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See a sample rate comparisonCPT 67430 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.
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
| Key Fact | Detail |
|---|---|
| Service Type | Surgery Surgical Procedures on the Eye and Ocular Adnexa |
| Common Place of Service | 20 - Urgent Care Facility 22 - On Campus Outpatient Hospital |
| Common Modifiers | None LT - Left side of body RT - Right side of body |
| Complexity Level | High |
| Medicare Fee Schedule | View Medicare rates for 67430 |
| Medicaid Fee Schedule | View Medicaid rates for 67430 |
National average reimbursement for CPT 67430 by major payers:
$1,716.45
$1,645.78
$1,835.75
$2,149.27
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CPT 67430
5 of 25 sample ratesHigher to lower in this preview
Hackensack Musculoskeletal Surgery Center, LLC
Hackensack Musculoskeletal Surgery Center LLC
$5,944.00Published rateBcc Chandler LLC
$2,855.00Published rateBeverly Hills Regional Surgery Center Lp
$2,200.00Published rateM-S Surgery Center LLC
Ms Surgery Center LLC
$1,484.00Published rateEyecare Surgery Center, LLC
Eyecare Surgery Center LLC
$793.00Published rate
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See a sample payer proposalCPT 67430 vs. Other Surgical Procedures on the Eye and Ocular Adnexa Codes
The CPT 67430 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 67430 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 |
|---|---|---|
| 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 |
| 67440-CPT | High | Surgery On The Eye Socket, Surgery On The Eye Socket To Remove A Portion Of Bone. The Procedure Includes Removing Fluid From The Eye And Replacing The Bone. |
| 67445-CPT | High | Surgery On The Eye Socket, Surgery On The Eye Socket To Remove One Or More Of The Four Walls Of The Eye Socket And Replace It With New Bone Or A Synthetic Equal. |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 67430. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 67430 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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