$664.62
Both codes apply to pterygium excision or transposition. Choose 65420 without a graft and 65426 when the procedure includes a graft.
On this page
CMS RVU26D · Effective 2026-10-01
65420 Pterygium removal Medicare reimbursement rates in Delaware
Reports excision or transposition of a pterygium without a graft, typically when the conjunctival growth extends onto the cornea and requires surgical removal. Compare 65420 office and facility rates across CMS payment localities in Delaware.
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.
What does Medicare pay for 65420 in Delaware?
Delaware has 1 payment locality in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the payment area shown below, using the same CMS release.
Office / nonfacility
$535.31
1 of 1 localities have a supported rate.
Payment area: Delaware
One mapped payment locality.
Facility setting
$332.03
1 of 1 localities have a supported rate.
Payment area: Delaware
One mapped payment locality.
These are locality ranges, not averages or address-specific quotes. A facility-setting amount covers the physician service; it does not include a hospital’s separate bill. Choose a locality below to inspect its calculation, compare other payment areas, or price a percentage of Medicare.
Ophthalmology surgery
About 65420: Pterygium excision without graft
Reports excision or transposition of a pterygium without a graft, typically when the conjunctival growth extends onto the cornea and requires surgical removal.
An ophthalmologist excises or repositions a pterygium, a fibrovascular growth that arises from the conjunctiva and extends onto the cornea. This code describes the procedure without a graft; it is not for a biopsy of a corneal lesion or treatment of a different corneal surface condition. Pterygium surgery is commonly performed in an operating-room setting, though the service may also occur in an office-based surgical setting.
Select the code based on the operative service: report 65420 when the pterygium is removed or transposed without a graft, and document the lesion, eye, and technique. Medicare assigns a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. For bilateral surgery with modifier 50, CMS pays 150%. When multiple procedures occur in one session, the highest-valued procedure is paid in full and the others at 50%. Medicare does not pay an assistant at surgery for this code; co-surgeons and team surgery are not permitted.
CMS billing rules for 65420
- 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 RVU4.25 · 26%
- Practice expense (office) RVU11.58 · 72%
- Malpractice RVU0.35 · 2%
1K
Medicare services in 2024 · #2942 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.
65420 compared with similar codes
Office rates for Delaware, from the same CMS release.
$692.40
65400 addresses excision of a corneal lesion; 65420 is for removal or transposition of a pterygium.
$142.72
65410 is for biopsy of a corneal lesion. Use 65420 when the service is pterygium excision or transposition, not diagnostic tissue sampling.
Compare 65420 by payment locality
Find the payment area for your service address, then open its rate page for calculation inputs, release history and the percentage-of-Medicare tool. A city may cross payment-area boundaries; the ZIP lookup above helps resolve the location.
1 of 1 payment localities
Delaware →
Office / nonfacility
$535.31
Facility
$332.03
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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 65420 in Delaware.
PPRRVU2026_Oct_nonQPP.csv
7,320
- Code
- 65420
- Physician work
- 4.25
- Practice expense
- 11.58
- Malpractice
- 0.35
GPCI2026.csv
40
- Locality
- Delaware
- Physician work
- 1.005
- Practice expense
- 0.988
- Malpractice
- 0.899
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 4.25 | × 1.005 | 4.2712 |
| Practice expense | 11.58 | × 0.988 | 11.4410 |
| Malpractice | 0.35 | × 0.899 | 0.3146 |
| Total RVUs | 16.0269 | ||
| Conversion factor | × 33.4009 | ||
Office / nonfacility rate, Delaware$535.31
Explore RVUs, geographic factors and the full formula
Office / nonfacility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 4.25 | 1.005 |
| Practice expense | 11.58 | 0.988 |
| Malpractice | 0.35 | 0.899 |
(4.25 × 1.005 + 11.58 × 0.988 + 0.35 × 0.899) × $33.4009 = $535.31
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 4.25 | 1.005 |
| Practice expense | 5.42 | 0.988 |
| Malpractice | 0.35 | 0.899 |
(4.25 × 1.005 + 5.42 × 0.988 + 0.35 × 0.899) × $33.4009 = $332.03
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.
65420 billing questions
How is 65420 different from 65426?
Both describe pterygium excision or transposition. Use 65420 when no graft is used; use 65426 when the procedure includes a graft.
Can a graft be billed separately with 65420?
When a graft is used as part of the pterygium procedure, 65426 is the corresponding code. Code 65420 describes the procedure without a graft.
What does the 90-day global period include?
The day-before preoperative visit and 90 days of related postoperative care are included in the global period.
How is bilateral pterygium surgery paid?
CMS identifies this as a bilateral procedure; when modifier 50 is reported, payment is 150%.
What should the operative note support?
Document that the lesion was a pterygium, the eye treated, whether it was excised or transposed, and whether a graft was used.
Can an assistant surgeon or co-surgeon be paid?
CMS applies a statutory restriction on assistant-at-surgery payment 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.
7,31765290,,Repair of eye socket wound,A,,6.37,5.57,NA,5.57,,0.49,12.43,12.43,0,090,0.10,0.70,0.20,2,1,1,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,31865400,,Removal of eye lesion,A,,7.31,13.00,,7.76,,0.60,20.91,15.67,0,090,0.10,0.70,0.20,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,31965410,,Biopsy of cornea,A,,1.43,2.77,,1.05,,0.11,4.31,2.59,0,000,0.00,0.00,0.00,2,1,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,32065420,,Removal of eye lesion,A,,4.25,11.58,,5.42,,0.35,16.18,10.02,0,090,0.10,0.70,0.20,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,32165426,,Removal of eye lesion,A,,5.90,13.72,,6.01,,0.46,20.08,12.37,0,090,0.10,0.70,0.20,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,32265430,,Corneal smear,A,,1.43,1.92,,1.02,,0.11,3.46,2.56,0,000,0.00,0.00,0.00,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,32365435,,Curette/treat cornea,A,,0.90,1.53,,0.84,,0.07,2.50,1.81,0,000,0.00,0.00,0.00,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
3704112,CO,01,COLORADO,1.012,1.064,0.781
3813102,CT,00,CONNECTICUT,1.020,1.077,1.210
3912202,DC,01,DC + MD/VA SUBURBS,1.054,1.178,1.113
4012102,DE,01,DELAWARE,1.005,0.988,0.899
4109102,FL,03,FORT LAUDERDALE,1.000,1.013,1.808
4209102,FL,04,MIAMI,1.000,1.041,2.529
4309102,FL,99,REST OF FLORIDA,1.000,0.956,1.503