Billing code 67420: OrbitotomyMedicare rate & RVUs in Illinois
A surgeon uses a lateral orbital bone flap or window to inspect the orbit, with or without biopsy, when direct exploration is needed.
CMS doesn’t publish an office rate for 67420 in Illinois.
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 67420 covers
This service involves reaching the orbit through a lateral approach that uses a bone flap or window, then inspecting the orbital contents; biopsy may be performed as part of the exploration. Ophthalmologists, often oculoplastic or orbital surgeons, perform it in an operating room when an orbital mass or other finding requires direct access and inspection. The approach is more extensive than exploration through the conjunctiva without a bone flap.
Report 67420 when the documented service is lateral orbitotomy for exploration, with or without biopsy. The operative report should support the lateral approach and bone flap or window, the reason for exploration, and the findings; document any biopsy performed. Medicare assigns a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. For multiple procedures in the same session, the highest-valued procedure is paid in full and other procedures at 50%. Bilateral reporting with modifier 50 is paid at 150%. An assistant at surgery may be paid; co-surgeon payment requires supporting documentation, and team surgery is 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 67420 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.
| Payment locality | Office | Facility |
|---|---|---|
| Chicago | Unavailable | $1,601.32 |
| East St. Louis | Unavailable | $1,515.60 |
| Rest Of Illinois | Unavailable | $1,479.65 |
| Suburban Chicago | Unavailable | $1,581.42 |
How the 67420 rate is calculated
Each of 67420’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 · 67420
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 21.32Practice expense 21.66Malpractice 2.05
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 67420
67420 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 67420
Orbitotomy
| 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) | 2 | Paid. |
| Co-surgeons (62) | 1 | Permitted with supporting documentation. |
| 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 · 67420
Orbitotomy
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
67420 without 50 · national facility
$1,504.04
Orbitotomy
67420-50 · Bilateral: 150%
$2,256.06
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).
67420 compared with similar codes
Compare codes
67420 vs 67400 vs 67412 vs 67413 vs 67414: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 67400Orbitotomy
- Choose 67400 for exploration through a transconjunctival approach without a bone flap. 67420 describes lateral orbital access with a bone flap or window.
- 67412Orbital surgery
- 67412 describes a lateral orbitotomy for drainage. Use 67420 when the documented purpose is exploration, with or without biopsy.
- 67413Orbital surgery
- 67413 is for lateral orbitotomy with removal of a foreign body. 67420 is for exploration, not removal of a foreign body as the defining service.
- 67414Orbital decompression
- 67414 describes lateral orbitotomy with removal of an orbital lesion. 67420 describes exploration, which may include biopsy but is not lesion removal.
67420 billing questions
How is 67420 different from 67400?
67420 involves lateral orbital access with a bone flap or window. 67400 is exploration through a transconjunctival approach without a bone flap.
Can a biopsy be included with 67420?
Yes. Exploration may include biopsy; the operative report should describe the tissue sampled and the reason for sampling.
Should 67420 be used when the surgeon drains the orbit?
No. When the lateral orbitotomy is performed to drain orbital contents, compare the service with 67412, which describes the drainage service.
What postoperative care is included?
The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care.
How is bilateral surgery reported?
For a bilateral procedure, modifier 50 is paid at 150% under the CMS rule supplied for this code.
Can an assistant or co-surgeon be paid?
An assistant at surgery may be paid. Co-surgeons are paid only with supporting documentation; team surgery is 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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