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CPT code 65125: Ocular implant revision, with graft2026 Medicare rate & RVUs in Queens, NY

Revision of an existing orbital implant with graft material to address implant-related problems in an anophthalmic socket, performed by an ophthalmic surgeon.

CMS RVU26DEffective Oct 1, 2026One payment locality

In Queens, NY, Medicare pays $528.10 for 65125 in the office and $297.94 when it’s performed in a hospital or facility.

$528.10Office (non-facility)
$297.94Hospital or facility
+15.9%vs the national office rate ($455.59)

Check a contract rate as a % of Medicare · 65125 nationwide

Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.

We’ll open 65125 for the payment locality that covers the ZIP.

On this page 11 sections
  1. Rate in Queens, NY
  2. What 65125 covers
  3. Compared with other areas
  4. Rate map
  5. How it’s calculated
  6. Payment rules
  7. Related codes
  8. Rate history
  9. Where it applies
  10. Billing questions
  11. Sources

What 65125 covers

This service revises an orbital implant already present in an anophthalmic socket, using a graft as part of the reconstruction. An ophthalmic or oculoplastic surgeon may correct an implant-related problem such as exposure or poor fit. The operation addresses the existing implant rather than placing a new implant during eye removal, and is typically performed in an operating-room setting.

Report 65125 when the operative work revises the existing implant and includes grafting. The operative report should identify the implant problem, the revision performed, and the graft used. The code has a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. For bilateral reporting with modifier 50, CMS pays 150%. When multiple procedures occur in the same session, the highest-valued procedure is paid in full and the others at 50%. Assistant-at-surgery payment is restricted; co-surgeon payment requires supporting documentation, and team surgery is not permitted.

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.

How Queens, NY compares for 65125

Across 109 of 109 payment localities, the office rate for 65125 runs from $403.50 in Arkansas to $614.02 in San Benito County, CA. Queens, NY pays $528.10. The RVUs are the same everywhere; the geographic indexes change the dollars.

65125 in Queens, NY vs other payment areas
  1. Queens, NY · this page$528.10
  2. Manhattan, NY · New York$522.49−$5.61
  3. NYC suburbs and Long Island, NY · New York$533.95+$5.85
  4. Poughkeepsie and northern NYC suburbs, NY · New York$494.50−$33.60
  5. Rest of New York · New York$436.07−$92.03
  6. Los Angeles, CA · California$519.50−$8.60
  7. Washington, DC area · District of Columbia$522.93−$5.17

Other areas in New York first, then benchmark localities. Bars start at $0.

Every other payment area

65125 in every other Medicare payment locality
Payment localityOfficeFacility
Miami, FLFlorida$482.32$279.61
Chicago, ILIllinois$468.85$273.15
AlaskaAlaska$527.26$319.87
AlabamaAlabama$409.38$238.99
ArkansasArkansas$403.50$236.23
ArizonaArizona$443.82$255.13
Bakersfield, CACalifornia$487.05$273.63
Chico, CACalifornia$486.23$272.81

65125 rates by state

Office rate range in each state. Select a state to see its payment localities.

MEWIVTNHMTNDMNMINYMARIWAIDWYSDIAILINOHPANJCTORNVUTCONEMOKYWVVAMDDECAAZNMKSOKARTNNCSCDCTXLAMSALGAFLAKHI

Explore a state

Local rates. Clear comparisons.

Hover or focus a tile to see its rate range. Select it to open the state’s fee schedule.

$403.50

$550.13

Color shows the midpoint of each state’s locality range.

View every state and territory as a table
65125 office rate range by state
State / territoryOffice rate rangeLocalities
AK$527.261
AL$409.381
AR$403.501
AZ$443.821
CA$486.23–$614.0229
CO$476.841
CT$485.711
DC$522.931
DE$451.191
FL$444.80–$482.323
GA$420.40–$463.042
GU$498.751
HI$498.751
IA$421.591
ID$423.931
IL$430.65–$471.984
IN$426.431
KS$418.741
KY$417.061
LA$416.06–$436.622
MA$473.65–$525.132
MD$460.06–$522.933
ME$425.18–$449.442
MI$427.03–$449.392
MN$459.591
MO$408.36–$439.253
MS$406.051
MT$455.571
NC$429.751
ND$450.631
NE$424.161
NH$468.511
NJ$492.00–$517.382
NM$428.991
NV$454.531
NY$436.07–$533.955
OH$426.021
OK$417.271
OR$451.75–$492.972
PA$427.19–$473.092
PR$459.211
RI$467.951
SC$428.441
SD$450.041
TN$420.721
TX$424.33–$474.618
UT$434.301
VA$447.34–$522.932
VI$459.211
VT$448.061
WA$473.03–$536.722
WI$435.501
WV$414.561
WY$453.421

See 65125 in every payment locality

How the 65125 rate is calculated

Each of 65125’s three RVUs is multiplied by a geographic index (GPCI) for the payment locality, added up, and multiplied by the conversion factor. Drag the indexes or enter a ZIP to see what moves the rate.

How the rate is built · 65125

RVUs × geographic indexes × conversion factor

Office or facility?

Work3.19

3.19 RVUs× 1.000 GPCI

Practice expense10.20

10.20 RVUs× 1.000 GPCI

Malpractice0.25

0.25 RVUs× 1.000 GPCI

Adjusted RVUs

13.6400

Conversion factor

$33.4009

Medicare rate

$455.59

Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.

The exact Queens, NY inputs and CMS source lines

PPRRVU2026_Oct_nonQPP.csv

7,296

Code
65125
Physician work
3.19
Practice expense
10.20
Malpractice
0.25

GPCI2026.csv

81

Locality
Queens, NY
Physician work
1.064
Practice expense
1.182
Malpractice
1.442
Office calculation for 65125 in Queens, NY
ComponentRVULocality factorAdjusted
Physician work3.19× 1.0643.3942
Practice expense10.20× 1.18212.0564
Malpractice0.25× 1.4420.3605
Total RVUs15.8111
Conversion factor× 33.4009

Office rate, Queens, NY$528.10

Office: (3.19 × 1.064 + 10.2 × 1.182 + 0.25 × 1.442) × $33.4009 = $528.10

Facility: (3.19 × 1.064 + 4.37 × 1.182 + 0.25 × 1.442) × $33.4009 = $297.94

Open 65125 in the RVU calculator

Payment rules and modifiers for 65125

65125 has a 90-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 65125

Ocular implant revision, with graft

RuleCMS valueWhat it means
Global period090Major surgery: the day before, the day of, and 90 days after are included.
Multiple procedures2Standard reduction: highest-valued procedure at 100%, others at 50%.
Bilateral (modifier 50)1Bilateral with modifier 50 pays 150% of the fee schedule amount.
Assistant at surgery (80/81/82/AS)1Not paid (statutory restriction).
Co-surgeons (62)1Permitted with supporting documentation.
Team surgery (66)0Not permitted.
Professional/technical0Physician service: no professional/technical split.
Split (54/55/56)0.10/0.70/0.20Share of the payment for pre-op, the procedure itself, and post-op care.

Global surgery period · 65125

Ocular implant revision, with graft

90-day global period ends

Dec 30, 2026

Covers Sep 30, 2026 through Dec 30, 2026 (92 days, including the day before surgery).

Visit on Oct 31, 2026

Day 30 of the 90-day post-op period: related follow-up care is included in the surgical payment.

  • 24Unrelated E/M visit by the same physician
  • 79Unrelated procedure (starts its own global period)
  • 58Staged, more extensive, or therapy procedure that was planned
  • 78Unplanned return to the operating room for a related complication
SurgeryVisit
Sep 23, 2026Jan 10, 2027

Pre-op dayGlobal period

What modifiers do to the payment

Modifier 50 · payment effect

With and without the modifier

65125 without 50 · national office

$455.59

Ocular implant revision, with graft

65125-50 · Bilateral: 150%

$683.39

Both sides on one line with modifier 50 are paid at 150% of the fee schedule amount (subject to multiple-procedure rules with other procedures).

When to use modifier 50

Codes related to 65125

Related codes aren’t interchangeable: bill the code that matches the service performed.

Codes related to 65125
CodeHow it relatesOffice range, Queens, NY
Same family
65150Ocular implant revision, with graftAnother ocular implant revision code; distinguish the reported procedure and whether grafting is performed.No office rate
Used instead
65155Ocular implant, reinsertionUsed for reinsertion of an ocular implant rather than revision with grafting.No office rate
65175Ocular implant removal, implant removal aloneRemoval of an ocular implant is reported when the implant is removed rather than revised.No office rate
65130Ocular implant insertion, extraocular muscles attachedDescribes insertion of a new implant with muscles attached, not revision of an existing implant.No office rate
65135Ocular implant, extraocular muscles attachedDescribes insertion of a new implant with muscles not attached, rather than implant revision.No office rate

How 65125 has changed in Queens, NY

65125 · Office / nonfacility

$528.10

Effective 2026-10-01

The base rate is $21.73 higher than on 2025-10-01, moving from $506.37 to $528.10 (4.3%).

It is unchanged from the immediately preceding available release, effective 2026-07-01.

Base rate by release · bars start at $0 · select a bar to compare

One bar per available release, ordered by effective date. Missing rates remain gaps. These comparisons hold the code, setting and locality identifiers constant; they do not isolate which policy or input caused a change.

What changed, release by release

  1. January 1, 2026

    RVU26A

    $506.37changed to$528.10

    • Conversion factor 32.3465 changed to 33.4009
    • Work RVU 3.27 changed to 3.19
    • Practice expense RVU 9.88 changed to 10.20
    • Work GPCI 1.065 changed to 1.064
    • Practice expense GPCI 1.195 changed to 1.182
    • Malpractice GPCI 1.462 changed to 1.442

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    $529.46changed to$506.37

    • Conversion factor 33.2875 changed to 32.3465
    • Practice expense RVU 10.09 changed to 9.88

    Held through RVU25B, RVU25C, RVU25D.

  3. March 9, 2024

    RVU24AR

    $520.82changed to$529.46

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $548.21changed to$520.82

    • Conversion factor 33.8872 changed to 32.7442
    • Practice expense RVU 10.06 changed to 10.09
    • Work GPCI 1.061 changed to 1.065
    • Practice expense GPCI 1.212 changed to 1.195
    • Malpractice GPCI 2.061 changed to 1.462

  5. January 1, 2023

    RVU23A

    $566.64changed to$548.21

    • Conversion factor 34.6062 changed to 33.8872
    • Practice expense RVU 9.98 changed to 10.06
    • Work GPCI 1.056 changed to 1.061
    • Practice expense GPCI 1.228 changed to 1.212
    • Malpractice GPCI 2.661 changed to 2.061

    Held through RVU23B, RVU23C, RVU23D.

  6. January 1, 2022

    RVU22A

    $579.47changed to$566.64

    • Conversion factor 34.8931 changed to 34.6062
    • Practice expense RVU 10.17 changed to 9.98

    Held through RVU22B, RVU22C, RVU22D.

  7. January 1, 2021

    RVU21A

    $559.55changed to$579.47

    • Conversion factor 36.0896 changed to 34.8931
    • Practice expense RVU 9.44 changed to 10.17
    • Work GPCI 1.054 changed to 1.056
    • Practice expense GPCI 1.214 changed to 1.228
    • Malpractice GPCI 2.391 changed to 2.661

    Held through RVU21B, RVU21C, RVU21D.

  8. January 1, 2020

    RVU20A

    $554.03changed to$559.55

    • Conversion factor 36.0391 changed to 36.0896
    • Practice expense RVU 9.52 changed to 9.44
    • Malpractice RVU 0.24 changed to 0.25
    • Work GPCI 1.052 changed to 1.054
    • Practice expense GPCI 1.200 changed to 1.214
    • Malpractice GPCI 2.121 changed to 2.391

    Held through RVU20B, RVU20C, RVU20D.

  9. January 1, 2019

    RVU19A

    $555.15changed to$554.03

    • Conversion factor 35.9996 changed to 36.0391
    • Practice expense RVU 9.56 changed to 9.52

    Held through RVU19B, RVU19C, RVU19D.

  10. January 1, 2018

    RVU18AR1

    $542.83changed to$555.15

    • Conversion factor 35.8887 changed to 35.9996
    • Practice expense RVU 9.20 changed to 9.56
    • Malpractice RVU 0.30 changed to 0.24
    • Malpractice GPCI 2.151 changed to 2.121

    Held through RVU18B, RVU18C, RVU18D.

  11. January 1, 2017

    RVU17A

    $546.50changed to$542.83

    • Conversion factor 35.8043 changed to 35.8887
    • Practice expense RVU 9.37 changed to 9.20
    • Malpractice RVU 0.27 changed to 0.30
    • Practice expense GPCI 1.199 changed to 1.200
    • Malpractice GPCI 2.181 changed to 2.151

    Held through RVU17B, RVU17C, RVU17D.

  12. January 1, 2016

    RVU16A

    $546.55changed to$546.50

    • Conversion factor 35.9335 changed to 35.8043
    • Practice expense RVU 9.38 changed to 9.37
    • Malpractice RVU 0.24 changed to 0.27

    Held through RVU16B, RVU16C, RVU16D.

  13. July 1, 2015

    RVU15C

    $543.83changed to$546.55

    • Conversion factor 35.7547 changed to 35.9335

    Held through RVU15D.

  14. January 1, 2015

    RVU15A

    $563.58changed to$543.83

    • Conversion factor 35.8228 changed to 35.7547
    • Practice expense RVU 9.32 changed to 9.38
    • Malpractice RVU 0.61 changed to 0.24
    • Work GPCI 1.057 changed to 1.052
    • Practice expense GPCI 1.197 changed to 1.199
    • Malpractice GPCI 1.836 changed to 2.181

    Held through RVU15B.

  15. January 1, 2014

    RVU14A

    $570.20changed to$563.58

    • Conversion factor 34.0230 changed to 35.8228
    • Practice expense RVU 10.32 changed to 9.32
    • Malpractice RVU 0.64 changed to 0.61
    • Work GPCI 1.062 changed to 1.057
    • Practice expense GPCI 1.195 changed to 1.197
    • Malpractice GPCI 1.491 changed to 1.836

    Held through RVU14B, RVU14C, RVU14D.

  16. January 1, 2013

    RVU13AR

    Earliest loaded release: $570.20

    Held through RVU13B, RVU13C, RVU13D.

Rates in every CMS release
Effective fromOfficeFacilityCMS release
2026-10-01$528.10$297.94RVU26D
2026-07-01$528.10$297.94RVU26C
2026-04-01$528.10$297.94RVU26B
2026-01-01$528.10$297.94RVU26A
2025-10-01$506.37$328.56RVU25D
2025-07-01$506.37$328.56RVU25C
2025-04-01$506.37$328.56RVU25B
2025-01-01$506.37$328.56RVU25A
2024-10-01$529.46$337.72RVU24D
2024-07-01$529.46$337.72RVU24C
2024-04-01$529.46$337.72RVU24B
2024-03-09$529.46$337.72RVU24AR
2024-01-01$520.82$332.21RVU24A
2023-10-01$548.21$346.14RVU23D
2023-07-01$548.21$346.14RVU23C
2023-04-01$548.21$346.14RVU23B
2023-01-01$548.21$346.14RVU23A
2022-10-01$566.64$353.73RVU22D
2022-07-01$566.64$353.73RVU22C
2022-04-01$566.64$353.73RVU22B
2022-01-01$566.64$353.73RVU22A
2021-10-01$579.47$355.80RVU21D
2021-07-01$579.47$355.80RVU21C
2021-04-01$579.47$355.80RVU21B
2021-01-01$579.47$355.80RVU21A
2020-10-01$559.55$353.63RVU20D
2020-07-01$559.55$353.63RVU20C
2020-04-01$559.55$353.63RVU20B
2020-01-01$559.55$353.63RVU20A
2019-10-01$554.03$350.34RVU19D
2019-07-01$554.03$350.34RVU19C
2019-04-01$554.03$350.34RVU19B
2019-01-01$554.03$350.34RVU19A
2018-10-01$555.15$351.25RVU18D
2018-07-01$555.15$351.25RVU18C
2018-04-01$555.15$351.25RVU18B
2018-01-01$555.15$351.25RVU18AR1
2017-10-01$542.83$345.58RVU17D
2017-07-01$542.83$345.58RVU17C
2017-04-01$542.83$345.58RVU17B
2017-01-01$542.83$345.58RVU17A
2016-10-01$546.50$347.74RVU16D
2016-07-01$546.50$347.74RVU16C
2016-04-01$546.50$347.74RVU16B
2016-01-01$546.50$347.74RVU16A
2015-10-01$546.55$347.07RVU15D
2015-07-01$546.55$347.07RVU15C
2015-04-01$543.83$345.34RVU15B
2015-01-01$543.83$345.34RVU15A
2014-10-01$563.58$368.05RVU14D
2014-07-01$563.58$368.05RVU14C
2014-04-01$563.58$368.05RVU14B
2014-01-01$563.58$368.05RVU14A
2013-10-01$570.20$362.44RVU13D
2013-07-01$570.20$362.44RVU13C
2013-04-01$570.20$362.44RVU13B
2013-01-01$570.20$362.44RVU13AR

Price 65125 for an earlier date of service

Where the Queens, NY rate applies

Queens, NY is a Medicare payment area, not a city. Our Census mapping connects it to 1 cities and communities in New York. Some span more than one payment area; confirm with the service ZIP.

Browse all communities in New York

65125 billing questions

How does 65125 differ from 65150?

65125 identifies implant revision with grafting. Choose based on the procedure documented; 65150 is another implant-revision code for a different circumstance.

Should 65125 be used for a newly placed implant?

No. It describes revision of an implant already present. Codes such as 65130 or 65135 describe insertion rather than revision.

What documentation supports 65125?

The operative report should establish the existing implant, the problem being corrected, the revision performed, and use of graft material.

How is bilateral 65125 reported?

Use modifier 50 for a bilateral procedure. CMS pays bilateral reporting at 150%.

What postoperative care is included?

The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care.

Can an assistant or co-surgeon be paid?

Assistant-at-surgery payment is subject to a statutory restriction. 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 indexes and the conversion factor. Services without a published rate are labeled, never given a made-up amount. Amounts are Medicare allowed amounts before claim adjustments: not a patient’s bill or a commercial rate.

CMS RVU26D · effective Oct 1, 2026 through the day before Jan 1, 2027

Show the CMS file lines behind this rate
RVUs for 65125PPRRVU2026_Oct_nonQPP.csv, line 7,296 (RVU26D)
Geographic factors for Queens, NYGPCI2026.csv, line 81 (RVU26D)

Open CMS sourceHow we calculate rates

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