CPT code 65778: Amniotic membrane, without sutures2026 Medicare rate & RVUs in Montana
Reports placement of an amniotic membrane on the ocular surface without sutures, often to support healing of a persistent epithelial defect or other surface injury.
In Montana, Medicare pays $1,274.24 for 65778 in the office and $35.74 when it’s performed in a hospital or facility.
Check a contract rate as a % of Medicare · 65778 nationwide
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
On this page 11 sections
What 65778 covers
An ophthalmologist places an amniotic membrane over the ocular surface without suturing it in place. The service may be used for a persistent corneal epithelial defect, a nonhealing corneal ulcer, or ocular surface damage after injury. It is commonly performed in an office or ambulatory surgical setting when the clinician determines that membrane coverage is appropriate to support surface healing.
Report this code when the membrane is placed on the ocular surface without sutures; documentation should identify the clinical indication, treated eye, and placement method. The service has a 0-day global period, so same-day preoperative and postoperative care is included. If multiple procedures are performed in the same session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% multiple-procedure reduction. For bilateral reporting with modifier 50, CMS payment is 150%. Assistant-at-surgery payment requires documentation of medical necessity; co-surgeons and team surgery are 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 Montana compares for 65778
Across 109 of 109 payment localities, the office rate for 65778 runs from $1,097.98 in Arkansas to $1,827.16 in San Benito County, CA. Montana pays $1,274.24. The RVUs are the same everywhere; the geographic indexes change the dollars.
- Montana · this page$1,274.24
- Los Angeles, CA · California$1,502.85+$228.61
- Washington, DC area · District of Columbia$1,497.58+$223.34
- Miami, FL · Florida$1,327.35+$53.11
- Chicago, IL · Illinois$1,282.39+$8.15
- Manhattan, NY · New York$1,478.55+$204.31
- Alaska · Alaska$1,368.30+$94.06
Other areas in Montana first, then benchmark localities. Bars start at $0.
Every other payment area
| Payment locality | Office | Facility |
|---|---|---|
| AlabamaAlabama | $1,117.97 | $34.28 |
| ArkansasArkansas | $1,097.98 | $34.10 |
| ArizonaArizona | $1,235.44 | $35.33 |
| Bakersfield, CACalifornia | $1,393.81 | $36.41 |
| Chico, CACalifornia | $1,393.66 | $36.26 |
| El Centro, CACalifornia | $1,393.67 | $36.26 |
| Fresno, CACalifornia | $1,393.66 | $36.26 |
| Hanford, CACalifornia | $1,393.66 | $36.26 |
| Madera, CACalifornia | $1,393.66 | $36.26 |
| Merced, CACalifornia | $1,393.66 | $36.26 |
| Modesto, CACalifornia | $1,393.66 | $36.26 |
| Napa, CACalifornia | $1,671.39 | $39.04 |
| Oxnard, CACalifornia | $1,501.19 | $37.28 |
| Redding, CACalifornia | $1,393.66 | $36.26 |
| Rest of CaliforniaCalifornia | $1,393.66 | $36.26 |
| Riverside, CACalifornia | $1,394.11 | $36.71 |
| Sacramento, CACalifornia | $1,477.63 | $37.25 |
| Salinas, CACalifornia | $1,472.51 | $37.08 |
| San Diego, CACalifornia | $1,518.58 | $37.32 |
| Marin County, CACalifornia | $1,786.79 | $40.49 |
| San Francisco, CACalifornia | $1,786.74 | $40.45 |
| San Benito County, CACalifornia | $1,827.16 | $41.23 |
| Santa Clara County, CACalifornia | $1,826.97 | $41.05 |
| San Luis Obispo, CACalifornia | $1,447.22 | $36.56 |
| Santa Cruz, CACalifornia | $1,541.99 | $37.20 |
| Santa Maria, CACalifornia | $1,481.15 | $37.05 |
| Santa Rosa, CACalifornia | $1,558.42 | $37.54 |
| Stockton, CACalifornia | $1,393.66 | $36.26 |
| Vallejo, CACalifornia | $1,671.32 | $38.97 |
| Visalia, CACalifornia | $1,393.66 | $36.26 |
| Yuba City, CACalifornia | $1,393.66 | $36.26 |
| ColoradoColorado | $1,353.99 | $36.22 |
| ConnecticutConnecticut | $1,370.98 | $37.11 |
| DelawareDelaware | $1,259.30 | $35.66 |
| Fort Lauderdale, FLFlorida | $1,291.52 | $36.91 |
| Rest of FloridaFlorida | $1,220.11 | $36.10 |
| Atlanta, GAGeorgia | $1,294.52 | $36.20 |
| Rest of GeorgiaGeorgia | $1,139.98 | $35.24 |
| Hawaii, Guam, HIHawaii | $1,444.32 | $36.14 |
| IowaIowa | $1,167.57 | $34.34 |
| IdahoIdaho | $1,173.90 | $34.47 |
| East St. Louis, ILIllinois | $1,175.96 | $36.53 |
| Rest of IllinoisIllinois | $1,166.64 | $35.88 |
| Suburban Chicago, ILIllinois | $1,309.10 | $37.15 |
| IndianaIndiana | $1,182.63 | $34.54 |
| KansasKansas | $1,154.01 | $34.40 |
| KentuckyKentucky | $1,135.88 | $34.85 |
| New Orleans, LALouisiana | $1,200.94 | $35.51 |
| Rest of LouisianaLouisiana | $1,130.95 | $34.88 |
| Metropolitan Boston, MAMassachusetts | $1,516.85 | $38.08 |
| Rest of MassachusettsMassachusetts | $1,340.42 | $36.28 |
| Baltimore area, MDMaryland | $1,365.92 | $37.01 |
| Rest of MarylandMaryland | $1,289.35 | $35.99 |
| Rest of MaineMaine | $1,174.10 | $34.67 |
| Southern Maine, MEMaine | $1,262.54 | $35.18 |
| Detroit, MIMichigan | $1,231.57 | $36.41 |
| Rest of MichiganMichigan | $1,166.06 | $35.30 |
| MinnesotaMinnesota | $1,309.42 | $35.00 |
| Metropolitan Kansas City, MOMissouri | $1,198.24 | $35.28 |
| Metropolitan St. Louis, MOMissouri | $1,214.46 | $35.40 |
| Rest of MissouriMissouri | $1,102.33 | $34.74 |
| MississippiMississippi | $1,100.77 | $34.42 |
| North CarolinaNorth Carolina | $1,190.31 | $34.79 |
| North DakotaNorth Dakota | $1,273.45 | $34.95 |
| NebraskaNebraska | $1,177.51 | $34.37 |
| New HampshireNew Hampshire | $1,325.14 | $35.86 |
| Northern New JerseyNew Jersey | $1,475.34 | $38.68 |
| Rest of New JerseyNew Jersey | $1,390.06 | $37.61 |
| New MexicoNew Mexico | $1,171.13 | $35.43 |
| NevadaNevada | $1,275.27 | $35.52 |
| NYC suburbs and Long Island, NYNew York | $1,512.55 | $39.96 |
| Poughkeepsie and northern NYC suburbs, NYNew York | $1,394.08 | $37.92 |
| Queens, NYNew York | $1,503.27 | $39.36 |
| Rest of New YorkNew York | $1,211.57 | $34.99 |
| OhioOhio | $1,165.89 | $35.14 |
| OklahomaOklahoma | $1,140.68 | $34.69 |
| Portland, OROregon | $1,412.59 | $36.61 |
| Rest of OregonOregon | $1,268.87 | $35.31 |
| Metropolitan Philadelphia, PAPennsylvania | $1,326.06 | $36.78 |
| Rest of PennsylvaniaPennsylvania | $1,172.04 | $35.09 |
| Puerto RicoPuerto Rico | $1,287.93 | $35.80 |
| Rhode IslandRhode Island | $1,315.72 | $36.35 |
| South CarolinaSouth Carolina | $1,179.38 | $35.01 |
| South DakotaSouth Dakota | $1,273.36 | $34.85 |
| TennesseeTennessee | $1,160.28 | $34.48 |
| Austin, TXTexas | $1,346.39 | $36.05 |
| Beaumont, TXTexas | $1,162.05 | $35.01 |
| Brazoria, TXTexas | $1,262.96 | $35.60 |
| Dallas, TXTexas | $1,269.32 | $35.77 |
| Fort Worth, TXTexas | $1,256.88 | $35.71 |
| Galveston, TXTexas | $1,265.52 | $35.68 |
| Houston, TXTexas | $1,266.25 | $36.41 |
| Rest of TexasTexas | $1,210.59 | $35.25 |
| UtahUtah | $1,199.38 | $35.18 |
| VirginiaVirginia | $1,252.68 | $35.23 |
| Virgin Islands, VIUnited States Virgin Islands | $1,287.93 | $35.80 |
| VermontVermont | $1,261.13 | $35.01 |
| Rest of WashingtonWashington | $1,340.29 | $36.15 |
| King County, WAWashington | $1,558.10 | $38.46 |
| WisconsinWisconsin | $1,221.01 | $34.52 |
| West VirginiaWest Virginia | $1,111.66 | $35.40 |
| WyomingWyoming | $1,273.90 | $35.39 |
65778 rates by state
Office rate range in each state. Select a state to see its payment localities.
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.
$1,097.98
$1,610.41
Color shows the midpoint of each state’s locality range.
View every state and territory as a table
| State / territory | Office rate range | Localities |
|---|---|---|
| AK | $1,368.30 | 1 |
| AL | $1,117.97 | 1 |
| AR | $1,097.98 | 1 |
| AZ | $1,235.44 | 1 |
| CA | $1,393.66–$1,827.16 | 29 |
| CO | $1,353.99 | 1 |
| CT | $1,370.98 | 1 |
| DC | $1,497.58 | 1 |
| DE | $1,259.30 | 1 |
| FL | $1,220.11–$1,327.35 | 3 |
| GA | $1,139.98–$1,294.52 | 2 |
| GU | $1,444.32 | 1 |
| HI | $1,444.32 | 1 |
| IA | $1,167.57 | 1 |
| ID | $1,173.90 | 1 |
| IL | $1,166.64–$1,309.10 | 4 |
| IN | $1,182.63 | 1 |
| KS | $1,154.01 | 1 |
| KY | $1,135.88 | 1 |
| LA | $1,130.95–$1,200.94 | 2 |
| MA | $1,340.42–$1,516.85 | 2 |
| MD | $1,289.35–$1,497.58 | 3 |
| ME | $1,174.10–$1,262.54 | 2 |
| MI | $1,166.06–$1,231.57 | 2 |
| MN | $1,309.42 | 1 |
| MO | $1,102.33–$1,214.46 | 3 |
| MS | $1,100.77 | 1 |
| MT | $1,274.24 | 1 |
| NC | $1,190.31 | 1 |
| ND | $1,273.45 | 1 |
| NE | $1,177.51 | 1 |
| NH | $1,325.14 | 1 |
| NJ | $1,390.06–$1,475.34 | 2 |
| NM | $1,171.13 | 1 |
| NV | $1,275.27 | 1 |
| NY | $1,211.57–$1,512.55 | 5 |
| OH | $1,165.89 | 1 |
| OK | $1,140.68 | 1 |
| OR | $1,268.87–$1,412.59 | 2 |
| PA | $1,172.04–$1,326.06 | 2 |
| PR | $1,287.93 | 1 |
| RI | $1,315.72 | 1 |
| SC | $1,179.38 | 1 |
| SD | $1,273.36 | 1 |
| TN | $1,160.28 | 1 |
| TX | $1,162.05–$1,346.39 | 8 |
| UT | $1,199.38 | 1 |
| VA | $1,252.68–$1,497.58 | 2 |
| VI | $1,287.93 | 1 |
| VT | $1,261.13 | 1 |
| WA | $1,340.29–$1,558.10 | 2 |
| WI | $1,221.01 | 1 |
| WV | $1,111.66 | 1 |
| WY | $1,273.90 | 1 |
How the 65778 rate is calculated
Each of 65778’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 · 65778
RVUs × geographic indexes × conversion factor
Work0.82
0.82 RVUs× 1.000 GPCI
Practice expense37.29
37.29 RVUs× 1.000 GPCI
Malpractice0.04
0.04 RVUs× 1.000 GPCI
Adjusted RVUs
38.1500
Conversion factor
$33.4009
Medicare rate
$1,274.24
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
The exact Montana inputs and CMS source lines
PPRRVU2026_Oct_nonQPP.csv
7,340
- Code
- 65778
- Physician work
- 0.82
- Practice expense
- 37.29
- Malpractice
- 0.04
GPCI2026.csv
71
- Locality
- Montana
- Physician work
- 1.000
- Practice expense
- 1.000
- Malpractice
- 0.998
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 0.82 | × 1.000 | 0.8200 |
| Practice expense | 37.29 | × 1.000 | 37.2900 |
| Malpractice | 0.04 | × 0.998 | 0.0399 |
| Total RVUs | 38.1499 | ||
| Conversion factor | × 33.4009 | ||
Office rate, Montana$1274.24
Office: (0.82 × 1 + 37.29 × 1 + 0.04 × 0.998) × $33.4009 = $1274.24
Facility: (0.82 × 1 + 0.21 × 1 + 0.04 × 0.998) × $33.4009 = $35.74
Payment rules and modifiers for 65778
The CMS indicators that decide how 65778 is paid alongside other services.
CMS payment indicators · 65778
Amniotic membrane, without sutures
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 000 | Same-day global: pre- and post-op care on the day of the procedure is included. |
| Multiple procedures | 2 | Standard reduction: highest-valued procedure at 100%, others at 50%. |
| Bilateral (modifier 50) | 1 | Bilateral with modifier 50 pays 150% of the fee schedule amount. |
| Assistant at surgery (80/81/82/AS) | 0 | Not paid without supporting documentation. |
| Co-surgeons (62) | 0 | Not permitted. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 0 | Physician service: no professional/technical split. |
What modifiers do to the payment
Modifier 50 · payment effect
With and without the modifier
65778 without 50 · national office
$1,274.24
Amniotic membrane, without sutures
65778-50 · Bilateral: 150%
$1,911.36
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).
How 65778 has changed in Montana
65778 · Office / nonfacility
$1274.24
Effective 2026-10-01
The base rate is $56.75 higher than on 2025-10-01, moving from $1217.49 to $1274.24 (4.7%).
It is unchanged from the immediately preceding available release, effective 2026-07-01.
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
January 1, 2026
RVU26A
$1217.49changed to$1274.24
- Conversion factor 32.3465 changed to 33.4009
- Work RVU 0.84 changed to 0.82
- Practice expense RVU 36.76 changed to 37.29
- Malpractice GPCI 0.978 changed to 0.998
Held through RVU26B, RVU26C, RVU26D.
January 1, 2025
RVU25A
$1086.47changed to$1217.49
- Conversion factor 33.2875 changed to 32.3465
- Practice expense RVU 31.76 changed to 36.76
Held through RVU25B, RVU25C, RVU25D.
March 9, 2024
RVU24AR
$1068.74changed to$1086.47
- Conversion factor 32.7442 changed to 33.2875
Held through RVU24B, RVU24C, RVU24D.
January 1, 2024
RVU24A
$1345.63changed to$1068.74
- Conversion factor 33.8872 changed to 32.7442
- Work RVU 1.00 changed to 0.84
- Practice expense RVU 38.67 changed to 31.76
January 1, 2023
RVU23A
$1412.59changed to$1345.63
- Conversion factor 34.6062 changed to 33.8872
- Practice expense RVU 39.77 changed to 38.67
- Malpractice RVU 0.05 changed to 0.04
- Malpractice GPCI 0.977 changed to 0.978
Held through RVU23B, RVU23C, RVU23D.
January 1, 2022
RVU22A
$1494.08changed to$1412.59
- Conversion factor 34.8931 changed to 34.6062
- Practice expense RVU 41.77 changed to 39.77
Held through RVU22B, RVU22C, RVU22D.
January 1, 2021
RVU21A
$1436.91changed to$1494.08
- Conversion factor 36.0896 changed to 34.8931
- Practice expense RVU 38.75 changed to 41.77
- Malpractice GPCI 1.304 changed to 0.977
Held through RVU21B, RVU21C, RVU21D.
January 1, 2020
RVU20A
$1445.81changed to$1436.91
- Conversion factor 36.0391 changed to 36.0896
- Practice expense RVU 39.02 changed to 38.75
- Malpractice RVU 0.06 changed to 0.05
- Malpractice GPCI 1.631 changed to 1.304
Held through RVU20B, RVU20C, RVU20D.
January 1, 2019
RVU19A
$1448.91changed to$1445.81
- Conversion factor 35.9996 changed to 36.0391
- Practice expense RVU 39.15 changed to 39.02
Held through RVU19B, RVU19C, RVU19D.
January 1, 2018
RVU18AR1
$1441.14changed to$1448.91
- Conversion factor 35.8887 changed to 35.9996
- Practice expense RVU 39.07 changed to 39.15
- Malpractice GPCI 1.429 changed to 1.631
Held through RVU18B, RVU18C, RVU18D.
January 1, 2017
RVU17A
$1452.07changed to$1441.14
- Conversion factor 35.8043 changed to 35.8887
- Practice expense RVU 39.47 changed to 39.07
- Malpractice RVU 0.07 changed to 0.06
- Malpractice GPCI 1.226 changed to 1.429
Held through RVU17B, RVU17C, RVU17D.
January 1, 2016
RVU16A
$1399.10changed to$1452.07
- Conversion factor 35.9335 changed to 35.8043
- Work RVU 1.19 changed to 1.00
- Practice expense RVU 37.66 changed to 39.47
Held through RVU16B, RVU16C, RVU16D.
July 1, 2015
RVU15C
$1392.14changed to$1399.10
- Conversion factor 35.7547 changed to 35.9335
Held through RVU15D.
January 1, 2015
RVU15A
$1389.85changed to$1392.14
- Conversion factor 35.8228 changed to 35.7547
- Practice expense RVU 37.41 changed to 37.66
- Malpractice RVU 0.17 changed to 0.07
- Malpractice GPCI 1.165 changed to 1.226
Held through RVU15B.
January 1, 2014
RVU14A
$1470.08changed to$1389.85
- Conversion factor 34.0230 changed to 35.8228
- Practice expense RVU 41.82 changed to 37.41
- Malpractice RVU 0.18 changed to 0.17
- Malpractice GPCI 1.103 changed to 1.165
Held through RVU14B, RVU14C, RVU14D.
January 1, 2013
RVU13AR
Earliest loaded release: $1470.08
Held through RVU13B, RVU13C, RVU13D.
| Effective from | Office | Facility | CMS release |
|---|---|---|---|
| 2026-10-01 | $1,274.24 | $35.74 | RVU26D |
| 2026-07-01 | $1,274.24 | $35.74 | RVU26C |
| 2026-04-01 | $1,274.24 | $35.74 | RVU26B |
| 2026-01-01 | $1,274.24 | $35.74 | RVU26A |
| 2025-10-01 | $1,217.49 | $42.02 | RVU25D |
| 2025-07-01 | $1,217.49 | $42.02 | RVU25C |
| 2025-04-01 | $1,217.49 | $42.02 | RVU25B |
| 2025-01-01 | $1,217.49 | $42.02 | RVU25A |
| 2024-10-01 | $1,086.47 | $43.24 | RVU24D |
| 2024-07-01 | $1,086.47 | $43.24 | RVU24C |
| 2024-04-01 | $1,086.47 | $43.24 | RVU24B |
| 2024-03-09 | $1,086.47 | $43.24 | RVU24AR |
| 2024-01-01 | $1,068.74 | $42.54 | RVU24A |
| 2023-10-01 | $1,345.63 | $52.50 | RVU23D |
| 2023-07-01 | $1,345.63 | $52.50 | RVU23C |
| 2023-04-01 | $1,345.63 | $52.50 | RVU23B |
| 2023-01-01 | $1,345.63 | $52.50 | RVU23A |
| 2022-10-01 | $1,412.59 | $53.60 | RVU22D |
| 2022-07-01 | $1,412.59 | $53.60 | RVU22C |
| 2022-04-01 | $1,412.59 | $53.60 | RVU22B |
| 2022-01-01 | $1,412.59 | $53.60 | RVU22A |
| 2021-10-01 | $1,494.08 | $54.04 | RVU21D |
| 2021-07-01 | $1,494.08 | $54.04 | RVU21C |
| 2021-04-01 | $1,494.08 | $54.04 | RVU21B |
| 2021-01-01 | $1,494.08 | $54.04 | RVU21A |
| 2020-10-01 | $1,436.91 | $56.49 | RVU20D |
| 2020-07-01 | $1,436.91 | $56.49 | RVU20C |
| 2020-04-01 | $1,436.91 | $56.49 | RVU20B |
| 2020-01-01 | $1,436.91 | $56.49 | RVU20A |
| 2019-10-01 | $1,445.81 | $58.31 | RVU19D |
| 2019-07-01 | $1,445.81 | $58.31 | RVU19C |
| 2019-04-01 | $1,445.81 | $58.31 | RVU19B |
| 2019-01-01 | $1,445.81 | $58.31 | RVU19A |
| 2018-10-01 | $1,448.91 | $58.96 | RVU18D |
| 2018-07-01 | $1,448.91 | $58.96 | RVU18C |
| 2018-04-01 | $1,448.91 | $58.96 | RVU18B |
| 2018-01-01 | $1,448.91 | $58.96 | RVU18AR1 |
| 2017-10-01 | $1,441.14 | $59.42 | RVU17D |
| 2017-07-01 | $1,441.14 | $59.42 | RVU17C |
| 2017-04-01 | $1,441.14 | $59.42 | RVU17B |
| 2017-01-01 | $1,441.14 | $59.42 | RVU17A |
| 2016-10-01 | $1,452.07 | $60.00 | RVU16D |
| 2016-07-01 | $1,452.07 | $60.00 | RVU16C |
| 2016-04-01 | $1,452.07 | $60.00 | RVU16B |
| 2016-01-01 | $1,452.07 | $60.00 | RVU16A |
| 2015-10-01 | $1,399.10 | $72.08 | RVU15D |
| 2015-07-01 | $1,399.10 | $72.08 | RVU15C |
| 2015-04-01 | $1,392.14 | $71.72 | RVU15B |
| 2015-01-01 | $1,392.14 | $71.72 | RVU15A |
| 2014-10-01 | $1,389.85 | $76.59 | RVU14D |
| 2014-07-01 | $1,389.85 | $76.59 | RVU14C |
| 2014-04-01 | $1,389.85 | $76.59 | RVU14B |
| 2014-01-01 | $1,389.85 | $76.59 | RVU14A |
| 2013-10-01 | $1,470.08 | $74.46 | RVU13D |
| 2013-07-01 | $1,470.08 | $74.46 | RVU13C |
| 2013-04-01 | $1,470.08 | $74.46 | RVU13B |
| 2013-01-01 | $1,470.08 | $74.46 | RVU13AR |
Where the Montana rate applies
Montana is a Medicare payment area, not a city. Our Census mapping connects it to 497 cities and communities in Montana. Some span more than one payment area; confirm with the service ZIP.
- Absarokee
- Acton
- Alberton
- Alder
- Alzada
- Amsterdam
- Anaconda-Deer Lodge County
- Antelope
65778 billing questions
How does this differ from 65779?
Both codes report amniotic membrane placement on the ocular surface. Use 65778 when the membrane is placed without sutures and 65779 when it is sutured.
What documentation supports 65778?
Document the ocular surface condition being treated, the eye involved, and that the amniotic membrane was placed without sutures.
Is same-day postoperative care separately included?
No. The 0-day global period includes same-day preoperative and postoperative care.
How is bilateral placement reported?
CMS lists this as a bilateral procedure; reporting modifier 50 results in payment at 150%.
What happens when another procedure is performed in the same session?
Under the standard multiple-procedure rule, the highest-valued procedure is paid in full and the other procedure is paid at 50%.
Can an assistant surgeon be paid for this service?
Assistant-at-surgery payment is allowed only when medical necessity is documented. Co-surgeons and team surgery are 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
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