No office rate
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.
On this page
CMS RVU26D · Effective 2026-10-01
67450 Orbital exploration Medicare reimbursement rates in New Jersey
Reports surgical exploration of the orbit through a bone flap or window, with or without biopsy, to evaluate an orbital process. Compare 67450 office and facility rates across CMS payment localities in New Jersey.
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 67450 in New Jersey?
New Jersey has 2 payment localities in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the 2 payment areas shown below, using the same CMS release.
Office / nonfacility
No supported rate
Facility setting
$1304.31–$1360.65
2 of 2 localities have a supported rate.
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 67450: Orbital exploration with biopsy
Reports surgical exploration of the orbit through a bone flap or window, with or without biopsy, to evaluate an orbital process.
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.
CMS billing rules for 67450
- 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 paid only with supporting documentation.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU15.02 · 41%
- Practice expense (office) RVU20.24 · 55%
- Malpractice RVU1.21 · 3%
31
Medicare services in 2024 · #5657 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.
67450 compared with similar codes
Office rates for New Jersey, from the same CMS release.
No office rate
67405 is for orbital drainage. Use 67450 when the operative purpose is exploration, with or without biopsy, rather than drainage.
No office rate
67415 describes aspiration or injection of orbital contents. It is not the open exploration and biopsy service represented by 67450.
No office rate
67445 is orbital decompression involving bone removal. Use 67450 when the documented service is exploration, with or without biopsy.
Compare 67450 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.
2 of 2 payment localities
Northern Nj →
Office / nonfacility
Unavailable
Facility
$1360.65
Rest Of New Jersey →
Office / nonfacility
Unavailable
Facility
$1304.31
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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 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.
7,47567430,,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
7,47967500,,Inject/treat eye socket,A,,1.15,1.13,,0.42,,0.08,2.36,1.65,0,000,0.00,0.00,0.00,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,48067505,,Inject/treat eye socket,A,,1.15,1.31,,0.51,,0.08,2.54,1.74,0,000,0.00,0.00,0.00,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,48167515,,Inject/treat eye socket,A,,0.73,0.76,,0.36,,0.06,1.55,1.15,0,000,0.00,0.00,0.00,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00