No office rate
Use 67412 for transconjunctival access without a bone flap. Use 67430 when the surgeon uses a lateral approach with a bone flap or window to remove the orbital foreign body.
On this page
CMS RVU26D · Effective 2026-10-01
67412 Orbital surgery Medicare reimbursement rates in Wisconsin
Report this orbital operation when a surgeon removes a foreign body through a transconjunctival approach without creating a bone flap. Compare 67412 office and facility rates across CMS payment localities in Wisconsin.
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 67412 in Wisconsin?
Wisconsin 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
$832.92
1 of 1 localities have a supported rate.
Payment area: Wisconsin
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 67412: Transconjunctival orbital foreign-body removal
Report this orbital operation when a surgeon removes a foreign body through a transconjunctival approach without creating a bone flap.
An ophthalmologist or oculoplastic surgeon uses a transconjunctival route to reach the orbit and remove a foreign body without creating a bone flap. A typical case involves a retained fragment within the eye socket, rather than an object on the ocular surface or inside the globe. The service may occur in a hospital or ambulatory surgical setting, depending on the patient and operative plan.
Select this code when the operative note supports both the orbital location and the transconjunctival approach, and describes removal of the foreign body. The code includes the operative exploration needed to locate and extract it. Medicare assigns a 90-day global period, including the day-before preoperative visit and related postoperative care during that period. When multiple procedures occur in the same session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% reduction. For bilateral reporting with modifier 50, Medicare pays 150%. Assistant-at-surgery services are not paid; co-surgeons require supporting documentation, and team surgery is not permitted.
CMS billing rules for 67412
- 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 paid only with supporting documentation.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU10.04 · 38%
- Practice expense (office) RVU15.28 · 58%
- Malpractice RVU0.84 · 3%
1.8K
Medicare services in 2024 · #2544 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.
67412 compared with similar codes
Office rates for Wisconsin, from the same CMS release.
No office rate
Use 67400 for transconjunctival orbital exploration, with or without biopsy, when the service is not foreign-body removal. Use 67412 when the operation removes an orbital foreign body.
No office rate
Use 67413 for transconjunctival removal of an orbital tumor. Use 67412 when the target is a foreign body rather than a tumor.
No office rate
Use 67414 for transconjunctival orbital decompression. Use 67412 when the operative objective is removal of a foreign body.
Compare 67412 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
Wisconsin →
Office / nonfacility
Unavailable
Facility
$832.92
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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 67412 in Wisconsin.
PPRRVU2026_Oct_nonQPP.csv
7,470
- Code
- 67412
- Physician work
- 10.04
- Practice expense
- 15.28
- Malpractice
- 0.84
GPCI2026.csv
111
- Locality
- Wisconsin
- Physician work
- 1.000
- Practice expense
- 0.958
- Malpractice
- 0.308
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 10.04 | × 1.000 | 10.0400 |
| Practice expense | 15.28 | × 0.958 | 14.6382 |
| Malpractice | 0.84 | × 0.308 | 0.2587 |
| Total RVUs | 24.9370 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Wisconsin$832.92
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 10.04 | 1 |
| Practice expense | 15.28 | 0.958 |
| Malpractice | 0.84 | 0.308 |
(10.04 × 1 + 15.28 × 0.958 + 0.84 × 0.308) × $33.4009 = $832.92
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.
67412 billing questions
How does this differ from 67430?
Both involve orbital foreign-body removal. This code describes a transconjunctival route without a bone flap; 67430 describes a lateral approach using a bone flap or window.
Can orbital exploration be billed separately?
The exploration needed to locate and remove the foreign body is part of this operation. The operative report should establish the orbital site, approach, and removal.
Does the 90-day global period include postoperative care?
Yes. Related postoperative care for 90 days and the day-before preoperative visit are included in the global period.
How is bilateral surgery reported?
For bilateral surgery, report modifier 50; Medicare pays 150% under the CMS bilateral rule for this code.
Can an assistant surgeon or co-surgeon be reported?
Medicare does not pay an assistant at surgery for this code. Co-surgeon payment requires supporting documentation, and 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.
7,46767399,,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
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
10802402,WA,02,SEATTLE (KING CNTY),1.050,1.227,0.817
10902402,WA,99,REST OF WASHINGTON,1.013,1.053,0.761
11011402,WV,16,WEST VIRGINIA,1.000,0.869,1.431
11106302,WI,00,WISCONSIN,1.000,0.958,0.308
11203602,WY,21,WYOMING**,1.000,1.000,0.740
113"MAC Assignments as of November 22, 2023",,,,,,
114,,,,,,