No office rate
Both involve orbital exploration with a bone flap or window. Select 67430 for the transcranial approach and 67420 for the lateral approach.
On this page
CMS RVU26D · Effective 2026-10-01
67430 Orbital exploration Medicare reimbursement rates in Iowa
Reports surgical exploration of the orbit through a transcranial bone flap or window, with or without biopsy, when this access route is required. Compare 67430 office and facility rates across CMS payment localities in Iowa.
Amounts below use the non-QP conversion factor for participating physicians. These are base physician payments before claim-level adjustments, not patient costs or total hospital charges.
What does Medicare pay for 67430 in Iowa?
Iowa has 1 payment locality in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the payment area shown below, using the same CMS release.
Office / nonfacility
No supported rate
Facility setting
$1131.27
1 of 1 localities have a supported rate.
Payment area: Iowa
One mapped payment locality.
These are locality ranges, not averages or address-specific quotes. A facility-setting amount covers the physician service; it does not include a hospital’s separate bill. Choose a locality below to inspect its calculation, compare other payment areas, or price a percentage of Medicare.
Ophthalmic surgery
About 67430: Transcranial orbital exploration with bone flap
Reports surgical exploration of the orbit through a transcranial bone flap or window, with or without biopsy, when this access route is required.
The surgeon reaches the orbit from the cranial side by creating a bone flap or window, then explores the orbital contents; biopsy may be performed during the exploration. This approach is selected when the orbital area requires transcranial exposure rather than access through the eyelid or orbit itself. The procedure is performed in an operating room by a surgeon treating orbital disease, commonly an ophthalmic or oculoplastic surgeon.
Choose this code for the transcranial approach and exploration, not simply because a biopsy was taken. The operative report should identify the approach, bone opening, area explored, and any biopsy performed. CMS assigns a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. For bilateral procedures reported with modifier 50, CMS pays 150%. In a same-session multiple-procedure claim, the highest-valued procedure is paid in full and others at 50%. An assistant at surgery may be paid; co-surgeons and team surgery are not permitted.
CMS billing rules for 67430
- Global period
- Major surgery with a 90-day global period: the day-before preoperative visit and 90 days of related postoperative care are included.
- Multiple procedures
- Standard multiple procedure reduction: the highest-valued procedure is paid in full and others at 50% when performed in the same session.
- Bilateral procedures
- Bilateral procedure with modifier 50 is paid at 150%.
- Assistant at surgery
- Assistant at surgery may be paid.
- Co-surgeons
- Co-surgeons not permitted.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU14.91 · 41%
- Practice expense (office) RVU20.20 · 56%
- Malpractice RVU1.20 · 3%
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.
67430 compared with similar codes
Office rates for Iowa, from the same CMS release.
No office rate
67400 describes exploration without a bone flap. Use 67430 when the surgeon accesses the orbit transcranially through a bone flap or window.
No office rate
67412 is for orbital surgery without a bone flap that removes a lesion. This code describes transcranial exploration, with or without biopsy.
No office rate
67414 describes orbital decompression without a bone flap. This code is for transcranial exploration rather than decompression.
Compare 67430 by payment locality
Find the payment area for your service address, then open its rate page for calculation inputs, release history and the percentage-of-Medicare tool. A city may cross payment-area boundaries; the ZIP lookup above helps resolve the location.
1 of 1 payment localities
Iowa →
Office / nonfacility
Unavailable
Facility
$1131.27
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How this local rate is calculated
Each RVU component is multiplied by its own geographic practice cost index (GPCI). The three adjusted components are added, then multiplied by the conversion factor. These are the inputs used for 67430 in Iowa.
PPRRVU2026_Oct_nonQPP.csv
7,475
- Code
- 67430
- Physician work
- 14.91
- Practice expense
- 20.20
- Malpractice
- 1.20
GPCI2026.csv
53
- Locality
- Iowa
- Physician work
- 1.000
- Practice expense
- 0.915
- Malpractice
- 0.397
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 14.91 | × 1.000 | 14.9100 |
| Practice expense | 20.20 | × 0.915 | 18.4830 |
| Malpractice | 1.20 | × 0.397 | 0.4764 |
| Total RVUs | 33.8694 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Iowa$1131.27
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 14.91 | 1 |
| Practice expense | 20.2 | 0.915 |
| Malpractice | 1.2 | 0.397 |
(14.91 × 1 + 20.2 × 0.915 + 1.2 × 0.397) × $33.4009 = $1131.27
The office and facility calculations use their respective practice-expense RVUs. The facility amount here is the physician fee, not a separate hospital or facility bill.
67430 billing questions
How does this differ from 67420?
Both describe orbital exploration using a bone flap or window. This code is for the transcranial approach; 67420 is for the lateral approach.
Is biopsy included?
Yes. Exploration may include biopsy, so the biopsy does not change the selection of this exploration code.
When is 67400 a better fit?
Use 67400 for orbital exploration without a bone flap, through a non-bone-flap approach. This code requires transcranial access with a bone flap or window.
How is a bilateral service reported?
Report modifier 50 for a bilateral procedure. CMS pays the bilateral service at 150%.
What postoperative care is included?
The 90-day global period includes the day-before preoperative visit and 90 days of related 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 indices and the applicable conversion factor. Unavailable or separately priced services are labeled rather than assigned a made-up amount.
Source: RVU26D. Effective 2026-10-01 through the day before 2027-01-01.
7,47267414,,Explr/decompress eye socket,A,,17.49,18.35,NA,18.35,,1.56,37.40,37.40,0,090,0.10,0.70,0.20,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,47367415,,Aspiration orbital contents,A,,1.72,0.60,NA,0.60,,0.14,2.46,2.46,0,000,0.00,0.00,0.00,2,1,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,47467420,,Explore/treat eye socket,A,,21.32,21.66,NA,21.66,,2.05,45.03,45.03,0,090,0.10,0.70,0.20,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,47567430,,Explore/treat eye socket,A,,14.91,20.20,NA,20.20,,1.20,36.31,36.31,0,090,0.10,0.70,0.20,2,1,2,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,47667440,,Explore/drain eye socket,A,,14.47,19.58,NA,19.58,,1.16,35.21,35.21,0,090,0.10,0.70,0.20,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,47767445,,Explr/decompress eye socket,A,,18.64,19.05,NA,19.05,,1.58,39.27,39.27,0,090,0.10,0.70,0.20,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,47867450,,Explore/biopsy eye socket,A,,15.02,20.24,NA,20.24,,1.21,36.47,36.47,0,090,0.10,0.70,0.20,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5006102,IL,15,SUBURBAN CHICAGO,1.007,1.027,1.772
5106102,IL,99,REST OF ILLINOIS,1.000,0.913,1.563
5208102,IN,00,INDIANA,1.000,0.927,0.486
5305102,IA,00,IOWA,1.000,0.915,0.397
5405202,KS,00,KANSAS,1.000,0.904,0.504
5515102,KY,00,KENTUCKY,1.000,0.889,0.915
5607202,LA,01,NEW ORLEANS,1.000,0.941,1.136