$503.37
Both codes describe pterygium surgery; report 65426 when the surgeon places a graft and 65420 when surgery is performed without one.
On this page
CMS RVU26D · Effective 2026-10-01
65426 Pterygium removal Medicare reimbursement rates in Nebraska
Reports removal or repositioning of a pterygium that extends onto the cornea when the surgeon also places a graft to cover the ocular surface. Compare 65426 office and facility rates across CMS payment localities in Nebraska.
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 65426 in Nebraska?
Nebraska 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
$625.85
1 of 1 localities have a supported rate.
Payment area: Nebraska
One mapped payment locality.
Facility setting
$388.16
1 of 1 localities have a supported rate.
Payment area: Nebraska
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.
Ophthalmology surgery
About 65426: Pterygium excision with graft
Reports removal or repositioning of a pterygium that extends onto the cornea when the surgeon also places a graft to cover the ocular surface.
An ophthalmologist removes or repositions a pterygium, a fibrovascular growth that advances from the conjunctiva onto the cornea, and places a graft over the resulting surface defect. The procedure is typically performed in an operating room or ambulatory surgery center when the growth causes symptoms, threatens vision, or warrants surgical treatment. The graft distinguishes this service from pterygium surgery without a graft.
Choose this code when the operative report supports both pterygium excision or transposition and graft placement. Document the treated eye, the pterygium and its corneal involvement, the surgical method, and the graft. Medicare assigns a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. When multiple procedures are performed in one session, the highest-valued procedure is paid in full and others at 50%. For bilateral surgery reported with modifier 50, payment is 150%. Medicare does not pay an assistant at surgery; co-surgeons and team surgery are not permitted.
CMS billing rules for 65426
- 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
- Statutory restriction: assistant at surgery is not paid.
- Co-surgeons
- Co-surgeons not permitted.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU5.90 · 29%
- Practice expense (office) RVU13.72 · 68%
- Malpractice RVU0.46 · 2%
9.2K
Medicare services in 2024 · #1520 by national volume
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.
65426 compared with similar codes
Office rates for Nebraska, from the same CMS release.
$652.51
This code is for pterygium excision or transposition with a graft. Code 65400 addresses excision of a corneal lesion rather than pterygium surgery.
$134.55
Code 65410 represents corneal biopsy for tissue diagnosis. Use 65426 when the procedure is pterygium removal or transposition with graft placement.
Compare 65426 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
Nebraska →
Office / nonfacility
$625.85
Facility
$388.16
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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 65426 in Nebraska.
PPRRVU2026_Oct_nonQPP.csv
7,321
- Code
- 65426
- Physician work
- 5.90
- Practice expense
- 13.72
- Malpractice
- 0.46
GPCI2026.csv
72
- Locality
- Nebraska
- Physician work
- 1.000
- Practice expense
- 0.923
- Malpractice
- 0.378
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 5.90 | × 1.000 | 5.9000 |
| Practice expense | 13.72 | × 0.923 | 12.6636 |
| Malpractice | 0.46 | × 0.378 | 0.1739 |
| Total RVUs | 18.7374 | ||
| Conversion factor | × 33.4009 | ||
Office / nonfacility rate, Nebraska$625.85
Explore RVUs, geographic factors and the full formula
Office / nonfacility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 5.9 | 1 |
| Practice expense | 13.72 | 0.923 |
| Malpractice | 0.46 | 0.378 |
(5.9 × 1 + 13.72 × 0.923 + 0.46 × 0.378) × $33.4009 = $625.85
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 5.9 | 1 |
| Practice expense | 6.01 | 0.923 |
| Malpractice | 0.46 | 0.378 |
(5.9 × 1 + 6.01 × 0.923 + 0.46 × 0.378) × $33.4009 = $388.16
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.
65426 billing questions
When should this code be selected instead of 65420?
Use this code when pterygium surgery includes placement of a graft. Code 65420 describes pterygium surgery without a graft.
Is graft placement included in this service?
Yes. Graft placement is part of the service represented by this code; it is the feature that distinguishes it from 65420.
What documentation supports reporting this code?
The operative report should identify the pterygium, the treated eye, excision or transposition, and placement of the graft.
How is bilateral surgery handled?
CMS treats this as a bilateral procedure. When both eyes are treated and modifier 50 is reported, payment is 150%.
Which postoperative care is included?
The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care.
Can an assistant or co-surgeon be paid?
CMS does not pay an assistant at surgery for this code. Co-surgeons and team surgery are 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 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.
7,31865400,,Removal of eye lesion,A,,7.31,13.00,,7.76,,0.60,20.91,15.67,0,090,0.10,0.70,0.20,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,31965410,,Biopsy of cornea,A,,1.43,2.77,,1.05,,0.11,4.31,2.59,0,000,0.00,0.00,0.00,2,1,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,32065420,,Removal of eye lesion,A,,4.25,11.58,,5.42,,0.35,16.18,10.02,0,090,0.10,0.70,0.20,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,32165426,,Removal of eye lesion,A,,5.90,13.72,,6.01,,0.46,20.08,12.37,0,090,0.10,0.70,0.20,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,32265430,,Corneal smear,A,,1.43,1.92,,1.02,,0.11,3.46,2.56,0,000,0.00,0.00,0.00,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,32365435,,Curette/treat cornea,A,,0.90,1.53,,0.84,,0.07,2.50,1.81,0,000,0.00,0.00,0.00,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,32465436,,Curette/treat cornea,A,,4.70,6.66,,4.44,,0.38,11.74,9.52,0,090,0.10,0.70,0.20,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6905302,MO,01,METROPOLITAN ST. LOUIS,1.000,0.952,1.002
7005302,MO,99,REST OF MISSOURI,1.000,0.862,0.974
7103202,MT,01,MONTANA**,1.000,1.000,0.998
7205402,NE,00,NEBRASKA,1.000,0.923,0.378
7301312,NV,00,NEVADA**,1.000,1.001,0.833
7414312,NH,40,NEW HAMPSHIRE,1.000,1.041,0.875
7512402,NJ,01,NORTHERN NJ,1.063,1.160,1.068