$141.22
65400 excises a superficial lesion; 65410 obtains a corneal tissue sample by biopsy for diagnosis.
On this page
CMS RVU26D · Effective 2026-10-01
65400 Corneal excision Medicare reimbursement rates in Vermont
Ophthalmologists report this procedure to excise a superficial corneal lesion when the target is removed rather than sampled, scraped, or destroyed. Compare 65400 office and facility rates across CMS payment localities in Vermont.
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 65400 in Vermont?
Vermont 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
$684.17
1 of 1 localities have a supported rate.
Payment area: Vermont
One mapped payment locality.
Facility setting
$510.90
1 of 1 localities have a supported rate.
Payment area: Vermont
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 65400: Superficial corneal lesion excision
Ophthalmologists report this procedure to excise a superficial corneal lesion when the target is removed rather than sampled, scraped, or destroyed.
An ophthalmologist uses magnification and microsurgical instruments to excise a focal lesion from the corneal surface. This code is for superficial corneal lesions other than pterygium; removed tissue may be sent for pathology when clinically indicated. It describes removal of the lesion itself, not a diagnostic corneal biopsy alone, epithelial scraping for recurrent erosion, or destruction by a method such as freezing or photocoagulation. The service may be performed in an office procedure setting or an outpatient surgical facility, depending on the lesion and clinical circumstances.
Report 65400 when documentation identifies a superficial corneal lesion and supports excision, including its location, extent, and the work performed. Distinguish it from biopsy, epithelial removal for recurrent erosion, and pterygium surgery. CMS assigns a 90-day global period, including the day-before preoperative visit and related postoperative care during that period. For multiple procedures in one session, CMS pays the highest-valued procedure in full and reduces other procedures to 50%. Bilateral reporting with modifier 50 is paid at 150%. CMS does not pay an assistant at surgery; co-surgeons and team surgery are not permitted.
CMS billing rules for 65400
- 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 RVU7.31 · 35%
- Practice expense (office) RVU13.00 · 62%
- Malpractice RVU0.60 · 3%
12.7K
Medicare services in 2024 · #1355 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.
65400 compared with similar codes
Office rates for Vermont, from the same CMS release.
$530.78
65420 is for pterygium excision or transposition without a graft. 65400 is for a superficial corneal lesion other than pterygium.
$81.84
65435 removes corneal epithelium to treat recurrent erosion; 65400 excises a focal superficial corneal lesion.
$328.26
65450 destroys a corneal lesion by a destructive method; 65400 removes the lesion by excision.
Compare 65400 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
Vermont →
Office / nonfacility
$684.17
Facility
$510.90
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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 65400 in Vermont.
PPRRVU2026_Oct_nonQPP.csv
7,318
- Code
- 65400
- Physician work
- 7.31
- Practice expense
- 13.00
- Malpractice
- 0.60
GPCI2026.csv
105
- Locality
- Vermont
- Physician work
- 1.000
- Practice expense
- 0.990
- Malpractice
- 0.506
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 7.31 | × 1.000 | 7.3100 |
| Practice expense | 13.00 | × 0.990 | 12.8700 |
| Malpractice | 0.60 | × 0.506 | 0.3036 |
| Total RVUs | 20.4836 | ||
| Conversion factor | × 33.4009 | ||
Office / nonfacility rate, Vermont$684.17
Explore RVUs, geographic factors and the full formula
Office / nonfacility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 7.31 | 1 |
| Practice expense | 13 | 0.99 |
| Malpractice | 0.6 | 0.506 |
(7.31 × 1 + 13 × 0.99 + 0.6 × 0.506) × $33.4009 = $684.17
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 7.31 | 1 |
| Practice expense | 7.76 | 0.99 |
| Malpractice | 0.6 | 0.506 |
(7.31 × 1 + 7.76 × 0.99 + 0.6 × 0.506) × $33.4009 = $510.90
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.
65400 billing questions
How does 65400 differ from a corneal biopsy?
Use 65400 when the superficial lesion is excised. Use 65410 when the service is a corneal biopsy to obtain tissue for diagnosis rather than excision of the lesion.
Does the 90-day global period include postoperative visits?
Related postoperative care during the 90-day period is included, as is the day-before preoperative visit.
When is modifier 50 used?
For bilateral performance, report modifier 50; CMS pays the bilateral procedure at 150%.
Can an assistant or co-surgeon be reported?
CMS does not pay an assistant at surgery for 65400. Co-surgeons and team surgery are not permitted.
How are other procedures performed in the same session paid?
CMS pays the highest-valued procedure in full and reduces the other procedures to 50% under the standard multiple procedure rule.
When should 65400 be distinguished from 65435?
65400 is for excision of a superficial corneal lesion. 65435 is for corneal epithelial removal to treat recurrent corneal erosion.
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.
7,31565285,,Repair of eye wound,A,,14.98,11.63,NA,11.63,,1.21,27.82,27.82,0,090,0.10,0.70,0.20,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,31665286,,Repair of eye wound,A,,6.46,13.96,,5.61,,0.50,20.92,12.57,0,090,0.10,0.70,0.20,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,31765290,,Repair of eye socket wound,A,,6.37,5.57,NA,5.57,,0.49,12.43,12.43,0,090,0.10,0.70,0.20,2,1,1,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
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
10204412,TX,18,HOUSTON,1.008,0.993,1.376
10304412,TX,99,REST OF TEXAS,1.000,0.949,0.903
10403502,UT,09,UTAH,1.000,0.940,0.898
10514512,VT,50,VERMONT,1.000,0.990,0.506
10611302,VA,00,VIRGINIA,1.000,0.983,0.706
10709202,VI,50,VIRGIN ISLANDS,1.000,1.011,0.985
10802402,WA,02,SEATTLE (KING CNTY),1.050,1.227,0.817