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

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 New Mexico, Medicare pays $169.48 for 68100 in the office and $79.13 when it’s performed in a hospital or facility.

$169.48Office (non-facility)
$79.13Hospital or facility
−5.7%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 New Mexico
  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 New Mexico 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. New Mexico pays $169.48. The RVUs are the same everywhere; the geographic indexes change the dollars.

68100 in New Mexico vs other payment areas
  1. New Mexico · this page$169.48
  2. Los Angeles, CA · California$204.41+$34.93
  3. Washington, DC area · District of Columbia$205.98+$36.50
  4. Miami, FL · Florida$190.72+$21.24
  5. Chicago, IL · Illinois$185.42+$15.94
  6. Manhattan, NY · New York$206.04+$36.56
  7. Alaska · Alaska$208.67+$39.19

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

Every other payment area

68100 in every other Medicare payment locality
Payment localityOfficeFacility
AlabamaAlabama$161.61$75.39
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

68100 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.

$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 New Mexico 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

77

Locality
New Mexico
Physician work
1.000
Practice expense
0.917
Malpractice
1.201
Office calculation for 68100 in New Mexico
ComponentRVULocality factorAdjusted
Physician work1.32× 1.0001.3200
Practice expense3.95× 0.9173.6222
Malpractice0.11× 1.2010.1321
Total RVUs5.0743
Conversion factor× 33.4009

Office rate, New Mexico$169.48

Office: (1.32 × 1 + 3.95 × 0.917 + 0.11 × 1.201) × $33.4009 = $169.48

Facility: (1.32 × 1 + 1 × 0.917 + 0.11 × 1.201) × $33.4009 = $79.13

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

How 68100 has changed in New Mexico

68100 · Office / nonfacility

$169.48

Effective 2026-10-01

The base rate is $9.65 higher than on 2025-10-01, moving from $159.83 to $169.48 (6.0%).

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

    $159.83changed to$169.48

    • 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 0.908 changed to 0.917
    • Malpractice GPCI 1.172 changed to 1.201

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    $167.41changed to$159.83

    • 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

    $164.68changed to$167.41

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $169.92changed to$164.68

    • Conversion factor 33.8872 changed to 32.7442
    • Practice expense RVU 3.92 changed to 3.91
    • Practice expense GPCI 0.902 changed to 0.908
    • Malpractice GPCI 1.169 changed to 1.172
  5. January 1, 2023

    RVU23A

    $172.71changed to$169.92

    • Conversion factor 34.6062 changed to 33.8872
    • Practice expense GPCI 0.896 changed to 0.902
    • Malpractice GPCI 1.166 changed to 1.169

    Held through RVU23B, RVU23C, RVU23D.

  6. January 1, 2022

    RVU22A

    $174.14changed to$172.71

    • Conversion factor 34.8931 changed to 34.6062

    Held through RVU22B, RVU22C, RVU22D.

  7. January 1, 2021

    RVU21A

    $171.48changed to$174.14

    • Conversion factor 36.0896 changed to 34.8931
    • Practice expense RVU 3.60 changed to 3.92
    • Practice expense GPCI 0.908 changed to 0.896
    • Malpractice GPCI 1.207 changed to 1.166

    Held through RVU21B, RVU21C, RVU21D.

  8. January 1, 2020

    RVU20A

    $169.98changed to$171.48

    • 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 0.921 changed to 0.908
    • Malpractice GPCI 1.247 changed to 1.207

    Held through RVU20B, RVU20C, RVU20D.

  9. January 1, 2019

    RVU19A

    $166.81changed to$169.98

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

    Held through RVU19B, RVU19C, RVU19D.

  10. January 1, 2018

    RVU18AR1

    $163.05changed to$166.81

    • Conversion factor 35.8887 changed to 35.9996
    • Practice expense RVU 3.34 changed to 3.43
    • Practice expense GPCI 0.920 changed to 0.921
    • Malpractice GPCI 1.204 changed to 1.247

    Held through RVU18B, RVU18C, RVU18D.

  11. January 1, 2017

    RVU17A

    $162.39changed to$163.05

    • Conversion factor 35.8043 changed to 35.8887
    • Practice expense GPCI 0.919 changed to 0.920
    • Malpractice GPCI 1.161 changed to 1.204

    Held through RVU17B, RVU17C, RVU17D.

  12. January 1, 2016

    RVU16A

    $162.65changed to$162.39

    • Conversion factor 35.9335 changed to 35.8043
    • Practice expense RVU 3.33 changed to 3.34

    Held through RVU16B, RVU16C, RVU16D.

  13. July 1, 2015

    RVU15C

    $161.84changed to$162.65

    • Conversion factor 35.7547 changed to 35.9335

    Held through RVU15D.

  14. January 1, 2015

    RVU15A

    $164.56changed to$161.84

    • Conversion factor 35.8228 changed to 35.7547
    • Practice expense RVU 3.31 changed to 3.33
    • Malpractice RVU 0.19 changed to 0.10
    • Practice expense GPCI 0.918 changed to 0.919
    • Malpractice GPCI 1.079 changed to 1.161

    Held through RVU15B.

  15. January 1, 2014

    RVU14A

    $166.78changed to$164.56

    • Conversion factor 34.0230 changed to 35.8228
    • Practice expense RVU 3.66 changed to 3.31
    • Malpractice RVU 0.20 changed to 0.19
    • Practice expense GPCI 0.916 changed to 0.918
    • Malpractice GPCI 0.997 changed to 1.079

    Held through RVU14B, RVU14C, RVU14D.

  16. January 1, 2013

    RVU13AR

    Earliest loaded release: $166.78

    Held through RVU13B, RVU13C, RVU13D.

Rates in every CMS release
Effective fromOfficeFacilityCMS release
2026-10-01$169.48$79.13RVU26D
2026-07-01$169.48$79.13RVU26C
2026-04-01$169.48$79.13RVU26B
2026-01-01$169.48$79.13RVU26A
2025-10-01$159.83$89.04RVU25D
2025-07-01$159.83$89.04RVU25C
2025-04-01$159.83$89.04RVU25B
2025-01-01$159.83$89.04RVU25A
2024-10-01$167.41$90.64RVU24D
2024-07-01$167.41$90.64RVU24C
2024-04-01$167.41$90.64RVU24B
2024-03-09$167.41$90.64RVU24AR
2024-01-01$164.68$89.16RVU24A
2023-10-01$169.92$91.06RVU23D
2023-07-01$169.92$91.06RVU23C
2023-04-01$169.92$91.06RVU23B
2023-01-01$169.92$91.06RVU23A
2022-10-01$172.71$91.16RVU22D
2022-07-01$172.71$91.16RVU22C
2022-04-01$172.71$91.16RVU22B
2022-01-01$172.71$91.16RVU22A
2021-10-01$174.14$91.91RVU21D
2021-07-01$174.14$91.91RVU21C
2021-04-01$174.14$91.91RVU21B
2021-01-01$174.14$91.91RVU21A
2020-10-01$171.48$94.80RVU20D
2020-07-01$171.48$94.80RVU20C
2020-04-01$171.48$94.80RVU20B
2020-01-01$171.48$94.80RVU20A
2019-10-01$169.98$96.30RVU19D
2019-07-01$169.98$96.30RVU19C
2019-04-01$169.98$96.30RVU19B
2019-01-01$169.98$96.30RVU19A
2018-10-01$166.81$97.19RVU18D
2018-07-01$166.81$97.19RVU18C
2018-04-01$166.81$97.19RVU18B
2018-01-01$166.81$97.19RVU18AR1
2017-10-01$163.05$96.35RVU17D
2017-07-01$163.05$96.35RVU17C
2017-04-01$163.05$96.35RVU17B
2017-01-01$163.05$96.35RVU17A
2016-10-01$162.39$95.60RVU16D
2016-07-01$162.39$95.60RVU16C
2016-04-01$162.39$95.60RVU16B
2016-01-01$162.39$95.60RVU16A
2015-10-01$162.65$95.94RVU15D
2015-07-01$162.65$95.94RVU15C
2015-04-01$161.84$95.46RVU15B
2015-01-01$161.84$95.46RVU15A
2014-10-01$164.56$98.78RVU14D
2014-07-01$164.56$98.78RVU14C
2014-04-01$164.56$98.78RVU14B
2014-01-01$164.56$98.78RVU14A
2013-10-01$166.78$97.90RVU13D
2013-07-01$166.78$97.90RVU13C
2013-04-01$166.78$97.90RVU13B
2013-01-01$166.78$97.90RVU13AR

Price 68100 for an earlier date of service

Where the New Mexico rate applies

New Mexico is a Medicare payment area, not a city. Our Census mapping connects it to 528 cities and communities in New Mexico. Some span more than one payment area; confirm with the service ZIP.

  • Abeytas
  • Abiquiu
  • Acomita Lake
  • Adelino
  • Agua Fria
  • Alamillo
  • Alamo
  • Alamogordo

Browse all communities in New Mexico

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 New MexicoGPCI2026.csv, line 77 (RVU26D)

Open CMS sourceHow we calculate rates

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