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CPT code 68130: Conjunctival excision, adjacent sclera included2026 Medicare rate & RVUs in Idaho

Report this operation when an ophthalmologist removes a conjunctival lesion together with adjacent sclera, rather than excising conjunctiva alone or destroying the lesion.

CMS RVU26DEffective Oct 1, 2026One payment locality206 Medicare services in 2024

In Idaho, Medicare pays $517.41 for 68130 in the office and $336.41 when it’s performed in a hospital or facility.

$517.41Office (non-facility)
$336.41Hospital or facility
−6.7%vs the national office rate ($554.45)

Check a contract rate as a % of Medicare · 68130 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 68130 for the payment locality that covers the ZIP.

On this page 11 sections
  1. Rate in Idaho
  2. What 68130 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 68130 covers

An ophthalmologist removes a conjunctival lesion along with adjacent sclera when the lesion involves or requires excision of that underlying tissue. This is an ocular surface operation, commonly performed for a lesion that cannot be adequately removed by excising conjunctiva alone. The operative report should identify the lesion and site and describe removal of the adjacent sclera.

Choose this code based on the tissue removed, not lesion diameter: the defining feature is excision of adjacent sclera. Conjunctival excisions without adjacent sclera are distinguished by lesion size in nearby codes, while destruction uses a different code. CMS assigns a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. In a same-session multiple-procedure case, the highest-valued procedure is paid in full and other procedures at 50%. Bilateral reporting with modifier 50 is paid at 150%. Assistant-at-surgery payment is statutorily restricted; 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 Idaho compares for 68130

Across 109 of 109 payment localities, the office rate for 68130 runs from $495.09 in Arkansas to $732.31 in San Benito County, CA. Idaho pays $517.41. The RVUs are the same everywhere; the geographic indexes change the dollars.

68130 in Idaho vs other payment areas
  1. Idaho · this page$517.41
  2. Los Angeles, CA · California$625.41+$108.00
  3. Washington, DC area · District of Columbia$631.70+$114.29
  4. Miami, FL · Florida$590.26+$72.85
  5. Chicago, IL · Illinois$574.79+$57.38
  6. Manhattan, NY · New York$633.67+$116.26
  7. Alaska · Alaska$655.84+$138.43

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

Every other payment area

68130 in every other Medicare payment locality
Payment localityOfficeFacility
AlabamaAlabama$501.77$329.63
ArkansasArkansas$495.09$326.09
ArizonaArizona$540.90$350.27
Bakersfield, CACalifornia$588.39$372.78
Chico, CACalifornia$587.09$371.47
El Centro, CACalifornia$587.15$371.54
Fresno, CACalifornia$587.09$371.47
Hanford, CACalifornia$587.09$371.47

68130 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.

$495.09

$659.70

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

View every state and territory as a table
68130 office rate range by state
State / territoryOffice rate rangeLocalities
AK$655.841
AL$501.771
AR$495.091
AZ$540.901
CA$587.09–$732.3129
CO$577.531
CT$589.461
DC$631.701
DE$549.431
FL$544.67–$590.263
GA$516.51–$563.642
GU$600.221
HI$600.221
IA$514.521
ID$517.411
IL$529.34–$576.064
IN$520.211
KS$511.821
KY$511.681
LA$510.76–$534.142
MA$574.28–$632.562
MD$559.52–$631.703
ME$519.40–$546.152
MI$523.55–$550.492
MN$555.931
MO$502.34–$536.483
MS$498.831
MT$554.431
NC$524.501
ND$546.521
NE$517.261
NH$568.161
NJ$596.90–$625.842
NM$526.011
NV$552.601
NY$531.73–$647.425
OH$521.931
OK$511.341
OR$548.99–$595.332
PA$522.96–$575.402
PR$558.381
RI$568.541
SC$523.941
SD$545.581
TN$514.141
TX$519.75–$575.028
UT$530.591
VA$544.15–$631.702
VI$558.381
VT$544.101
WA$573.30–$645.462
WI$529.461
WV$511.081
WY$550.981

See 68130 in every payment locality

How the 68130 rate is calculated

Each of 68130’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 · 68130

RVUs × geographic indexes × conversion factor

Office or facility?

Work4.97

4.97 RVUs× 1.000 GPCI

Practice expense11.23

11.23 RVUs× 1.000 GPCI

Malpractice0.40

0.40 RVUs× 1.000 GPCI

Adjusted RVUs

16.6000

Conversion factor

$33.4009

Medicare rate

$554.45

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

The exact Idaho inputs and CMS source lines

PPRRVU2026_Oct_nonQPP.csv

7,538

Code
68130
Physician work
4.97
Practice expense
11.23
Malpractice
0.40

GPCI2026.csv

47

Locality
Idaho
Physician work
1.000
Practice expense
0.920
Malpractice
0.473
Office calculation for 68130 in Idaho
ComponentRVULocality factorAdjusted
Physician work4.97× 1.0004.9700
Practice expense11.23× 0.92010.3316
Malpractice0.40× 0.4730.1892
Total RVUs15.4908
Conversion factor× 33.4009

Office rate, Idaho$517.41

Office: (4.97 × 1 + 11.23 × 0.92 + 0.4 × 0.473) × $33.4009 = $517.41

Facility: (4.97 × 1 + 5.34 × 0.92 + 0.4 × 0.473) × $33.4009 = $336.41

Open 68130 in the RVU calculator

Payment rules and modifiers for 68130

68130 has a 90-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 68130

Conjunctival excision, adjacent sclera included

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)0Not permitted.
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 · 68130

Conjunctival excision, adjacent sclera included

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

68130 without 50 · national office

$554.45

Conjunctival excision, adjacent sclera included

68130-50 · Bilateral: 150%

$831.68

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 68130

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

Codes related to 68130
CodeHow it relatesOffice range, Idaho
Used instead
68100Conjunctival biopsy, diagnostic tissue samplingBiopsy is for sampling a conjunctival lesion rather than excision with adjacent sclera.$167.21
68135Lesion destruction, conjunctivaDestroys a conjunctival lesion instead of excising it with adjacent sclera.$149.56
Same family
68110Conjunctival excision, lesion under 1 cmConjunctival lesion excision without adjacent sclera, for lesions under 1 cm.$221.12
68115Conjunctival excision, lesion larger than 1 cmConjunctival lesion excision without adjacent sclera, for lesions over 1 cm.$307.97

How 68130 has changed in Idaho

68130 · Office / nonfacility

$517.41

Effective 2026-10-01

The base rate is $28.98 higher than on 2025-10-01, moving from $488.43 to $517.41 (5.9%).

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

    $488.43changed to$517.41

    • Conversion factor 32.3465 changed to 33.4009
    • Work RVU 5.10 changed to 4.97
    • Practice expense RVU 10.81 changed to 11.23
    • Practice expense GPCI 0.908 changed to 0.920
    • Malpractice GPCI 0.461 changed to 0.473

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    $508.98changed to$488.43

    • Conversion factor 33.2875 changed to 32.3465
    • Practice expense RVU 11.02 changed to 10.81

    Held through RVU25B, RVU25C, RVU25D.

  3. March 9, 2024

    RVU24AR

    $500.68changed to$508.98

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $509.23changed to$500.68

    • Conversion factor 33.8872 changed to 32.7442
    • Practice expense RVU 10.93 changed to 11.02
    • Malpractice RVU 0.38 changed to 0.40
    • Practice expense GPCI 0.893 changed to 0.908
    • Malpractice GPCI 0.439 changed to 0.461

  5. January 1, 2023

    RVU23A

    $510.49changed to$509.23

    • Conversion factor 34.6062 changed to 33.8872
    • Practice expense RVU 10.82 changed to 10.93
    • Malpractice RVU 0.39 changed to 0.38
    • Practice expense GPCI 0.877 changed to 0.893
    • Malpractice GPCI 0.416 changed to 0.439

    Held through RVU23B, RVU23C, RVU23D.

  6. January 1, 2022

    RVU22A

    $515.95changed to$510.49

    • Conversion factor 34.8931 changed to 34.6062
    • Practice expense RVU 10.86 changed to 10.82

    Held through RVU22B, RVU22C, RVU22D.

  7. January 1, 2021

    RVU21A

    $512.58changed to$515.95

    • Conversion factor 36.0896 changed to 34.8931
    • Practice expense RVU 10.03 changed to 10.86
    • Malpractice RVU 0.38 changed to 0.39
    • Practice expense GPCI 0.890 changed to 0.877
    • Malpractice GPCI 0.464 changed to 0.416

    Held through RVU21B, RVU21C, RVU21D.

  8. January 1, 2020

    RVU20A

    $516.02changed to$512.58

    • Conversion factor 36.0391 changed to 36.0896
    • Practice expense RVU 10.01 changed to 10.03
    • Malpractice RVU 0.37 changed to 0.38
    • Practice expense GPCI 0.902 changed to 0.890
    • Malpractice GPCI 0.512 changed to 0.464

    Held through RVU20B, RVU20C, RVU20D.

  9. January 1, 2019

    RVU19A

    $511.89changed to$516.02

    • Conversion factor 35.9996 changed to 36.0391
    • Practice expense RVU 9.90 changed to 10.01

    Held through RVU19B, RVU19C, RVU19D.

  10. January 1, 2018

    RVU18AR1

    $504.40changed to$511.89

    • Conversion factor 35.8887 changed to 35.9996
    • Practice expense RVU 9.74 changed to 9.90
    • Practice expense GPCI 0.900 changed to 0.902
    • Malpractice GPCI 0.510 changed to 0.512

    Held through RVU18B, RVU18C, RVU18D.

  11. January 1, 2017

    RVU17A

    $502.17changed to$504.40

    • Conversion factor 35.8043 changed to 35.8887
    • Practice expense RVU 9.73 changed to 9.74
    • Practice expense GPCI 0.898 changed to 0.900
    • Malpractice GPCI 0.508 changed to 0.510

    Held through RVU17B, RVU17C, RVU17D.

  12. January 1, 2016

    RVU16A

    $503.48changed to$502.17

    • Conversion factor 35.9335 changed to 35.8043
    • Practice expense RVU 9.72 changed to 9.73
    • Malpractice RVU 0.36 changed to 0.37

    Held through RVU16B, RVU16C, RVU16D.

  13. July 1, 2015

    RVU15C

    $500.97changed to$503.48

    • Conversion factor 35.7547 changed to 35.9335

    Held through RVU15D.

  14. January 1, 2015

    RVU15A

    $500.29changed to$500.97

    • Conversion factor 35.8228 changed to 35.7547
    • Practice expense RVU 9.69 changed to 9.72
    • Malpractice RVU 0.33 changed to 0.36
    • Practice expense GPCI 0.896 changed to 0.898
    • Malpractice GPCI 0.556 changed to 0.508

    Held through RVU15B.

  15. January 1, 2014

    RVU14A

    $504.94changed to$500.29

    • Conversion factor 34.0230 changed to 35.8228
    • Practice expense RVU 10.66 changed to 9.69
    • Malpractice RVU 0.35 changed to 0.33
    • Practice expense GPCI 0.894 changed to 0.896
    • Malpractice GPCI 0.603 changed to 0.556

    Held through RVU14B, RVU14C, RVU14D.

  16. January 1, 2013

    RVU13AR

    Earliest loaded release: $504.94

    Held through RVU13B, RVU13C, RVU13D.

Rates in every CMS release
Effective fromOfficeFacilityCMS release
2026-10-01$517.41$336.41RVU26D
2026-07-01$517.41$336.41RVU26C
2026-04-01$517.41$336.41RVU26B
2026-01-01$517.41$336.41RVU26A
2025-10-01$488.43$370.65RVU25D
2025-07-01$488.43$370.65RVU25C
2025-04-01$488.43$370.65RVU25B
2025-01-01$488.43$370.65RVU25A
2024-10-01$508.98$381.43RVU24D
2024-07-01$508.98$381.43RVU24C
2024-04-01$508.98$381.43RVU24B
2024-03-09$508.98$381.43RVU24AR
2024-01-01$500.68$375.21RVU24A
2023-10-01$509.23$378.81RVU23D
2023-07-01$509.23$378.81RVU23C
2023-04-01$509.23$378.81RVU23B
2023-01-01$509.23$378.81RVU23A
2022-10-01$510.49$377.56RVU22D
2022-07-01$510.49$377.56RVU22C
2022-04-01$510.49$377.56RVU22B
2022-01-01$510.49$377.56RVU22A
2021-10-01$515.95$379.46RVU21D
2021-07-01$515.95$379.46RVU21C
2021-04-01$515.95$379.46RVU21B
2021-01-01$515.95$379.46RVU21A
2020-10-01$512.58$388.28RVU20D
2020-07-01$512.58$388.28RVU20C
2020-04-01$512.58$388.28RVU20B
2020-01-01$512.58$388.28RVU20A
2019-10-01$516.02$394.12RVU19D
2019-07-01$516.02$394.12RVU19C
2019-04-01$516.02$394.12RVU19B
2019-01-01$516.02$394.12RVU19A
2018-10-01$511.89$394.66RVU18D
2018-07-01$511.89$394.66RVU18C
2018-04-01$511.89$394.66RVU18B
2018-01-01$511.89$394.66RVU18AR1
2017-10-01$504.40$390.39RVU17D
2017-07-01$504.40$390.39RVU17C
2017-04-01$504.40$390.39RVU17B
2017-01-01$504.40$390.39RVU17A
2016-10-01$502.17$389.00RVU16D
2016-07-01$502.17$389.00RVU16C
2016-04-01$502.17$389.00RVU16B
2016-01-01$502.17$389.00RVU16A
2015-10-01$503.48$389.25RVU15D
2015-07-01$503.48$389.25RVU15C
2015-04-01$500.97$387.31RVU15B
2015-01-01$500.97$387.31RVU15A
2014-10-01$500.29$388.27RVU14D
2014-07-01$500.29$388.27RVU14C
2014-04-01$500.29$388.27RVU14B
2014-01-01$500.29$388.27RVU14A
2013-10-01$504.94$386.31RVU13D
2013-07-01$504.94$386.31RVU13C
2013-04-01$504.94$386.31RVU13B
2013-01-01$504.94$386.31RVU13AR

Price 68130 for an earlier date of service

Where the Idaho rate applies

Idaho is a Medicare payment area, not a city. Our Census mapping connects it to 235 cities and communities in Idaho. Some span more than one payment area; confirm with the service ZIP.

  • Aberdeen
  • Acequia
  • Albion
  • American Falls
  • Ammon
  • Arbon Valley
  • Arco
  • Arimo

Browse all communities in Idaho

68130 billing questions

When should 68130 be chosen over 68110 or 68115?

Use 68130 when adjacent sclera is excised with the conjunctival lesion. The size-based codes describe conjunctival lesion excision without that scleral component.

What operative documentation supports 68130?

Document the lesion's site and the removal of adjacent sclera, along with the operative work performed. The scleral excision distinguishes this service from conjunctival excision alone.

Can modifier 50 be used for bilateral excision?

CMS identifies this as a bilateral procedure; reporting with modifier 50 is paid 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.

How does CMS treat other procedures performed in the same session?

The highest-valued procedure is paid in full, and the other procedures are paid at 50%. Assistant-at-surgery payment is statutorily 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 68130PPRRVU2026_Oct_nonQPP.csv, line 7,538 (RVU26D)
Geographic factors for IdahoGPCI2026.csv, line 47 (RVU26D)

Open CMS sourceHow we calculate rates

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