Billing code 65430: Corneal scrapingMedicare rate & RVUs in Illinois
An ophthalmologist scrapes material from a suspected infected corneal surface to obtain a specimen for smear, culture, or both.
Medicare pays $112.06–$120.98 for 65430 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 65430 covers
An ophthalmologist uses a sterile instrument to collect superficial material from the corneal surface when an ulcer or infiltrate raises concern for infectious keratitis. The sample is placed on slides and/or submitted for culture, allowing microbiology testing to identify an organism and guide treatment. The service is typically performed in an eye clinic or hospital setting; it is diagnostic sampling, not removal of diseased tissue or therapeutic epithelial debridement.
Report 65430 for the corneal scraping itself when the record identifies the eye, the suspicious corneal finding, and specimen collection for smear, culture, or both. Laboratory microscopy and culture are distinct testing services and may be separately reported by the laboratory when performed. CMS assigns a 0-day global period, so same-day preoperative and postoperative care is included. When other procedures are performed in the same session, the highest-valued procedure is paid in full and the others are subject to a 50% multiple-procedure reduction. For bilateral scraping, modifier 50 is paid at 150%. Medicare 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 65430 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
$112.06 to $120.98
| Payment locality | Office | Facility |
|---|---|---|
| Chicago | $120.98 | $90.77 |
| East St. Louis | $114.16 | $86.51 |
| Rest Of Illinois | $112.06 | $84.61 |
| Suburban Chicago | $120.47 | $89.60 |
How the 65430 rate is calculated
Each of 65430’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 · 65430
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 1.43Practice expense 1.92Malpractice 0.11
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 65430
The CMS indicators that decide how 65430 is paid alongside other services.
CMS payment indicators · 65430
Corneal scraping
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 000 | Same-day global: pre- and post-op care on the day of the procedure is 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. |
What modifiers do to the payment
Modifier 50 · payment effect
With and without the modifier
65430 without 50 · national office
$115.57
Corneal scraping
65430-50 · Bilateral: 150%
$173.36
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).
65430 compared with similar codes
Compare codes
65430 vs 65410 vs 65435 vs 65400: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 65410Corneal biopsy
- 65430 collects superficial corneal material for smear or culture. 65410 describes a corneal biopsy, a different sampling technique.
- 65435Corneal treatment
- 65430 is diagnostic specimen collection. 65435 treats the corneal surface by removing epithelium, with or without chemical cauterization.
- 65400Corneal excision
- 65430 scrapes the cornea to obtain a diagnostic specimen. 65400 is used for excision of a corneal lesion, not routine infectious sampling.
65430 billing questions
When should 65430 be used instead of 65410?
Use 65430 when the clinician scrapes the corneal surface to obtain material for smear, culture, or both. Use 65410 when the service is a corneal biopsy rather than surface scraping.
Can the laboratory testing be billed separately?
The code represents collection of the corneal specimen. Microscopy or culture performed on that specimen is a distinct laboratory service and may be reported separately by the laboratory when performed.
What documentation supports 65430?
Document the eye, the corneal ulcer or infiltrate prompting diagnostic sampling, the scraping performed, and whether material was collected for smear, culture, or both.
How is bilateral corneal scraping reported?
When both corneas are scraped, report the bilateral procedure with modifier 50. CMS pays the bilateral procedure at 150%.
How does another procedure in the same session affect payment?
CMS pays the highest-valued procedure in full and applies a 50% multiple-procedure reduction to the others. Same-day preoperative and postoperative care is included in 65430's 0-day global period.
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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