No office rate
Choose 67400 for exploration through a transconjunctival approach without a bone flap. 67420 describes lateral orbital access with a bone flap or window.
On this page
CMS RVU26D · Effective 2026-10-01
67420 Orbitotomy Medicare reimbursement rates in Vermont
A surgeon uses a lateral orbital bone flap or window to inspect the orbit, with or without biopsy, when direct exploration is needed. Compare 67420 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 67420 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
$1462.98
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 67420: Lateral orbitotomy with exploration
A surgeon uses a lateral orbital bone flap or window to inspect the orbit, with or without biopsy, when direct exploration is needed.
This service involves reaching the orbit through a lateral approach that uses a bone flap or window, then inspecting the orbital contents; biopsy may be performed as part of the exploration. Ophthalmologists, often oculoplastic or orbital surgeons, perform it in an operating room when an orbital mass or other finding requires direct access and inspection. The approach is more extensive than exploration through the conjunctiva without a bone flap.
Report 67420 when the documented service is lateral orbitotomy for exploration, with or without biopsy. The operative report should support the lateral approach and bone flap or window, the reason for exploration, and the findings; document any biopsy performed. Medicare 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 at 50%. 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 67420
- 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 RVU21.32 · 47%
- Practice expense (office) RVU21.66 · 48%
- Malpractice RVU2.05 · 5%
140
Medicare services in 2024 · #4609 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.
67420 compared with similar codes
Office rates for Vermont, from the same CMS release.
No office rate
67412 describes a lateral orbitotomy for drainage. Use 67420 when the documented purpose is exploration, with or without biopsy.
No office rate
67413 is for lateral orbitotomy with removal of a foreign body. 67420 is for exploration, not removal of a foreign body as the defining service.
No office rate
67414 describes lateral orbitotomy with removal of an orbital lesion. 67420 describes exploration, which may include biopsy but is not lesion removal.
Compare 67420 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
$1462.98
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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 67420 in Vermont.
PPRRVU2026_Oct_nonQPP.csv
7,474
- Code
- 67420
- Physician work
- 21.32
- Practice expense
- 21.66
- Malpractice
- 2.05
GPCI2026.csv
105
- Locality
- Vermont
- Physician work
- 1.000
- Practice expense
- 0.990
- Malpractice
- 0.506
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 21.32 | × 1.000 | 21.3200 |
| Practice expense | 21.66 | × 0.990 | 21.4434 |
| Malpractice | 2.05 | × 0.506 | 1.0373 |
| Total RVUs | 43.8007 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Vermont$1462.98
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 21.32 | 1 |
| Practice expense | 21.66 | 0.99 |
| Malpractice | 2.05 | 0.506 |
(21.32 × 1 + 21.66 × 0.99 + 2.05 × 0.506) × $33.4009 = $1462.98
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.
67420 billing questions
How is 67420 different from 67400?
67420 involves lateral orbital access with a bone flap or window. 67400 is exploration through a transconjunctival approach without a bone flap.
Can a biopsy be included with 67420?
Yes. Exploration may include biopsy; the operative report should describe the tissue sampled and the reason for sampling.
Should 67420 be used when the surgeon drains the orbit?
No. When the lateral orbitotomy is performed to drain orbital contents, compare the service with 67412, which describes the drainage service.
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 reported?
For a bilateral procedure, modifier 50 is paid at 150% under the CMS rule supplied for this code.
Can an assistant or co-surgeon be paid?
An assistant at surgery may be paid. Co-surgeons are paid only with 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.
7,47167413,,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
7,47367415,,Aspiration orbital contents,A,,1.72,0.60,NA,0.60,,0.14,2.46,2.46,0,000,0.00,0.00,0.00,2,1,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,47467420,,Explore/treat eye socket,A,,21.32,21.66,NA,21.66,,2.05,45.03,45.03,0,090,0.10,0.70,0.20,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,47567430,,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
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