Billing code 65125: Ocular implant revisionMedicare rate & RVUs
Revision of an existing orbital implant with graft material to address implant-related problems in an anophthalmic socket, performed by an ophthalmic surgeon.
Medicare pays $455.59 for 65125 nationally in the office and $260.86 in a hospital or facility. Local office rates run $403.50–$614.02.
Medicare rate · 65125
Ocular implant revision
- Work RVUs
- 3.19
- Total RVUs
- 13.64
- Global days
- 090
National rate · 2026
$455.59
Office setting, before claim adjustments.
See every locality for 65125 →Billed by an NP, PA or therapist? →
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 10 sections
What 65125 covers
This service revises an orbital implant already present in an anophthalmic socket, using a graft as part of the reconstruction. An ophthalmic or oculoplastic surgeon may correct an implant-related problem such as exposure or poor fit. The operation addresses the existing implant rather than placing a new implant during eye removal, and is typically performed in an operating-room setting.
Report 65125 when the operative work revises the existing implant and includes grafting. The operative report should identify the implant problem, the revision performed, and the graft used. The code has a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. For bilateral reporting with modifier 50, CMS pays 150%. When multiple procedures occur in the same session, the highest-valued procedure is paid in full and the others at 50%. Assistant-at-surgery payment is restricted; co-surgeon payment requires supporting documentation, and team surgery is 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 65125 pays more and less
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
109 payment localities
$403.50 to $614.02
109 of 109 payment localities
| Payment locality | Office | Facility |
|---|---|---|
| Alabama | $409.38 | $238.99 |
| Alaska* | $527.26 | $319.87 |
| Arizona | $443.82 | $255.13 |
| Arkansas | $403.50 | $236.23 |
| Atlanta | $463.04 | $265.19 |
| Austin | $474.61 | $268.59 |
| Bakersfield | $487.05 | $273.63 |
| Baltimore/Surr. Cntys | $484.14 | $275.20 |
| Beaumont | $424.33 | $247.13 |
| Brazoria | $451.54 | $258.56 |
| Chicago | $468.85 | $273.15 |
| Chico | $486.23 | $272.81 |
| Colorado | $476.84 | $269.65 |
| Connecticut | $485.71 | $275.98 |
| Dallas | $454.00 | $260.05 |
| Dc + Md/Va Suburbs | $522.93 | $293.54 |
| Delaware | $451.19 | $258.80 |
| Detroit | $449.39 | $261.48 |
| East St. Louis | $436.80 | $257.65 |
| El Centro | $486.27 | $272.85 |
| Fort Lauderdale | $466.76 | $269.51 |
| Fort Worth | $450.70 | $258.70 |
| Fresno | $486.23 | $272.81 |
| Galveston | $452.62 | $259.26 |
| Hanford-Corcoran | $486.23 | $272.81 |
| Hawaii, Guam | $498.75 | $277.34 |
| Houston | $457.20 | $263.83 |
| Idaho | $423.93 | $244.78 |
| Indiana | $426.43 | $245.91 |
| Iowa | $421.59 | $243.42 |
| Kansas | $418.74 | $242.71 |
| Kentucky | $417.06 | $243.95 |
| Los Angeles-Long Beach-Anaheim (Los Angeles/Orange Cnty) | $519.50 | $289.13 |
| Madera | $486.23 | $272.81 |
| Manhattan | $522.49 | $296.22 |
| Merced | $486.23 | $272.81 |
| Metropolitan Boston | $525.13 | $292.63 |
| Metropolitan Kansas City | $434.61 | $251.77 |
| Metropolitan Philadelphia | $473.09 | $270.37 |
| Metropolitan St. Louis | $439.25 | $253.87 |
| Miami | $482.32 | $279.61 |
| Minnesota | $459.59 | $259.22 |
| Mississippi | $406.05 | $238.39 |
| Modesto | $486.23 | $272.81 |
| Montana** | $455.57 | $260.84 |
| Napa | $566.53 | $309.88 |
| Nebraska | $424.16 | $244.43 |
| Nevada** | $454.53 | $259.61 |
| New Hampshire | $468.51 | $265.80 |
| New Mexico | $428.99 | $250.42 |
| New Orleans | $436.62 | $253.38 |
| North Carolina | $429.75 | $248.07 |
| North Dakota** | $450.63 | $255.90 |
| Northern Nj | $517.38 | $291.50 |
| Nyc Suburbs/Long Island | $533.95 | $302.42 |
| Ohio | $426.02 | $248.23 |
| Oklahoma | $417.27 | $243.38 |
| Oxnard-Thousand Oaks-Ventura | $517.43 | $287.26 |
| Portland | $492.97 | $276.63 |
| Poughkpsie/N Nyc Suburbs | $494.50 | $281.28 |
| Puerto Rico | $459.21 | $262.34 |
| Queens | $528.10 | $297.94 |
| Redding | $486.23 | $272.81 |
| Rest Of California | $486.23 | $272.81 |
| Rest Of Florida | $444.80 | $258.64 |
| Rest Of Georgia | $420.40 | $246.70 |
| Rest Of Illinois | $430.65 | $252.86 |
| Rest Of Louisiana | $416.06 | $243.72 |
| Rest Of Maine | $425.18 | $246.03 |
| Rest Of Maryland | $460.06 | $262.99 |
| Rest Of Massachusetts | $473.65 | $268.61 |
| Rest Of Michigan | $427.03 | $249.24 |
| Rest Of Missouri | $408.36 | $240.50 |
| Rest Of New Jersey | $492.00 | $279.36 |
| Rest Of New York | $436.07 | $251.08 |
| Rest Of Oregon | $451.75 | $257.80 |
| Rest Of Pennsylvania | $427.19 | $248.43 |
| Rest Of Texas | $437.40 | $252.61 |
| Rest Of Washington | $473.03 | $267.99 |
| Rhode Island | $467.95 | $266.80 |
| Riverside-San Bernardino-Ontario | $488.98 | $275.56 |
| Sacramento-Roseville-Folsom | $511.08 | $284.61 |
| Salinas | $509.19 | $283.50 |
| San Diego-Chula Vista-Carlsbad | $521.74 | $288.84 |
| San Francisco-Oakland-Berkeley (Marin Cnty) | $600.88 | $326.31 |
| San Francisco-Oakland-Berkeley (San Francisco/San Mateo/Alameda/Contra Costa Cnty) | $600.59 | $326.03 |
| San Jose-Sunnyvale-Santa Clara (San Benito Cnty) | $614.02 | $333.22 |
| San Jose-Sunnyvale-Santa Clara (Santa Clara Cnty) | $612.86 | $332.06 |
| San Luis Obispo-Paso Robles | $500.88 | $279.09 |
| Santa Cruz-Watsonville | $527.20 | $290.61 |
| Santa Maria-Santa Barbara | $511.25 | $284.20 |
| Santa Rosa-Petaluma | $532.59 | $293.46 |
| Seattle (King Cnty) | $536.72 | $297.79 |
| South Carolina | $428.44 | $248.52 |
| South Dakota** | $450.04 | $255.32 |
| Southern Maine | $449.44 | $256.47 |
| Stockton | $486.23 | $272.81 |
| Suburban Chicago | $471.98 | $271.99 |
| Tennessee | $420.72 | $243.71 |
| Utah | $434.30 | $251.25 |
| Vallejo | $566.12 | $309.47 |
| Vermont | $448.06 | $255.28 |
| Virgin Islands | $459.21 | $262.34 |
| Virginia | $447.34 | $255.92 |
| Visalia | $486.23 | $272.81 |
| West Virginia | $414.56 | $245.34 |
| Wisconsin | $435.50 | $248.95 |
| Wyoming** | $453.42 | $258.69 |
| Yuba City | $486.23 | $272.81 |
65125 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.
$403.50
$550.13
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 | $527.26 | 1 |
| AL | $409.38 | 1 |
| AR | $403.50 | 1 |
| AZ | $443.82 | 1 |
| CA | $486.23–$614.02 | 29 |
| CO | $476.84 | 1 |
| CT | $485.71 | 1 |
| DC | $522.93 | 1 |
| DE | $451.19 | 1 |
| FL | $444.80–$482.32 | 3 |
| GA | $420.40–$463.04 | 2 |
| GU | $498.75 | 1 |
| HI | $498.75 | 1 |
| IA | $421.59 | 1 |
| ID | $423.93 | 1 |
| IL | $430.65–$471.98 | 4 |
| IN | $426.43 | 1 |
| KS | $418.74 | 1 |
| KY | $417.06 | 1 |
| LA | $416.06–$436.62 | 2 |
| MA | $473.65–$525.13 | 2 |
| MD | $460.06–$522.93 | 3 |
| ME | $425.18–$449.44 | 2 |
| MI | $427.03–$449.39 | 2 |
| MN | $459.59 | 1 |
| MO | $408.36–$439.25 | 3 |
| MS | $406.05 | 1 |
| MT | $455.57 | 1 |
| NC | $429.75 | 1 |
| ND | $450.63 | 1 |
| NE | $424.16 | 1 |
| NH | $468.51 | 1 |
| NJ | $492.00–$517.38 | 2 |
| NM | $428.99 | 1 |
| NV | $454.53 | 1 |
| NY | $436.07–$533.95 | 5 |
| OH | $426.02 | 1 |
| OK | $417.27 | 1 |
| OR | $451.75–$492.97 | 2 |
| PA | $427.19–$473.09 | 2 |
| PR | $459.21 | 1 |
| RI | $467.95 | 1 |
| SC | $428.44 | 1 |
| SD | $450.04 | 1 |
| TN | $420.72 | 1 |
| TX | $424.33–$474.61 | 8 |
| UT | $434.30 | 1 |
| VA | $447.34–$522.93 | 2 |
| VI | $459.21 | 1 |
| VT | $448.06 | 1 |
| WA | $473.03–$536.72 | 2 |
| WI | $435.50 | 1 |
| WV | $414.56 | 1 |
| WY | $453.42 | 1 |
How the 65125 rate is calculated
Each of 65125’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 · 65125
RVUs × geographic indexes × conversion factor
Work3.19
3.19 RVUs× 1.000 GPCI
Practice expense10.20
10.20 RVUs× 1.000 GPCI
Malpractice0.25
0.25 RVUs× 1.000 GPCI
Adjusted RVUs
13.6400
Conversion factor
$33.4009
Medicare rate
$455.59
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 65125
65125 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 65125
Ocular implant revision
| 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) | 1 | Permitted with supporting documentation. |
| 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 · 65125
Ocular implant revision
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
65125 without 50 · national office
$455.59
Ocular implant revision
65125-50 · Bilateral: 150%
$683.39
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).
65125 compared with similar codes
Compare codes · National
5 codes, side by side
How to choose
- 65150Ocular implant revision
- Both codes involve ocular implant revision. Use 65125 for revision with grafting; select 65150 when the documented revision fits that code's circumstance instead.
- 65155Ocular implant
- 65155 describes reinsertion of an ocular implant. 65125 describes revision of an implant with grafting, not simply putting an implant back in place.
- 65175Ocular implant removal
- 65175 is for removal of the ocular implant. 65125 applies when the implant is revised with grafting rather than removed.
- 65130Ocular implant insertion
- 65130 describes insertion of a new ocular implant with muscles attached. 65125 revises an implant that is already present and includes grafting.
65125 billing questions
How does 65125 differ from 65150?
65125 identifies implant revision with grafting. Choose based on the procedure documented; 65150 is another implant-revision code for a different circumstance.
Should 65125 be used for a newly placed implant?
No. It describes revision of an implant already present. Codes such as 65130 or 65135 describe insertion rather than revision.
What documentation supports 65125?
The operative report should establish the existing implant, the problem being corrected, the revision performed, and use of graft material.
How is bilateral 65125 reported?
Use modifier 50 for a bilateral procedure. CMS pays bilateral reporting 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.
Can an assistant or co-surgeon be paid?
Assistant-at-surgery payment is subject to a statutory restriction. Co-surgeon payment requires supporting documentation, and team surgery is 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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