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Billing code 65130: Ocular implant insertionMedicare rate & RVUs

Reports insertion of an ocular implant with extraocular muscles attached, typically when placing an implant in an anophthalmic socket.

CMS RVU26DEffective Oct 1, 2026109 payment localities

Medicare pays $761.54 for 65130 nationally in a facility.

Medicare rate · 65130

Ocular implant insertion

Work RVUs
8.21
Total RVUs
22.80
Global days
090

National rate · 2026

$761.54

Facility setting, before claim adjustments.

See every locality for 65130 →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
  1. Medicare rate
  2. What 65130 covers
  3. By payment locality
  4. Rate map
  5. How it’s calculated
  6. Payment rules
  7. Similar codes
  8. Related codes
  9. Billing questions
  10. Sources

What 65130 covers

An ophthalmic or oculoplastic surgeon inserts an implant into an anophthalmic socket and attaches the extraocular muscles to the implant. This is distinct from removing the eye and placing an implant during the same operation. The service is generally performed in an operating room when a patient needs implant placement in a socket after a prior eye removal or other circumstance leaving the socket without an implant.

Select this code when the operative report supports both implant insertion and attachment of the muscles; use the sibling code when the muscles are not attached. Document the socket and implant work, the muscle attachment, and whether another procedure was performed in the same session. Medicare includes the day-before preoperative visit and 90 days of related postoperative care in the global period. For multiple procedures in one session, the highest-valued procedure is paid in full and other procedures are reduced. Modifier 50 bilateral reporting is paid at 150%. 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 65130 pays more and less

The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.

109 of 109 payment localities

65130 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$693.92
Alaska*Unavailable$919.17
ArizonaUnavailable$743.98
ArkansasUnavailable$685.36
AtlantaUnavailable$774.18
AustinUnavailable$786.62
BakersfieldUnavailable$802.96
Baltimore/Surr. CntysUnavailable$805.06
BeaumontUnavailable$718.09
BrazoriaUnavailable$754.77

65130 rates by state

Office rate range in each state. Select a state to see its payment localities.

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Local rates. Clear comparisons.

Hover or focus a tile to see its rate range. Select it to open the state’s fee schedule.

View every state and territory as a table
65130 office rate range by state
State / territoryOffice rate rangeLocalities
AKNo published base rate1
ALNo published base rate1
ARNo published base rate1
AZNo published base rate1
CANo published base rate29
CONo published base rate1
CTNo published base rate1
DCNo published base rate1
DENo published base rate1
FLNo published base rate3
GANo published base rate2
GUNo published base rate1
HINo published base rate1
IANo published base rate1
IDNo published base rate1
ILNo published base rate4
INNo published base rate1
KSNo published base rate1
KYNo published base rate1
LANo published base rate2
MANo published base rate2
MDNo published base rate3
MENo published base rate2
MINo published base rate2
MNNo published base rate1
MONo published base rate3
MSNo published base rate1
MTNo published base rate1
NCNo published base rate1
NDNo published base rate1
NENo published base rate1
NHNo published base rate1
NJNo published base rate2
NMNo published base rate1
NVNo published base rate1
NYNo published base rate5
OHNo published base rate1
OKNo published base rate1
ORNo published base rate2
PANo published base rate2
PRNo published base rate1
RINo published base rate1
SCNo published base rate1
SDNo published base rate1
TNNo published base rate1
TXNo published base rate8
UTNo published base rate1
VANo published base rate2
VINo published base rate1
VTNo published base rate1
WANo published base rate2
WINo published base rate1
WVNo published base rate1
WYNo published base rate1

How the 65130 rate is calculated

Each of 65130’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 · 65130

RVUs × geographic indexes × conversion factor

Work8.21

8.21 RVUs× 1.000 GPCI

Practice expense13.94

13.94 RVUs× 1.000 GPCI

Malpractice0.65

0.65 RVUs× 1.000 GPCI

Adjusted RVUs

22.8000

Conversion factor

$33.4009

Medicare rate

$761.54

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

Payment rules and modifiers for 65130

65130 has a 90-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 65130

Ocular implant insertion

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)1Permitted with supporting documentation.
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 · 65130

Ocular implant insertion

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

65130 without 50 · national facility

$761.54

Ocular implant insertion

65130-50 · Bilateral: 150%

$1,142.31

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

65130 compared with similar codes

Compare codes · National

5 codes, side by side

  • 65130

    Ocular implant insertion8.21 wRVU

    Not priced

  • 65135

    Ocular implant8.39 wRVU

    Not priced

  • 65103

    Eye removal8.62 wRVU

    Not priced

  • 65140

    Ocular implant9.22 wRVU

    Not priced

  • 65125

    Ocular implant revision3.19 wRVU

    $455.59

How to choose

65135Ocular implant
Both report ocular implant insertion. Choose 65130 when the extraocular muscles are attached to the implant; choose 65135 when they are not.
65103Eye removal
65103 combines enucleation with implant placement. 65130 reports implant insertion into a socket without the eye-removal service.
65140Ocular implant
65140 concerns attachment of extraocular muscles to an implant. 65130 includes insertion of the implant with muscle attachment.
65125Ocular implant revision
65125 is for revision of an existing ocular implant, not insertion of an implant into the socket.

Codes related to 65130

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

Codes related to 65130
CodeHow it relatesNational office range
Same family
65135Ocular implantSibling insertion code for an implant placed without attaching the extraocular muscles.No office rate
Used instead
65103Eye removalConsider when implant placement is part of enucleation rather than a separate socket insertion.No office rate
65140Ocular implantCovers muscle attachment to an implant when the service is attachment rather than implant insertion.No office rate

65130 billing questions

How does this differ from 65135?

Use 65130 when the extraocular muscles are attached to the inserted implant. Use 65135 when the implant is inserted without attaching the muscles.

Is this the code for implant placement during enucleation?

No. When the eye is removed and an implant is placed during that operation, consider the enucleation code that includes implant placement, such as 65103 when its requirements are met.

What documentation supports reporting 65130?

The operative report should establish that an ocular implant was inserted and that the extraocular muscles were attached to it. Document the socket and any other procedures performed in the same session.

Can the surgeon report routine postoperative visits separately?

Related postoperative care during the 90-day global period is included. The day-before preoperative visit is also included.

How are bilateral procedures and assistant surgeons handled?

CMS pays bilateral reporting with modifier 50 at 150%. Assistant-at-surgery payment is restricted; co-surgeon payment requires supporting documentation, and team surgery is not permitted.

What happens when another procedure is performed in the same session?

Under the standard multiple procedure reduction, the highest-valued procedure is paid in full and the other procedures are paid at 50%.

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 65130PPRRVU2026_Oct_nonQPP.csv, line 7,297 (RVU26D)

Open CMS sourceHow we calculate rates

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