CPT code 65400: Corneal excision2026 Medicare rate & RVUs in Illinois
Ophthalmologists report this procedure to excise a superficial corneal lesion when the target is removed rather than sampled, scraped, or destroyed.
Medicare pays $671.92–$728.25 for 65400 in the office in Illinois, from Rest Of Illinois to Chicago. 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 65400 covers
An ophthalmologist uses magnification and microsurgical instruments to excise a focal lesion from the corneal surface. This code is for superficial corneal lesions other than pterygium; removed tissue may be sent for pathology when clinically indicated. It describes removal of the lesion itself, not a diagnostic corneal biopsy alone, epithelial scraping for recurrent erosion, or destruction by a method such as freezing or photocoagulation. The service may be performed in an office procedure setting or an outpatient surgical facility, depending on the lesion and clinical circumstances.
Report 65400 when documentation identifies a superficial corneal lesion and supports excision, including its location, extent, and the work performed. Distinguish it from biopsy, epithelial removal for recurrent erosion, and pterygium surgery. CMS assigns a 90-day global period, including the day-before preoperative visit and related postoperative care during that period. For multiple procedures in one session, CMS pays the highest-valued procedure in full and reduces other procedures to 50%. Bilateral reporting with modifier 50 is paid at 150%. CMS does not pay an assistant at surgery; 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.
Where 65400 pays more and less in Illinois
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
4 payment localities
$671.92 to $728.25
| Payment locality | Office | Facility |
|---|---|---|
| Chicago | $728.25 | $552.35 |
| East St. Louis | $684.00 | $522.98 |
| Rest Of Illinois | $671.92 | $512.13 |
| Suburban Chicago | $727.32 | $547.57 |
How the 65400 rate is calculated
Each of 65400’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 · 65400
RVUs × geographic indexes × conversion factor
Work7.31
7.31 RVUs× 1.000 GPCI
Practice expense13.00
13.00 RVUs× 1.000 GPCI
Malpractice0.60
0.60 RVUs× 1.000 GPCI
Adjusted RVUs
20.9100
Conversion factor
$33.4009
Medicare rate
$698.41
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 65400
65400 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 65400
Corneal excision
| 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 · 65400
Corneal excision
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
65400 without 50 · national office
$698.41
Corneal excision
65400-50 · Bilateral: 150%
$1,047.62
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).
65400 compared with similar codes
Compare codes · National
5 codes, side by side
How to choose
- 65410Corneal biopsy
- 65400 excises a superficial lesion; 65410 obtains a corneal tissue sample by biopsy for diagnosis.
- 65420Pterygium removal
- 65420 is for pterygium excision or transposition without a graft. 65400 is for a superficial corneal lesion other than pterygium.
- 65435Corneal treatment
- 65435 removes corneal epithelium to treat recurrent erosion; 65400 excises a focal superficial corneal lesion.
- 65450Corneal treatment
- 65450 destroys a corneal lesion by a destructive method; 65400 removes the lesion by excision.
65400 billing questions
How does 65400 differ from a corneal biopsy?
Use 65400 when the superficial lesion is excised. Use 65410 when the service is a corneal biopsy to obtain tissue for diagnosis rather than excision of the lesion.
Does the 90-day global period include postoperative visits?
Related postoperative care during the 90-day period is included, as is the day-before preoperative visit.
When is modifier 50 used?
For bilateral performance, report modifier 50; CMS pays the bilateral procedure at 150%.
Can an assistant or co-surgeon be reported?
CMS does not pay an assistant at surgery for 65400. Co-surgeons and team surgery are not permitted.
How are other procedures performed in the same session paid?
CMS pays the highest-valued procedure in full and reduces the other procedures to 50% under the standard multiple procedure rule.
When should 65400 be distinguished from 65435?
65400 is for excision of a superficial corneal lesion. 65435 is for corneal epithelial removal to treat recurrent corneal erosion.
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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