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See a sample rate comparisonCPT 65426 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.
Repair/Remove Cornea Tissue, Surgery To Remove The Pterygium (Fleshy Tissue That Grows Over The Cornea) And Transplant With Tissue From The Upper Eyelid.
| Key Fact | Detail |
|---|---|
| Service Type | Surgery Surgical Procedures on the Eye and Ocular Adnexa |
| Common Place of Service | 24 - Ambulatory Surgical Center 22 - On Campus Outpatient Hospital |
| Common Modifiers | None RT - Right side of body LT - Left side of body |
| Complexity Level | Moderate |
| Medicare Fee Schedule | View Medicare rates for 65426 |
| Medicaid Fee Schedule | View Medicaid rates for 65426 |
National average reimbursement for CPT 65426 by major payers:
$792.13
$836.31
$902.57
$770.47
Compare published rates across providers.
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CPT 65426
5 of 25 sample ratesHigher to lower in this preview
Aurora Surgery Centers, LLC, Aurora Pleasant Prairie Ambulatory Surgery Center
Aurora Surgery Centers LLC
$7,810.00Published rateSummit Atlantic Surgery Center LLC
$1,875.00Published rateNorthern Ec LLC
$1,268.00Published rateOlney Endoscopy Center
$1,100.00Published ratePuget Sound Gastroenterology, PLLC, Evergreen Endoscopy Center
Puget Sound Gastroenterology, P.S.
$610.00Published rate
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See a sample payer proposalCPT 65426 vs. Other Surgical Procedures on the Eye and Ocular Adnexa Codes
The CPT 65426 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 65426 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 65426. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 65426 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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