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CPT code 68100: Conjunctival biopsy, diagnostic tissue sampling2026 Medicare rate & RVUs in Alabama

Reports sampling of conjunctival tissue for pathologic evaluation, commonly when an ocular surface abnormality requires diagnosis rather than complete removal.

CMS RVU26DEffective Oct 1, 2026One payment locality1.3K Medicare services in 2024

In Alabama, Medicare pays $161.61 for 68100 in the office and $75.39 when it’s performed in a hospital or facility.

$161.61Office (non-facility)
$75.39Hospital or facility
−10.1%vs the national office rate ($179.70)

Check a contract rate as a % of Medicare · 68100 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 68100 for the payment locality that covers the ZIP.

On this page 11 sections
  1. Rate in Alabama
  2. What 68100 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 68100 covers

Code 68100 represents removal of a conjunctival tissue sample for diagnostic examination rather than treatment by complete lesion removal. Ophthalmologists commonly use it for a suspicious conjunctival growth, pigmented area, or persistent abnormal tissue when histology is needed. The biopsy may be performed in an office or facility, and the specimen is submitted for pathologic evaluation.

Choose this service when tissue is sampled to establish a diagnosis; do not select an excision code solely because the sampled area has a particular size. The procedure note should identify the eye and conjunctival site, the tissue sampled, and the diagnostic purpose; document both eyes when bilateral. CMS assigns a 0-day global period, so same-day preoperative and postoperative care is included. In a session with multiple procedures, the highest-valued procedure is paid in full and the others at 50%. Bilateral reporting with modifier 50 is paid at 150%. Medicare does not pay assistant-at-surgery services; 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 Alabama compares for 68100

Across 109 of 109 payment localities, the office rate for 68100 runs from $159.31 in Arkansas to $241.16 in San Benito County, CA. Alabama pays $161.61. The RVUs are the same everywhere; the geographic indexes change the dollars.

68100 in Alabama vs other payment areas
  1. Alabama · this page$161.61
  2. Los Angeles, CA · California$204.41+$42.80
  3. Washington, DC area · District of Columbia$205.98+$44.37
  4. Miami, FL · Florida$190.72+$29.11
  5. Chicago, IL · Illinois$185.42+$23.81
  6. Manhattan, NY · New York$206.04+$44.43
  7. Alaska · Alaska$208.67+$47.06

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

Every other payment area

68100 in every other Medicare payment locality
Payment localityOfficeFacility
ArkansasArkansas$159.31$74.67
ArizonaArizona$175.08$79.60
Bakersfield, CACalifornia$191.76$83.77
Chico, CACalifornia$191.41$83.42
El Centro, CACalifornia$191.43$83.43
Fresno, CACalifornia$191.41$83.42
Hanford, CACalifornia$191.41$83.42
Madera, CACalifornia$191.41$83.42

68100 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.

$159.31

$216.29

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

View every state and territory as a table
68100 office rate range by state
State / territoryOffice rate rangeLocalities
AK$208.671
AL$161.611
AR$159.311
AZ$175.081
CA$191.41–$241.1629
CO$187.871
CT$191.511
DC$205.981
DE$177.961
FL$175.74–$190.723
GA$166.15–$182.682
GU$196.221
HI$196.221
IA$166.271
ID$167.211
IL$170.29–$186.404
IN$168.181
KS$165.211
KY$164.741
LA$164.37–$172.412
MA$186.65–$206.702
MD$181.42–$205.983
ME$167.75–$177.152
MI$168.69–$177.602
MN$180.941
MO$161.39–$173.373
MS$160.401
MT$179.691
NC$169.531
ND$177.511
NE$167.251
NH$184.651
NJ$193.95–$203.832
NM$169.481
NV$179.221
NY$172.01–$210.605
OH$168.251
OK$164.761
OR$178.08–$194.112
PA$168.68–$186.612
PR$181.091
RI$184.491
SC$169.121
SD$177.261
TN$165.991
TX$167.56–$187.028
UT$171.411
VA$176.37–$205.982
VI$181.091
VT$176.561
WA$186.38–$211.182
WI$171.611
WV$164.001
WY$178.741

See 68100 in every payment locality

How the 68100 rate is calculated

Each of 68100’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 · 68100

RVUs × geographic indexes × conversion factor

Office or facility?

Work1.32

1.32 RVUs× 1.000 GPCI

Practice expense3.95

3.95 RVUs× 1.000 GPCI

Malpractice0.11

0.11 RVUs× 1.000 GPCI

Adjusted RVUs

5.3800

Conversion factor

$33.4009

Medicare rate

$179.70

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

The exact Alabama inputs and CMS source lines

PPRRVU2026_Oct_nonQPP.csv

7,535

Code
68100
Physician work
1.32
Practice expense
3.95
Malpractice
0.11

GPCI2026.csv

4

Locality
Alabama
Physician work
1.000
Practice expense
0.875
Malpractice
0.566
Office calculation for 68100 in Alabama
ComponentRVULocality factorAdjusted
Physician work1.32× 1.0001.3200
Practice expense3.95× 0.8753.4563
Malpractice0.11× 0.5660.0623
Total RVUs4.8385
Conversion factor× 33.4009

Office rate, Alabama$161.61

Office: (1.32 × 1 + 3.95 × 0.875 + 0.11 × 0.566) × $33.4009 = $161.61

Facility: (1.32 × 1 + 1 × 0.875 + 0.11 × 0.566) × $33.4009 = $75.39

Open 68100 in the RVU calculator

Payment rules and modifiers for 68100

The CMS indicators that decide how 68100 is paid alongside other services.

CMS payment indicators · 68100

Conjunctival biopsy, diagnostic tissue sampling

RuleCMS valueWhat it means
Global period000Same-day global: pre- and post-op care on the day of the procedure is 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)0Not permitted.
Team surgery (66)0Not permitted.
Professional/technical0Physician service: no professional/technical split.

What modifiers do to the payment

Modifier 50 · payment effect

With and without the modifier

68100 without 50 · national office

$179.70

Conjunctival biopsy, diagnostic tissue sampling

68100-50 · Bilateral: 150%

$269.55

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 68100

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

Codes related to 68100
CodeHow it relatesOffice range, Alabama
Often billed with
88305Tissue pathology exam, level IV specimenMay represent pathologic examination of the submitted conjunctival specimen.$64.22
Used instead
68110Conjunctival excision, lesion under 1 cmUsed for excision of a conjunctival lesion smaller than 1 cm.$213.74
68115Conjunctival excision, lesion larger than 1 cmUsed for excision of a conjunctival lesion larger than 1 cm.$297.48
68135Lesion destruction, conjunctivaDescribes destruction of a conjunctival lesion rather than tissue sampling.$145.83
68130Conjunctival excision, adjacent sclera includedDescribes excision of a conjunctival lesion adjacent to the sclera.$501.77

How 68100 has changed in Alabama

68100 · Office / nonfacility

$161.61

Effective 2026-10-01

The base rate is $8.90 higher than on 2025-10-01, moving from $152.71 to $161.61 (5.8%).

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

    $152.71changed to$161.61

    • Conversion factor 32.3465 changed to 33.4009
    • Work RVU 1.35 changed to 1.32
    • Practice expense RVU 3.80 changed to 3.95
    • Malpractice RVU 0.12 changed to 0.11
    • Practice expense GPCI 0.869 changed to 0.875
    • Malpractice GPCI 0.575 changed to 0.566

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    $160.15changed to$152.71

    • Conversion factor 33.2875 changed to 32.3465
    • Practice expense RVU 3.91 changed to 3.80
    • Malpractice RVU 0.11 changed to 0.12

    Held through RVU25B, RVU25C, RVU25D.

  3. March 9, 2024

    RVU24AR

    $157.53changed to$160.15

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $165.17changed to$157.53

    • Conversion factor 33.8872 changed to 32.7442
    • Practice expense RVU 3.92 changed to 3.91
    • Practice expense GPCI 0.878 changed to 0.869
    • Malpractice GPCI 0.748 changed to 0.575

  5. January 1, 2023

    RVU23A

    $170.69changed to$165.17

    • Conversion factor 34.6062 changed to 33.8872
    • Practice expense GPCI 0.888 changed to 0.878
    • Malpractice GPCI 0.921 changed to 0.748

    Held through RVU23B, RVU23C, RVU23D.

  6. January 1, 2022

    RVU22A

    $172.10changed to$170.69

    • Conversion factor 34.8931 changed to 34.6062

    Held through RVU22B, RVU22C, RVU22D.

  7. January 1, 2021

    RVU21A

    $167.03changed to$172.10

    • Conversion factor 36.0896 changed to 34.8931
    • Practice expense RVU 3.60 changed to 3.92
    • Practice expense GPCI 0.889 changed to 0.888
    • Malpractice GPCI 0.707 changed to 0.921

    Held through RVU21B, RVU21C, RVU21D.

  8. January 1, 2020

    RVU20A

    $163.33changed to$167.03

    • Conversion factor 36.0391 changed to 36.0896
    • Practice expense RVU 3.52 changed to 3.60
    • Malpractice RVU 0.10 changed to 0.11
    • Practice expense GPCI 0.890 changed to 0.889
    • Malpractice GPCI 0.492 changed to 0.707

    Held through RVU20B, RVU20C, RVU20D.

  9. January 1, 2019

    RVU19A

    $160.27changed to$163.33

    • Conversion factor 35.9996 changed to 36.0391
    • Practice expense RVU 3.43 changed to 3.52

    Held through RVU19B, RVU19C, RVU19D.

  10. April 1, 2018

    RVU18B

    No ratechanged to$160.27

    Held through RVU18C, RVU18D.

  11. January 1, 2013

    RVU13AR

    Earliest loaded release: No rate

    Held through RVU13B, RVU13C, RVU13D, RVU14A, RVU14B, RVU14C, RVU14D, RVU15A, RVU15B, RVU15C, RVU15D, RVU16A, RVU16B, RVU16C, RVU16D, RVU17A, RVU17B, RVU17C, RVU17D, RVU18AR1.

Rates in every CMS release
Effective fromOfficeFacilityCMS release
2026-10-01$161.61$75.39RVU26D
2026-07-01$161.61$75.39RVU26C
2026-04-01$161.61$75.39RVU26B
2026-01-01$161.61$75.39RVU26A
2025-10-01$152.71$84.97RVU25D
2025-07-01$152.71$84.97RVU25C
2025-04-01$152.71$84.97RVU25B
2025-01-01$152.71$84.97RVU25A
2024-10-01$160.15$86.67RVU24D
2024-07-01$160.15$86.67RVU24C
2024-04-01$160.15$86.67RVU24B
2024-03-09$160.15$86.67RVU24AR
2024-01-01$157.53$85.26RVU24A
2023-10-01$165.17$88.40RVU23D
2023-07-01$165.17$88.40RVU23C
2023-04-01$165.17$88.40RVU23B
2023-01-01$165.17$88.40RVU23A
2022-10-01$170.69$89.87RVU22D
2022-07-01$170.69$89.87RVU22C
2022-04-01$170.69$89.87RVU22B
2022-01-01$170.69$89.87RVU22A
2021-10-01$172.10$90.61RVU21D
2021-07-01$172.10$90.61RVU21C
2021-04-01$172.10$90.61RVU21B
2021-01-01$172.10$90.61RVU21A
2020-10-01$167.03$91.95RVU20D
2020-07-01$167.03$91.95RVU20C
2020-04-01$167.03$91.95RVU20B
2020-01-01$167.03$91.95RVU20A
2019-10-01$163.33$92.12RVU19D
2019-07-01$163.33$92.12RVU19C
2019-04-01$163.33$92.12RVU19B
2019-01-01$163.33$92.12RVU19A
2018-10-01$160.27$92.98RVU18D
2018-07-01$160.27$92.98RVU18C
2018-04-01$160.27$92.98RVU18B
2018-01-01Rate data unavailableRate data unavailableRVU18AR1
2017-10-01Rate data unavailableRate data unavailableRVU17D
2017-07-01Rate data unavailableRate data unavailableRVU17C
2017-04-01Rate data unavailableRate data unavailableRVU17B
2017-01-01Rate data unavailableRate data unavailableRVU17A
2016-10-01Rate data unavailableRate data unavailableRVU16D
2016-07-01Rate data unavailableRate data unavailableRVU16C
2016-04-01Rate data unavailableRate data unavailableRVU16B
2016-01-01Rate data unavailableRate data unavailableRVU16A
2015-10-01Rate data unavailableRate data unavailableRVU15D
2015-07-01Rate data unavailableRate data unavailableRVU15C
2015-04-01Rate data unavailableRate data unavailableRVU15B
2015-01-01Rate data unavailableRate data unavailableRVU15A
2014-10-01Rate data unavailableRate data unavailableRVU14D
2014-07-01Rate data unavailableRate data unavailableRVU14C
2014-04-01Rate data unavailableRate data unavailableRVU14B
2014-01-01Rate data unavailableRate data unavailableRVU14A
2013-10-01Rate data unavailableRate data unavailableRVU13D
2013-07-01Rate data unavailableRate data unavailableRVU13C
2013-04-01Rate data unavailableRate data unavailableRVU13B
2013-01-01Rate data unavailableRate data unavailableRVU13AR

Price 68100 for an earlier date of service

Where the Alabama rate applies

Alabama is a Medicare payment area, not a city. Our Census mapping connects it to 595 cities and communities in Alabama. Some span more than one payment area; confirm with the service ZIP.

  • Abanda
  • Abbeville
  • Adamsville
  • Addison
  • Akron
  • Alabaster
  • Albertville
  • Alexander City

Browse all communities in Alabama

68100 billing questions

How does 68100 differ from 68110?

68100 represents sampling tissue to establish a diagnosis. 68110 represents excision of a conjunctival lesion smaller than 1 cm, when the service is lesion removal rather than a diagnostic sample.

Can the pathology examination be billed separately?

68100 represents obtaining the conjunctival specimen. The pathologist’s examination is a separate service and may be reported under the applicable surgical pathology code when performed.

How is a biopsy performed on both eyes reported?

Report modifier 50 when the service is bilateral and document the biopsy on each eye. CMS pays the bilateral procedure at 150%.

Is same-day preoperative or postoperative care included?

Yes. The 0-day global period includes same-day preoperative and postoperative care for the biopsy.

What happens when 68100 is performed with other procedures?

For procedures performed in the same session, CMS pays the highest-valued procedure in full and the other procedures at 50%. Assistant-at-surgery payment is restricted, and 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

Show the CMS file lines behind this rate
RVUs for 68100PPRRVU2026_Oct_nonQPP.csv, line 7,535 (RVU26D)
Geographic factors for AlabamaGPCI2026.csv, line 4 (RVU26D)

Open CMS sourceHow we calculate rates

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