Billing code 65420: Pterygium removalMedicare rate & RVUs in Guam
Reports excision or transposition of a pterygium without a graft, typically when the conjunctival growth extends onto the cornea and requires surgical removal.
Medicare pays $588.49 for 65420 in the office in Guam (Hawaii, Guam). Which amount applies depends on the service address.
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 9 sections
What 65420 covers
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.
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 in Hawaii, Guam
| Payment locality | Office | Facility |
|---|---|---|
| Hawaii, Guam | $588.49 | $354.56 |
How the 65420 rate is calculated
Each of 65420’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 · 65420
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 4.25Practice expense 11.58Malpractice 0.35
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 65420
65420 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 65420
Pterygium removal
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 090 | Major surgery: the day before, the day of, and 90 days after are included. |
| Multiple procedures | 2 | Standard reduction: highest-valued procedure at 100%, others at 50%. |
| Bilateral (modifier 50) | 1 | Bilateral with modifier 50 pays 150% of the fee schedule amount. |
| Assistant at surgery (80/81/82/AS) | 1 | Not paid (statutory restriction). |
| Co-surgeons (62) | 0 | Not permitted. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 0 | Physician service: no professional/technical split. |
| Split (54/55/56) | 0.10/0.70/0.20 | Share of the payment for pre-op, the procedure itself, and post-op care. |
Global surgery period · 65420
Pterygium removal
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.
Pre-op dayGlobal period
What modifiers do to the payment
Modifier 50 · payment effect
With and without the modifier
65420 without 50 · national office
$540.43
Pterygium removal
65420-50 · Bilateral: 150%
$810.64
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).
65420 compared with similar codes
Compare codes
65420 vs 65426 vs 65400 vs 65410: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 65426Pterygium removal
- Both codes apply to pterygium excision or transposition. Choose 65420 without a graft and 65426 when the procedure includes a graft.
- 65400Corneal excision
- 65400 addresses excision of a corneal lesion; 65420 is for removal or transposition of a pterygium.
- 65410Corneal biopsy
- 65410 is for biopsy of a corneal lesion. Use 65420 when the service is pterygium excision or transposition, not diagnostic tissue sampling.
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 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
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