Billing code 66130: Scleral lesion excisionMedicare rate & RVUs

Medicare pays $706.43 for 66130 nationally in the office and $476.63 in a hospital or facility. Local office rates run $635.63–$915.30.

Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.

What 66130 covers

An ophthalmologist uses this service to remove an abnormal growth arising from the sclera, the eye’s outer supporting coat. A scleral cyst is a representative example. The surgeon exposes the lesion through the overlying conjunctiva and removes it; conjunctival closure or advancement may be part of the operative approach. The procedure is generally performed in a surgical setting, with the site of service determined by the clinical circumstances.

Report the code when the operative documentation identifies the lesion as scleral and describes its removal. Documentation should distinguish the lesion’s origin from a growth confined to the conjunctiva and describe the surgical work performed. CMS assigns a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. When multiple procedures occur in the same session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% multiple-procedure reduction. Bilateral reporting with modifier 50 is paid at 150%. Assistant-at-surgery payment requires documented medical necessity; 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 66130 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

66130 rates by state

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

How the 66130 rate is calculated

Each of 66130’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.

Payment rules and modifiers for 66130

66130 has a 90-day global period: related visits in that window are included in the surgery payment.

What modifiers do to the payment

When to use modifier 50

66130 compared with similar codes

How to choose

68100Conjunctival biopsy

This code is for removing a scleral lesion. 68100 describes a conjunctival biopsy, which samples conjunctival tissue rather than excising a scleral lesion.

68110Conjunctival excision

Choose based on the lesion’s site: this code is for a lesion arising from the sclera, while 68110 is for a conjunctival lesion up to 1 cm.

68115Conjunctival excision

This code addresses a scleral lesion. 68115 is used for excision of a conjunctival lesion over 1 cm.

Codes related to 66130

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

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

Open CMS sourceHow we calculate rates