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See a sample rate comparisonCPT 65420 Fee Schedule
Last Verified: October 2026
Healthcare providers use this code to document and receive reimbursement for visits that address moderate-level medical decision-making, often including multiple diagnoses or prescription management.
Exc/Transpose Pterygium
| Key Fact | Detail |
|---|---|
| Service Type | Surgery Surgical Procedures on the Eye and Ocular Adnexa |
| Common Place of Service | 24 - Ambulatory Surgical Center 11 - Office |
| Common Modifiers | None RT - Right side of body LT - Left side of body |
| Complexity Level | Moderate |
| Medicare Fee Schedule | View Medicare rates for 65420 |
| Medicaid Fee Schedule | View Medicaid rates for 65420 |
National average reimbursement for CPT 65420 by major payers:
$661.22
$669.36
$707.18
$827.22
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CPT 65420
5 of 25 sample ratesHigher to lower in this preview
Hss Asc Of Manhattan LLC, Hss Asc Of Manhattan
$6,848.00Published ratePlymouth Orthopedic Surgery Center LLC, Plymouth Orthopedic Surgery Center
Plymouth Orthopedic Surgery Center LLC
$2,263.00Published rateRegional Eye Surgery Center, LLC
$1,689.00Published rateWashington Outpatient Surgery Center, LLC, Washington Outpatient Surgery Center
Washington Outpatient Surgery Center
$1,072.50Published rateRiverside Surgical Center
$735.00Published rate
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Payer Contract Negotiation
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See a sample payer proposalCPT 65420 vs. Other Surgical Procedures on the Eye and Ocular Adnexa Codes
The CPT 65420 code is part of the Surgery services used for Surgical Procedures on the Eye and Ocular Adnexa. It represents a moderate-complexity encounter and is one of several codes that vary based on time spent, level of medical decision-making, and documentation requirements.
The CPT 65420 code involves more provider time and moderate medical decision-making, unlike lower-level codes that require less time and simpler assessments. It typically includes multiple diagnoses, medication management, or test interpretation, leading to higher reimbursement and more detailed documentation requirements.
| Code | Complexity | Description |
|---|---|---|
| 65410-CPT | Low | Surgery For Cornea Biopsy, Surgery On The Middle Portion Of The Eye Membrane (Cornea). The Procedure Removes A Sample Of Tissue For Testing (Biopsy). |
| 65420-CPT | Moderate | Exc/Transpose Pterygium |
| 65426-CPT | Moderate | Repair/Remove Cornea Tissue, Surgery To Remove The Pterygium (Fleshy Tissue That Grows Over The Cornea) And Transplant With Tissue From The Upper Eyelid. |
| 65430-CPT | Low | Surgery For Cornea Biopsy, Surgery On The Middle Portion Of The Eye Membrane (Cornea). The Procedure Removes A Sample Of Tissue For Testing (Biopsy). |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 65420. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 65420 fee schedule helps patients estimate costs and providers optimize billing for accurate reimbursements.
Factors that affect fee schedules
Medicare & Medicaid Rates
Government-set reimbursement amounts
Private Insurance Rates
Negotiated rates between providers and insurance companies
Geographic Location
Costs may be higher in urban areas.
Provider Type
Hospital providers may have different rates than private practice.
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