CPT code 68130: Conjunctival excision, adjacent sclera included2026 Medicare rate & RVUs in Missouri
Report this operation when an ophthalmologist removes a conjunctival lesion together with adjacent sclera, rather than excising conjunctiva alone or destroying the lesion.
Medicare pays $502.34–$536.48 for 68130 in the office in Missouri, from Rest of Missouri to Metropolitan St. Louis, MO. Which amount applies depends on the service address.
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
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On this page 9 sections
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.
Where 68130 pays more and less in Missouri
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
3 payment localities
$502.34 to $536.48
| Payment locality | Office | Facility |
|---|---|---|
| Metropolitan Kansas City, MO | $531.27 | $346.54 |
| Metropolitan St. Louis, MO | $536.48 | $349.19 |
| Rest of Missouri | $502.34 | $332.76 |
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
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.
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
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 090 | Major surgery: the day before, the day of, and 90 days after are 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) | 1 | Not paid (statutory restriction). |
| Co-surgeons (62) | 0 | Not permitted. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 0 | Physician service: no professional/technical split. |
| Split (54/55/56) | 0.10/0.70/0.20 | Share 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.
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).
68130 compared with similar codes
Compare codes · National
5 codes, side by side
How to choose
- 68100Conjunctival biopsyDiagnostic tissue sampling
- 68100 describes conjunctival biopsy for tissue sampling. 68130 describes excision of a lesion together with adjacent sclera.
- 68110Conjunctival excisionLesion under 1 cm
- 68110 is for excision of a conjunctival lesion under 1 cm without the adjacent-sclera feature. Use 68130 when adjacent sclera is excised.
- 68115Conjunctival excisionLesion larger than 1 cm
- 68115 is for excision of a conjunctival lesion over 1 cm without the adjacent-sclera feature. Use 68130 when adjacent sclera is excised.
- 68135Lesion destructionConjunctiva
- 68135 describes destruction of a conjunctival lesion. 68130 is used when the lesion and adjacent sclera are surgically excised.
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
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