Billing code 67450: Orbital explorationMedicare rate & RVUs in Illinois
Reports surgical exploration of the orbit through a bone flap or window, with or without biopsy, to evaluate an orbital process.
CMS doesn’t publish an office rate for 67450 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 67450 covers
This service involves surgically opening the orbit through a bone flap or window to inspect orbital tissues, with biopsy when needed. It is typically performed by an ophthalmologist with orbital or oculoplastic expertise in a hospital or other surgical facility. A clinical situation may involve evaluating an orbital mass or unexplained orbital findings when direct operative access is needed to obtain tissue or inspect the space.
Report the code when the operative work is exploration, with or without biopsy, rather than drainage, lesion removal, or decompression. The operative report should support the approach, the structures explored, and whether tissue was sampled. CMS 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 are subject to the standard 50% reduction. 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 67450 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 | $1,277.36 |
| East St. Louis | Unavailable | $1,205.03 |
| Rest Of Illinois | Unavailable | $1,182.07 |
| Suburban Chicago | Unavailable | $1,271.10 |
How the 67450 rate is calculated
Each of 67450’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 · 67450
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 15.02Practice expense 20.24Malpractice 1.21
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 67450
67450 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 67450
Orbital exploration
| 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 · 67450
Orbital exploration
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
67450 without 50 · national facility
$1,218.13
Orbital exploration
67450-50 · Bilateral: 150%
$1,827.20
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).
67450 compared with similar codes
Compare codes
67450 vs 67400 vs 67405 vs 67415 vs 67445: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 67400Orbitotomy
- Both can involve orbital exploration and biopsy. Use 67450 when the surgeon uses a bone flap or window; use 67400 for exploration without a bone flap.
- 67405Orbital drainage
- 67405 is for orbital drainage. Use 67450 when the operative purpose is exploration, with or without biopsy, rather than drainage.
- 67415Orbital aspiration
- 67415 describes aspiration or injection of orbital contents. It is not the open exploration and biopsy service represented by 67450.
- 67445Orbital decompression
- 67445 is orbital decompression involving bone removal. Use 67450 when the documented service is exploration, with or without biopsy.
67450 billing questions
How does this differ from orbital exploration without a bone flap?
Choose 67450 when the documented exploration uses a bone flap or window. Code 67400 describes orbital exploration without a bone flap.
Can a biopsy be included in this service?
Yes. The exploration may include biopsy; document the tissue sampled and the operative findings.
Should this be reported when the surgeon drains an orbital collection?
Use the drainage code that matches the documented procedure rather than reporting exploration with biopsy for drainage alone.
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 handled?
CMS treats this as a bilateral procedure: report modifier 50 for bilateral work, which is paid at 150%.
Can an assistant or co-surgeon be reported?
Assistant-at-surgery payment may be available. Co-surgeon payment requires 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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