Billing code 65426: Pterygium removalMedicare rate & RVUs in Texas
Reports removal or repositioning of a pterygium that extends onto the cornea when the surgeon also places a graft to cover the ocular surface.
Medicare pays $628.36–$695.91 for 65426 in the office in Texas, from Beaumont to Austin. 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 65426 covers
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.
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 65426 pays more and less in Texas
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
8 payment localities
$628.36 to $695.91
8 of 8 payment localities
| Payment locality | Office | Facility |
|---|---|---|
| Austin | $695.91 | $423.45 |
| Beaumont | $628.36 | $394.01 |
| Brazoria | $664.76 | $409.56 |
| Dallas | $668.45 | $411.96 |
| Fort Worth | $664.07 | $410.15 |
| Galveston | $666.42 | $410.70 |
| Houston | $674.84 | $419.12 |
| Rest Of Texas | $645.83 | $401.44 |
How the 65426 rate is calculated
Each of 65426’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 · 65426
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 5.90Practice expense 13.72Malpractice 0.46
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 65426
65426 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 65426
Pterygium removal
| 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) | 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. |
| 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 · 65426
Pterygium removal
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
65426 without 50 · national office
$670.69
Pterygium removal
65426-50 · Bilateral: 150%
$1,006.04
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).
65426 compared with similar codes
Compare codes
65426 vs 65420 vs 65400 vs 65410: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 65420Pterygium removal
- Both codes describe pterygium surgery; report 65426 when the surgeon places a graft and 65420 when surgery is performed without one.
- 65400Corneal excision
- This code is for pterygium excision or transposition with a graft. Code 65400 addresses excision of a corneal lesion rather than pterygium surgery.
- 65410Corneal biopsy
- Code 65410 represents corneal biopsy for tissue diagnosis. Use 65426 when the procedure is pterygium removal or transposition with graft placement.
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 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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