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See a sample rate comparisonCPT 67420 Fee Schedule
Last Verified: October 2026
Healthcare providers use this code to document and receive reimbursement for visits that address high-level medical decision-making, often including multiple diagnoses or prescription management.
Surgery On The Eye Socket, Surgery On The Eye Socket To Remove A Portion Of Bone. The Procedure May Include Removing A Sample Of Tissue For Testing (Biopsy) Or Removing Abnormal Tissue.
| Key Fact | Detail |
|---|---|
| Service Type | Surgery Surgical Procedures on the Eye and Ocular Adnexa |
| Common Place of Service | 22 - On Campus Outpatient Hospital 24 - Ambulatory Surgical Center |
| Common Modifiers | None LT - Left side of body RT - Right side of body |
| Complexity Level | High |
| Medicare Fee Schedule | View Medicare rates for 67420 |
| Medicaid Fee Schedule | View Medicaid rates for 67420 |
National average reimbursement for CPT 67420 by major payers:
$2,079.14
$2,135.32
$2,354.92
$2,733.12
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CPT 67420
5 of 25 sample ratesHigher to lower in this preview
Los Robles Surgicenter, LLC, Los Robles Surgicenter
Los Robles Surgicenter LLC
$7,210.00Published rateMountain West Surgical Center, LLC
Mountain West Surgical Center LLC
$2,681.00Published rateEvergreen Eye Center, PLLC, Evergreen Eye Surgery Center
Evergreen Eye Center, Inc. P.S.
$1,750.00Published rateTrinity Development, LLC, South Alabama Outpatient Services
Trinity Development LLC
$1,089.00Published rateWinter Haven-Sebring Fl Ophthalmology Asc LLC, Eye Surgery & Laser Center Of Sebring
$575.00Published rate
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See a sample payer proposalCPT 67420 vs. Other Surgical Procedures on the Eye and Ocular Adnexa Codes
The CPT 67420 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 67420 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 |
|---|---|---|
| 67405-CPT | High | Orbitotomy W/O Bone Flap (Frntal Or Transconjunctival Approa);, Orbitotomy Without Bone Flap (Frontal Or Transconjunctival Approach); |
| 67415-CPT | Low | Fine Needle Aspiration Orbital Contents |
| 67420-CPT | High | Surgery On The Eye Socket, Surgery On The Eye Socket To Remove A Portion Of Bone. The Procedure May Include Removing A Sample Of Tissue For Testing (Biopsy) Or Removing Abnormal Tissue. |
| 67430-CPT | High | Orbitotomy With Bone Flap Or W, Orbitotomy With Bone Flap Or Window Lateral Approach (Egkroenlein) With Removal Of Foreign Body Orbitotomy With Bone Flap Or Window Lateral Approach (Eg |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 67420. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 67420 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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