Billing code 67810: Eyelid biopsyMedicare rate & RVUs in Illinois
Ophthalmologists report this incisional eyelid biopsy to sample suspicious eyelid skin or lid-margin tissue when diagnosis is needed without complete lesion excision.
Medicare pays $171.01–$187.89 for 67810 in the office in Illinois, from Rest Of Illinois to Suburban 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 67810 covers
An ophthalmologist, often an oculoplastic surgeon, takes a tissue sample from eyelid skin or the lid margin for diagnostic evaluation. Typical situations include a suspicious, changing, ulcerated, or nonhealing eyelid growth. The service may be performed in an office or facility setting, and the sample is submitted for tissue examination. This code describes obtaining a biopsy sample, not removing the entire lesion as treatment.
Report 67810 when the procedure is an incisional biopsy of eyelid skin or margin; document the sampled site, the lesion’s clinical appearance, and that tissue was obtained for diagnosis. The CMS global period is 0 days, so same-day preoperative and postoperative care is included. For bilateral procedures, modifier 50 is paid at 150%. When multiple procedures occur in the same session, the highest-valued procedure is paid in full and the others at 50%. Medicare does not pay an assistant at surgery for this service; 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 67810 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
$171.01 to $187.89
| Payment locality | Office | Facility |
|---|---|---|
| Chicago | $186.75 | $60.20 |
| East St. Louis | $173.64 | $57.79 |
| Rest Of Illinois | $171.01 | $56.05 |
| Suburban Chicago | $187.89 | $58.57 |
How the 67810 rate is calculated
Each of 67810’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 · 67810
RVUs × geographic indexes × conversion factor
Work1.15
1.15 RVUs× 1.000 GPCI
Practice expense4.16
4.16 RVUs× 1.000 GPCI
Malpractice0.11
0.11 RVUs× 1.000 GPCI
Adjusted RVUs
5.4200
Conversion factor
$33.4009
Medicare rate
$181.03
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 67810
The CMS indicators that decide how 67810 is paid alongside other services.
CMS payment indicators · 67810
Eyelid biopsy
| 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
67810 without 50 · national office
$181.03
Eyelid biopsy
67810-50 · Bilateral: 150%
$271.55
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).
67810 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 67840Eyelid lesion excision
- 67810 samples eyelid tissue for diagnosis. 67840 is used when the eyelid lesion is excised rather than biopsied.
- 68100Conjunctival biopsy
- 67810 applies to eyelid skin or lid-margin tissue; 68100 applies when the sampled tissue is conjunctiva.
- 11102Tangential skin biopsy
- 11102 describes a tangential skin biopsy for a different site and method. 67810 is specific to an incisional biopsy of eyelid skin or margin.
67810 billing questions
When should 67810 be chosen instead of 67840?
Use 67810 when tissue is sampled for diagnosis. Use 67840 when the eyelid lesion is excised rather than sampled.
Does 67810 include removal of the whole lesion?
No. It represents an incisional biopsy sample; document a complete excision separately when that is the service performed.
How is a bilateral eyelid biopsy reported?
CMS recognizes modifier 50 for bilateral reporting and pays the procedure at 150%. Document the eyelid sites sampled.
What happens when another procedure is performed in the same session?
Under the standard multiple procedure reduction, CMS pays the highest-valued procedure in full and the others at 50%.
Is same-day postoperative care separately included?
No. The 0-day global period includes same-day preoperative and postoperative care.
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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