

Office / nonfacility

$710.90

Base rate per service

Facility setting

$428.66

Base rate per service

Amounts below use the non-QP conversion factor for participating physicians. These are base physician payments before claim-level adjustments, not patient costs or total hospital charges.

Ophthalmology surgery

About 65426: Pterygium excision with graft

Reports removal or repositioning of a pterygium that extends onto the cornea when the surgeon also places a graft to cover the ocular surface.

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.

CMS billing rules for 65426

Global period
Major surgery with a 90-day global period: the day-before preoperative visit and 90 days of related postoperative care are included.
Multiple procedures
Standard multiple procedure reduction: the highest-valued procedure is paid in full and others at 50% when performed in the same session.
Bilateral procedures
Bilateral procedure with modifier 50 is paid at 150%.
Assistant at surgery
Statutory restriction: assistant at surgery is not paid.
Co-surgeons
Co-surgeons not permitted.
Team surgery
Team surgery not permitted.

Where the value comes from

  • Work RVU5.90 · 29%
  • Practice expense (office) RVU13.72 · 68%
  • Malpractice RVU0.46 · 2%

9.2K

Medicare services in 2024 · #1520 by national volume

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.

65426 compared with similar codes

Office rates for Redding, from the same CMS release.

65420

Pterygium removal

Without graft

$574.55

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

65400

Corneal excision

Superficial lesion, not pterygium

$734.95

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

65410

Corneal biopsy

Tissue sampling

$151.95

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

The same code, a different location

How does Redding compare?

In Bakersfield, the office rate for 65426 is $712.42—$1.52 higher than the $710.90 rate in Redding. Both use the same code, release and participation basis.

65426 across payment areas

Same release and payment basis · bars start at $0

  1. Redding · This locality

    $710.90

  2. Bakersfield

    $712.42

    $1.52 higher than Redding

  3. Chico

    $710.90

    The same base rate than Redding

  4. El Centro

    $710.98

    $0.08 higher than Redding

  5. Fresno

    $710.90

    The same base rate than Redding

  6. Hanford-Corcoran

    $710.90

    The same base rate than Redding

  7. Los Angeles-Long Beach-Anaheim (Los Angeles/Orange Cnty)

    $757.47

    $46.57 higher than Redding

Other payment areas listed in California appear first, followed by selected cross-country examples. The chart compares amounts, not distance.

Across 109 of 109 CMS payment localities with a supported office rate, 65426 ranges from $598.62 in Arkansas to $887.79 in San Jose-Sunnyvale-Santa Clara (San Benito Cnty). This is a geographic range, not an average.

The code’s RVUs stay the same in these comparisons. Geographic adjustments to work, practice expense and malpractice change the dollar amount. A city name alone may not identify the payment area for a service address.

Compare all 108 other payment areas

  • Madera

    California · 65426

    Office

    $710.90

    Facility

    $428.66

    The same base rate than Redding for the office setting.

  • Merced

    California · 65426

    Office

    $710.90

    Facility

    $428.66

    The same base rate than Redding for the office setting.

  • Modesto

    California · 65426

    Office

    $710.90

    Facility

    $428.66

    The same base rate than Redding for the office setting.

  • Napa

    California · 65426

    Office

    $821.27

    Facility

    $481.86

    $110.37 higher than Redding for the office setting.

  • Oxnard-Thousand Oaks-Ventura

    California · 65426

    Office

    $753.82

    Facility

    $449.43

    $42.92 higher than Redding for the office setting.

  • Rest Of California

    California · 65426

    Office

    $710.90

    Facility

    $428.66

    The same base rate than Redding for the office setting.

  • Riverside-San Bernardino-Ontario

    California · 65426

    Office

    $715.97

    Facility

    $433.73

    $5.07 higher than Redding for the office setting.

  • Sacramento-Roseville-Folsom

    California · 65426

    Office

    $745.35

    Facility

    $445.85

    $34.45 higher than Redding for the office setting.

  • Salinas

    California · 65426

    Office

    $742.53

    Facility

    $444.07

    $31.63 higher than Redding for the office setting.

  • San Diego-Chula Vista-Carlsbad

    California · 65426

    Office

    $759.38

    Facility

    $451.39

    $48.48 higher than Redding for the office setting.

  • San Francisco-Oakland-Berkeley (Marin Cnty)

    California · 65426

    Office

    $868.99

    Facility

    $505.88

    $158.09 higher than Redding for the office setting.

  • San Francisco-Oakland-Berkeley (San Francisco/San Mateo/Alameda/Contra Costa Cnty)

    California · 65426

    Office

    $868.46

    Facility

    $505.36

    $157.56 higher than Redding for the office setting.

  • San Jose-Sunnyvale-Santa Clara (San Benito Cnty)

    California · 65426

    Office

    $887.79

    Facility

    $516.44

    $176.89 higher than Redding for the office setting.

  • San Jose-Sunnyvale-Santa Clara (Santa Clara Cnty)

    California · 65426

    Office

    $885.65

    Facility

    $514.31

    $174.75 higher than Redding for the office setting.

  • San Luis Obispo-Paso Robles

    California · 65426

    Office

    $730.61

    Facility

    $437.29

    $19.71 higher than Redding for the office setting.

  • Santa Cruz-Watsonville

    California · 65426

    Office

    $766.23

    Facility

    $453.34

    $55.33 higher than Redding for the office setting.

  • Santa Maria-Santa Barbara

    California · 65426

    Office

    $745.15

    Facility

    $444.88

    $34.25 higher than Redding for the office setting.

  • Santa Rosa-Petaluma

    California · 65426

    Office

    $773.96

    Facility

    $457.72

    $63.06 higher than Redding for the office setting.

  • Stockton

    California · 65426

    Office

    $710.90

    Facility

    $428.66

    The same base rate than Redding for the office setting.

  • Vallejo

    California · 65426

    Office

    $820.52

    Facility

    $481.11

    $109.62 higher than Redding for the office setting.

  • Visalia

    California · 65426

    Office

    $710.90

    Facility

    $428.66

    The same base rate than Redding for the office setting.

  • Yuba City

    California · 65426

    Office

    $710.90

    Facility

    $428.66

    The same base rate than Redding for the office setting.

  • Dc + Md/Va Suburbs

    District of Columbia · 65426

    Office

    $764.64

    Facility

    $461.28

    $53.74 higher than Redding for the office setting.

  • Miami

    Florida · 65426

    Office

    $712.97

    Facility

    $444.89

    $2.07 higher than Redding for the office setting.

  • Chicago

    Illinois · 65426

    Office

    $694.26

    Facility

    $435.45

    $16.64 lower than Redding for the office setting.

  • Manhattan

    New York · 65426

    Office

    $766.54

    Facility

    $467.30

    $55.64 higher than Redding for the office setting.

  • Alaska*

    Alaska · 65426

    Office

    $792.11

    Facility

    $517.85

    $81.21 higher than Redding for the office setting.

  • Alabama

    Alabama · 65426

    Office

    $606.74

    Facility

    $381.41

    $104.16 lower than Redding for the office setting.

  • Arkansas

    Arkansas · 65426

    Office

    $598.62

    Facility

    $377.41

    $112.28 lower than Redding for the office setting.

  • Arizona

    Arizona · 65426

    Office

    $654.27

    Facility

    $404.73

    $56.63 lower than Redding for the office setting.

  • Colorado

    Colorado · 65426

    Office

    $699.02

    Facility

    $425.02

    $11.88 lower than Redding for the office setting.

  • Connecticut

    Connecticut · 65426

    Office

    $713.14

    Facility

    $435.79

    $2.24 higher than Redding for the office setting.

  • Delaware

    Delaware · 65426

    Office

    $664.62

    Facility

    $410.19

    $46.28 lower than Redding for the office setting.

  • Fort Lauderdale

    Florida · 65426

    Office

    $689.06

    Facility

    $428.19

    $21.84 lower than Redding for the office setting.

  • Rest Of Florida

    Florida · 65426

    Office

    $658.25

    Facility

    $412.06

    $52.65 lower than Redding for the office setting.

  • Atlanta

    Georgia · 65426

    Office

    $681.70

    Facility

    $420.06

    $29.20 lower than Redding for the office setting.

  • Rest Of Georgia

    Georgia · 65426

    Office

    $624.15

    Facility

    $394.44

    $86.75 lower than Redding for the office setting.

  • Hawaii, Guam

    Hawaii · 65426

    Office

    $727.00

    Facility

    $434.20

    $16.10 higher than Redding for the office setting.

  • Iowa

    Iowa · 65426

    Office

    $622.47

    Facility

    $386.84

    $88.43 lower than Redding for the office setting.

  • Idaho

    Idaho · 65426

    Office

    $625.93

    Facility

    $389.01

    $84.97 lower than Redding for the office setting.

  • East St. Louis

    Illinois · 65426

    Office

    $649.61

    Facility

    $412.69

    $61.29 lower than Redding for the office setting.

  • Rest Of Illinois

    Illinois · 65426

    Office

    $639.47

    Facility

    $404.35

    $71.43 lower than Redding for the office setting.

  • Suburban Chicago

    Illinois · 65426

    Office

    $696.30

    Facility

    $431.83

    $14.60 lower than Redding for the office setting.

  • Indiana

    Indiana · 65426

    Office

    $629.34

    Facility

    $390.62

    $81.56 lower than Redding for the office setting.

  • Kansas

    Kansas · 65426

    Office

    $619.08

    Facility

    $386.28

    $91.82 lower than Redding for the office setting.

  • Kentucky

    Kentucky · 65426

    Office

    $618.52

    Facility

    $389.58

    $92.38 lower than Redding for the office setting.

  • New Orleans

    Louisiana · 65426

    Office

    $645.74

    Facility

    $403.42

    $65.16 lower than Redding for the office setting.

  • Rest Of Louisiana

    Louisiana · 65426

    Office

    $617.34

    Facility

    $389.44

    $93.56 lower than Redding for the office setting.

  • Metropolitan Boston

    Massachusetts · 65426

    Office

    $765.98

    Facility

    $458.50

    $55.08 higher than Redding for the office setting.

  • Rest Of Massachusetts

    Massachusetts · 65426

    Office

    $695.01

    Facility

    $423.84

    $15.89 lower than Redding for the office setting.

  • Baltimore/Surr. Cntys

    Maryland · 65426

    Office

    $710.94

    Facility

    $434.62

    $0.04 higher than Redding for the office setting.

  • Rest Of Maryland

    Maryland · 65426

    Office

    $676.90

    Facility

    $416.29

    $34.00 lower than Redding for the office setting.

  • Rest Of Maine

    Maine · 65426

    Office

    $628.22

    Facility

    $391.30

    $82.68 lower than Redding for the office setting.

  • Southern Maine

    Maine · 65426

    Office

    $660.90

    Facility

    $405.69

    $50.00 lower than Redding for the office setting.

  • Detroit

    Michigan · 65426

    Office

    $665.19

    Facility

    $416.68

    $45.71 lower than Redding for the office setting.

  • Rest Of Michigan

    Michigan · 65426

    Office

    $632.80

    Facility

    $397.69

    $78.10 lower than Redding for the office setting.

  • Minnesota

    Minnesota · 65426

    Office

    $673.16

    Facility

    $408.17

    $37.74 lower than Redding for the office setting.

  • Metropolitan Kansas City

    Missouri · 65426

    Office

    $642.38

    Facility

    $400.57

    $68.52 lower than Redding for the office setting.

  • Metropolitan St. Louis

    Missouri · 65426

    Office

    $648.72

    Facility

    $403.56

    $62.18 lower than Redding for the office setting.

  • Rest Of Missouri

    Missouri · 65426

    Office

    $607.05

    Facility

    $385.07

    $103.85 lower than Redding for the office setting.

  • Mississippi

    Mississippi · 65426

    Office

    $602.98

    Facility

    $381.26

    $107.92 lower than Redding for the office setting.

  • Montana**

    Montana · 65426

    Office

    $670.66

    Facility

    $413.14

    $40.24 lower than Redding for the office setting.

  • North Carolina

    North Carolina · 65426

    Office

    $634.44

    Facility

    $394.17

    $76.46 lower than Redding for the office setting.

  • North Dakota**

    North Dakota · 65426

    Office

    $661.56

    Facility

    $404.04

    $49.34 lower than Redding for the office setting.

  • Nebraska

    Nebraska · 65426

    Office

    $625.85

    Facility

    $388.16

    $85.05 lower than Redding for the office setting.

  • New Hampshire

    New Hampshire · 65426

    Office

    $687.56

    Facility

    $419.48

    $23.34 lower than Redding for the office setting.

  • Northern Nj

    New Jersey · 65426

    Office

    $757.47

    Facility

    $458.75

    $46.57 higher than Redding for the office setting.

  • Rest Of New Jersey

    New Jersey · 65426

    Office

    $722.22

    Facility

    $441.01

    $11.32 higher than Redding for the office setting.

  • New Mexico

    New Mexico · 65426

    Office

    $635.74

    Facility

    $399.60

    $75.16 lower than Redding for the office setting.

  • Nevada**

    Nevada · 65426

    Office

    $668.58

    Facility

    $410.80

    $42.32 lower than Redding for the office setting.

  • Nyc Suburbs/Long Island

    New York · 65426

    Office

    $783.08

    Facility

    $476.89

    $72.18 higher than Redding for the office setting.

  • Poughkpsie/N Nyc Suburbs

    New York · 65426

    Office

    $726.32

    Facility

    $444.33

    $15.42 higher than Redding for the office setting.

  • Queens

    New York · 65426

    Office

    $773.50

    Facility

    $469.11

    $62.60 higher than Redding for the office setting.

  • Rest Of New York

    New York · 65426

    Office

    $643.21

    Facility

    $398.57

    $67.69 lower than Redding for the office setting.

  • Ohio

    Ohio · 65426

    Office

    $630.94

    Facility

    $395.83

    $79.96 lower than Redding for the office setting.

  • Oklahoma

    Oklahoma · 65426

    Office

    $618.23

    Facility

    $388.26

    $92.67 lower than Redding for the office setting.

  • Portland

    Oregon · 65426

    Office

    $720.78

    Facility

    $434.67

    $9.88 higher than Redding for the office setting.

  • Rest Of Oregon

    Oregon · 65426

    Office

    $664.29

    Facility

    $407.80

    $46.61 lower than Redding for the office setting.

  • Metropolitan Philadelphia

    Pennsylvania · 65426

    Office

    $695.99

    Facility

    $427.91

    $14.91 lower than Redding for the office setting.

  • Rest Of Pennsylvania

    Pennsylvania · 65426

    Office

    $632.27

    Facility

    $395.86

    $78.63 lower than Redding for the office setting.

  • Puerto Rico

    Puerto Rico · 65426

    Office

    $675.50

    Facility

    $415.15

    $35.40 lower than Redding for the office setting.

  • Rhode Island

    Rhode Island · 65426

    Office

    $687.90

    Facility

    $421.88

    $23.00 lower than Redding for the office setting.

  • South Carolina

    South Carolina · 65426

    Office

    $633.56

    Facility

    $395.61

    $77.34 lower than Redding for the office setting.

  • South Dakota**

    South Dakota · 65426

    Office

    $660.49

    Facility

    $402.97

    $50.41 lower than Redding for the office setting.

  • Tennessee

    Tennessee · 65426

    Office

    $621.87

    Facility

    $387.79

    $89.03 lower than Redding for the office setting.

  • Austin

    Texas · 65426

    Office

    $695.91

    Facility

    $423.45

    $14.99 lower than Redding for the office setting.

  • Beaumont

    Texas · 65426

    Office

    $628.36

    Facility

    $394.01

    $82.54 lower than Redding for the office setting.

  • Brazoria

    Texas · 65426

    Office

    $664.76

    Facility

    $409.56

    $46.14 lower than Redding for the office setting.

  • Dallas

    Texas · 65426

    Office

    $668.45

    Facility

    $411.96

    $42.45 lower than Redding for the office setting.

  • Fort Worth

    Texas · 65426

    Office

    $664.07

    Facility

    $410.15

    $46.83 lower than Redding for the office setting.

  • Galveston

    Texas · 65426

    Office

    $666.42

    Facility

    $410.70

    $44.48 lower than Redding for the office setting.

  • Houston

    Texas · 65426

    Office

    $674.84

    Facility

    $419.12

    $36.06 lower than Redding for the office setting.

  • Rest Of Texas

    Texas · 65426

    Office

    $645.83

    Facility

    $401.44

    $65.07 lower than Redding for the office setting.

  • Utah

    Utah · 65426

    Office

    $641.63

    Facility

    $399.56

    $69.27 lower than Redding for the office setting.

  • Virginia

    Virginia · 65426

    Office

    $658.38

    Facility

    $405.24

    $52.52 lower than Redding for the office setting.

  • Virgin Islands

    United States Virgin Islands · 65426

    Office

    $675.50

    Facility

    $415.15

    $35.40 lower than Redding for the office setting.

  • Vermont

    Vermont · 65426

    Office

    $658.52

    Facility

    $403.57

    $52.38 lower than Redding for the office setting.

  • Rest Of Washington

    Washington · 65426

    Office

    $693.87

    Facility

    $422.70

    $17.03 lower than Redding for the office setting.

  • Seattle (King Cnty)

    Washington · 65426

    Office

    $781.76

    Facility

    $465.78

    $70.86 higher than Redding for the office setting.

  • Wisconsin

    Wisconsin · 65426

    Office

    $640.81

    Facility

    $394.11

    $70.09 lower than Redding for the office setting.

  • West Virginia

    West Virginia · 65426

    Office

    $617.28

    Facility

    $393.49

    $93.62 lower than Redding for the office setting.

  • Wyoming**

    Wyoming · 65426

    Office

    $666.70

    Facility

    $409.17

    $44.20 lower than Redding for the office setting.

See how rates vary across the country

65426 · Office / nonfacility · Non-QP. Choose a state to explore its payment localities. A range means the amount varies within that state.

MEWIVTNHMTNDMNMINYMARIWAIDWYSDIAILINOHPANJCTORNVUTCONEMOKYWVVAMDDECAAZNMKSOKARTNNCSCDCTXLAMSALGAFLAKHI

Explore a state

Local rates. Clear comparisons.

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

$598.62

$799.35

Color shows the midpoint of each state’s locality range.

View all state and territory rates as a table
State / territoryRate rangeLocalities
AK$792.111
AL$606.741
AR$598.621
AZ$654.271
CA$710.90–$887.7929
CO$699.021
CT$713.141
DC$764.641
DE$664.621
FL$658.25–$712.973
GA$624.15–$681.702
GU$727.001
HI$727.001
IA$622.471
ID$625.931
IL$639.47–$696.304
IN$629.341
KS$619.081
KY$618.521
LA$617.34–$645.742
MA$695.01–$765.982
MD$676.90–$764.643
ME$628.22–$660.902
MI$632.80–$665.192
MN$673.161
MO$607.05–$648.723
MS$602.981
MT$670.661
NC$634.441
ND$661.561
NE$625.851
NH$687.561
NJ$722.22–$757.472
NM$635.741
NV$668.581
NY$643.21–$783.085
OH$630.941
OK$618.231
OR$664.29–$720.782
PA$632.27–$695.992
PR$675.501
RI$687.901
SC$633.561
SD$660.491
TN$621.871
TX$628.36–$695.918
UT$641.631
VA$658.38–$764.642
VI$675.501
VT$658.521
WA$693.87–$781.762
WI$640.811
WV$617.281
WY$666.701

Explore 65426 on the national rate map →

Where does this rate apply?

Redding is a Medicare payment area. Our Census mapping connects it to 32 cities and communities in California, including the examples shown here.

Some communities span more than one payment area. Follow a city link to compare all of its mapped areas, or check the service-location ZIP above for an address-level starting point.

Browse all communities in California →

Why are the office and facility amounts different?

For 65426 in Redding, the physician’s office rate is $710.90 and the facility-setting rate is $428.66: a difference of $282.24.

The calculation uses a different practice-expense RVU for each setting. Both amounts here are physician fee-schedule amounts. The facility figure does not include a hospital’s separate charges, so this comparison does not tell you the total cost of receiving care in each setting.

See the inputs behind this difference →

Use this rate

What is a percentage of Medicare worth?

Turn a percentage into dollars for 65426 in Redding. This uses the base rate on this page, so the locality and release stay consistent.

Reference amount per service

$781.99

$710.90 × 110% = $781.99

A contract may specify another Medicare year or additional adjustments. This is percentage arithmetic on the displayed base rate, not a claim adjudication.

Working with a whole code list?

Compare an offer across your annual code mix, including an older Medicare schedule or flat per-code rates.

Compare your contract offer →

How this local rate is calculated

Each RVU component is multiplied by its own geographic practice cost index (GPCI). The three adjusted components are added, then multiplied by the conversion factor. These are the inputs used for 65426 in Redding.

PPRRVU2026_Oct_nonQPP.csv

7,321

Code
65426
Physician work
5.90
Practice expense
13.72
Malpractice
0.46

GPCI2026.csv

19

Locality
Redding
Physician work
1.017
Practice expense
1.096
Malpractice
0.536
Office / nonfacility calculation for 65426 in Redding
ComponentRVULocality factorAdjusted
Physician work5.90× 1.0176.0003
Practice expense13.72× 1.09615.0371
Malpractice0.46× 0.5360.2466
Total RVUs21.2840
Conversion factor× 33.4009

Office / nonfacility rate, Redding$710.90

Values as parsed from CMS release RVU26D, effective 2026-10-01. The amount is rounded to the nearest cent only at the end.

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Office / nonfacility

Office / nonfacility calculation inputs
ComponentRVULocal GPCI
Work5.91.017
Practice expense13.721.096
Malpractice0.460.536

(5.9 × 1.017 + 13.72 × 1.096 + 0.46 × 0.536) × $33.4009 = $710.90

Facility

Facility calculation inputs
ComponentRVULocal GPCI
Work5.91.017
Practice expense6.011.096
Malpractice0.460.536

(5.9 × 1.017 + 6.01 × 1.096 + 0.46 × 0.536) × $33.4009 = $428.66

The office and facility calculations use their respective practice-expense RVUs. The facility amount here is the physician fee, not a separate hospital or facility bill.

How this rate has changed

65426 · Office / nonfacility

$710.90

Effective 2026-10-01

The base rate is $35.85 higher than on 2025-10-01, moving from $675.05 to $710.90 (5.3%).

It is unchanged from the immediately preceding available release, effective 2026-07-01.

Base rate by release · bars start at $0 · select a bar to compare

One bar per available release, ordered by effective date. Missing rates remain gaps. These comparisons hold the code, setting and locality identifiers constant; they do not isolate which policy or input caused a change.

What changed, release by release

  1. January 1, 2026

    RVU26A

    $675.05changed to$710.90

    • Conversion factor 32.3465 changed to 33.4009
    • Work RVU 6.05 changed to 5.90
    • Practice expense RVU 13.23 changed to 13.72
    • Malpractice RVU 0.49 changed to 0.46
    • Work GPCI 1.014 changed to 1.017
    • Practice expense GPCI 1.093 changed to 1.096
    • Malpractice GPCI 0.560 changed to 0.536

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    Earliest loaded release: $675.05

    Held through RVU25B, RVU25C, RVU25D.

Explore release dates and calculate this code in an earlier period →

Each row uses the accepted CMS release effective on that date and the same contractor and locality identifiers. Missing rates stay visible. Historical boundaries may differ; verify the service address for an older claim.

Inspect every release and its CMS source
Effective fromOffice / nonfacilityFacilityCMS release
2026-10-01$710.90$428.66RVU26D
2026-07-01$710.90$428.66RVU26C
2026-04-01$710.90$428.66RVU26B
2026-01-01$710.90$428.66RVU26A
2025-10-01$675.05$480.96RVU25D
2025-07-01$675.05$480.96RVU25C
2025-04-01$675.05$480.96RVU25B
2025-01-01$675.05$480.96RVU25A

65426 billing questions

When should this code be selected instead of 65420?

Use this code when pterygium surgery includes placement of a graft. Code 65420 describes pterygium surgery without a graft.

Is graft placement included in this service?

Yes. Graft placement is part of the service represented by this code; it is the feature that distinguishes it from 65420.

What documentation supports reporting this code?

The operative report should identify the pterygium, the treated eye, excision or transposition, and placement of the graft.

How is bilateral surgery handled?

CMS treats this as a bilateral procedure. When both eyes are treated and modifier 50 is reported, payment is 150%.

Which postoperative care is included?

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

Can an assistant or co-surgeon be paid?

CMS does not pay an assistant at surgery for this code. Co-surgeons and team surgery are not permitted.

Where these rates come from

FeeBase calculates base physician payments from CMS work, practice-expense, and malpractice RVUs, adjusted by each locality’s geographic indices and the applicable conversion factor. Unavailable or separately priced services are labeled rather than assigned a made-up amount.

Source: RVU26D. Effective 2026-10-01 through the day before 2027-01-01.

RVUs for 65426PPRRVU2026_Oct_nonQPP.csv, line 7,321 (RVU26D)
Geographic factors for ReddingGPCI2026.csv, line 19 (RVU26D)
Open CMS sourceHow this rate is calculatedBuild a fee sheet