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Billing code 66225: Scleral repairMedicare rate & RVUs

Reports surgical repair of a scleral staphyloma using graft material to reinforce or reconstruct the weakened area of the eye wall.

CMS RVU26DEffective Oct 1, 2026109 payment localities49 Medicare services in 2024

Medicare pays $793.27 for 66225 nationally in a facility.

Medicare rate · 66225

Scleral repair

Swap in your local Medicare rate.

Work RVUs
12.31
Total RVUs
23.75
Global days
090

National rate · 2026

$793.27

Facility setting, before claim adjustments.

See every locality for 66225 → · 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 66225 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 66225 covers

An ophthalmic surgeon uses graft material to repair a scleral staphyloma, an abnormal outward bulging of weakened sclera. The graft reinforces or reconstructs the affected area; the specific material and technique depend on the operative findings. This is a major eye operation generally performed in a surgical setting, rather than a minor office repair.

Report this code when the operative documentation supports repair of a scleral staphyloma and use of a graft. The record should identify the affected eye, the staphyloma, the repair performed, and the graft used. CMS assigns a 90-day global period, including the day-before preoperative visit and related postoperative care during the following 90 days. For bilateral procedures, modifier 50 is paid at 150%. When multiple procedures occur in one session, the highest-valued procedure is paid in full and others at 50%. An assistant at surgery is not paid; 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 66225 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

66225 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$735.19
Alaska*Unavailable$1,006.52
ArizonaUnavailable$777.65
ArkansasUnavailable$727.90
AtlantaUnavailable$806.80
AustinUnavailable$810.51
BakersfieldUnavailable$821.50
Baltimore/Surr. CntysUnavailable$833.22
BeaumontUnavailable$759.52
BrazoriaUnavailable$786.07

66225 rates by state

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

MEWIVTNHMTNDMNMINYMARIWAIDWYSDIAILINOHPANJCTORNVUTCONEMOKYWVVAMDDECAAZNMKSOKARTNNCSCDCTXLAMSALGAFLAKHI

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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
66225 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 66225 rate is calculated

Each of 66225’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 · 66225

RVUs × geographic indexes × conversion factor

Swap in your local Medicare rate.

Work 12.31Practice expense 10.44Malpractice 1.00

23.7500 adjusted RVUs×$33.4009 conversion factor=$793.27

All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.

Payment rules and modifiers for 66225

66225 has a 90-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 66225

Scleral repair

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 · 66225

Scleral repair

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.

  • 24 Unrelated E/M visit by the same physician
  • 79 Unrelated procedure (starts its own global period)
  • 58 Staged, more extensive, or therapy procedure that was planned
  • 78 Unplanned 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

66225 without 50 · national facility

$793.27

Scleral repair

66225-50 · Bilateral: 150%

$1,189.91

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

66225 compared with similar codes

Compare codes

66225 vs 66250 vs 67255: national Medicare rates

Swap in your local Medicare rate.

  • 66225
    Scleral repair · 12.31 wRVU
    —
  • 66250
    Eye wound repair · 6.92 wRVU
    $751.52
  • 67255
    Scleral reinforcement · 8.17 wRVU
    —

How to choose

66250Eye wound repair
66250 addresses revision or repair of an operative wound of the anterior segment, such as a leaking fistula. Use 66225 for repair of a scleral staphyloma with a graft.
67255Scleral reinforcement
67255 describes scleral reinforcement with a graft for an indication other than repair of a scleral staphyloma. The diagnosis and operative purpose distinguish it from 66225.

Codes related to 66225

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

Codes related to 66225
CodeHow it relatesNational office range
Used instead
66250Eye wound repairUsed for repair of an anterior-segment operative wound, rather than a scleral staphyloma.$671.83–$990.31
67255Scleral reinforcementScleral reinforcement with a graft for a different indication than staphyloma repair.No office rate

66225 billing questions

When should 66225 be chosen instead of 66220?

Use 66225 when the scleral staphyloma repair includes a graft. The corresponding repair without a graft is reported with 66220.

What documentation supports reporting 66225?

Document the scleral staphyloma, the eye treated, the repair performed, and the graft used. The operative note should make clear that the graft was part of the staphyloma repair.

Does the 90-day global period include routine postoperative care?

Yes. CMS includes the day-before preoperative visit and 90 days of related postoperative care in the global period.

How is bilateral repair reported?

CMS identifies this as a bilateral procedure; modifier 50 is paid at 150%. The documentation should support repair of both eyes.

Can an assistant or co-surgeon be reported?

CMS does not pay an assistant at surgery for this code. 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 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 66225PPRRVU2026_Oct_nonQPP.csv, line 7,375 (RVU26D)

Open CMS sourceHow we calculate rates

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