No office rate
Choose 67405 when the orbitotomy is performed to drain an orbital collection. Choose 67400 for exploration, with or without biopsy, when drainage is not the service performed.
On this page
CMS RVU26D · Effective 2026-10-01
67405 Orbital drainage Medicare reimbursement rates in Vermont
Reports open orbital drainage through an orbitotomy without a bone flap, such as drainage of an orbital abscess when drainage is the operative objective. Compare 67405 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 67405 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
No supported rate
Facility setting
$785.12
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.
Ophthalmic surgery
About 67405: Orbital drainage without bone flap
Reports open orbital drainage through an orbitotomy without a bone flap, such as drainage of an orbital abscess when drainage is the operative objective.
An ophthalmic or oculoplastic surgeon uses an orbitotomy without a bone flap to reach and drain an orbital collection, commonly an abscess. The service is generally performed in an operating room, often in a hospital facility, when operative access and drainage are needed rather than needle aspiration alone. The drainage is the defining purpose; exploration may provide access, but removal of a lesion or foreign body is a different operative objective.
Report 67405 when the operative documentation supports orbital drainage without a bone flap and identifies the site and collection treated. The 90-day global period includes the day-before preoperative visit and related postoperative care during the 90 days after surgery. When other procedures are performed in the same session, the highest-valued procedure is paid in full and other procedures are subject to the standard multiple-procedure reduction. For bilateral surgery reported with modifier 50, CMS pays 150%. Assistant-at-surgery payment is restricted; co-surgeons and team surgery are not permitted.
CMS billing rules for 67405
- 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 RVU8.97 · 37%
- Practice expense (office) RVU14.32 · 60%
- Malpractice RVU0.71 · 3%
90
Medicare services in 2024 · #4962 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.
67405 compared with similar codes
Office rates for Vermont, from the same CMS release.
No office rate
Both describe orbital drainage, but 67440 uses a bone flap or window through a lateral approach; 67405 is drainage without a bone flap.
No office rate
67415 describes aspiration of orbital contents. 67405 describes open drainage through an orbitotomy.
No office rate
67412 is used when orbitotomy treatment includes removal of a lesion. 67405 is for drainage as the operative objective.
Compare 67405 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
Unavailable
Facility
$785.12
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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 67405 in Vermont.
PPRRVU2026_Oct_nonQPP.csv
7,469
- Code
- 67405
- Physician work
- 8.97
- Practice expense
- 14.32
- Malpractice
- 0.71
GPCI2026.csv
105
- Locality
- Vermont
- Physician work
- 1.000
- Practice expense
- 0.990
- Malpractice
- 0.506
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 8.97 | × 1.000 | 8.9700 |
| Practice expense | 14.32 | × 0.990 | 14.1768 |
| Malpractice | 0.71 | × 0.506 | 0.3593 |
| Total RVUs | 23.5061 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Vermont$785.12
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 8.97 | 1 |
| Practice expense | 14.32 | 0.99 |
| Malpractice | 0.71 | 0.506 |
(8.97 × 1 + 14.32 × 0.99 + 0.71 × 0.506) × $33.4009 = $785.12
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.
67405 billing questions
When is 67405 appropriate instead of orbital aspiration?
Use 67405 for operative drainage through an orbitotomy without a bone flap. Orbital-content aspiration, rather than open surgical drainage, is described by 67415.
How does 67405 differ from 67400?
67405 identifies drainage as the operative objective. 67400 describes orbitotomy for exploration, with or without biopsy, when drainage is not the service performed.
Can 67405 be reported when a lesion is removed?
67405 is for drainage only. If the operative objective is removal of an orbital lesion, select the code that describes that procedure rather than reporting drainage for the same work.
What documentation supports 67405?
Document the orbital collection and its location, the orbitotomy approach, and the drainage performed. The operative report should make clear that drainage, rather than aspiration or lesion removal, was the objective.
How are bilateral procedures and other same-session procedures paid?
CMS pays bilateral surgery reported with modifier 50 at 150%. For multiple procedures in the same session, the highest-valued procedure is paid in full and the others are subject to the standard reduction.
Is postoperative care separately reported during the global period?
The 90-day global period includes the day-before preoperative visit and related postoperative care through 90 days after surgery.
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.
7,46667346,,Biopsy eye muscle,A,,2.80,1.81,NA,1.81,,0.21,4.82,4.82,0,000,0.00,0.00,0.00,2,1,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,46767399,,Unlisted px extraocular musc,C,,0.00,0.00,,0.00,,0.00,0.00,0.00,0,YYY,0.00,0.00,0.00,2,1,2,1,1,9,,33.4009,09,0,99,0.00,0.00,0.00
7,46867400,,Explore/biopsy eye socket,A,,10.92,15.47,NA,15.47,,0.89,27.28,27.28,0,090,0.10,0.70,0.20,2,1,1,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,46967405,,Explore/drain eye socket,A,,8.97,14.32,NA,14.32,,0.71,24.00,24.00,0,090,0.10,0.70,0.20,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,47067412,,Explore/treat eye socket,A,,10.04,15.28,NA,15.28,,0.84,26.16,26.16,0,090,0.10,0.70,0.20,2,1,1,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,47167413,,Explore/treat eye socket,A,,9.98,14.58,NA,14.58,,0.80,25.36,25.36,0,090,0.10,0.70,0.20,2,1,2,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,47267414,,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
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