No office rate
Both describe evisceration, but 65093 includes placement of an orbital implant; 65091 is for the procedure without an implant.
On this page
CMS RVU26D · Effective 2026-10-01
65091 Eye evisceration Medicare reimbursement rates in California
Reports removal of intraocular contents while preserving the scleral shell, without placing an orbital implant during the procedure. Compare 65091 office and facility rates across CMS payment localities in California.
Amounts below use the non-QP conversion factor for participating physicians. These are base physician payments before claim-level adjustments, not patient costs or total hospital charges.
What does Medicare pay for 65091 in California?
California has 29 payment localities in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the 29 payment areas shown below, using the same CMS release.
Office / nonfacility
No supported rate
Facility setting
$697.13–$860.12
29 of 29 localities have a supported rate.
Lowest: Chico
Highest: San Jose-Sunnyvale-Santa Clara (San Benito Cnty)
A spread of $162.99 per service.
These are locality ranges, not averages or address-specific quotes. A facility-setting amount covers the physician service; it does not include a hospital’s separate bill. Choose a locality below to inspect its calculation, compare other payment areas, or price a percentage of Medicare.
Where 65091 pays more and less in California
Ophthalmic surgery
About 65091: Eye evisceration without implant
Reports removal of intraocular contents while preserving the scleral shell, without placing an orbital implant during the procedure.
An ophthalmologist removes the contents of the eye while preserving its outer scleral shell; no orbital implant is placed during this procedure. It may be performed in an operating room for a blind, painful eye or a severely infected or traumatized eye when removal is selected. Evisceration differs from enucleation, which removes the globe itself.
Report this code when the operative record supports evisceration without implant placement, rather than evisceration with an implant or enucleation. Documentation should identify the eye, the procedure performed, and whether an implant was placed. Medicare assigns a 90-day global period, including the day-before preoperative visit and related postoperative care. For multiple procedures in one session, the highest-valued procedure is paid in full and others at 50%; bilateral reporting with modifier 50 is paid at 150%. Assistant-at-surgery payment requires medical-necessity documentation, and co-surgeon payment requires supporting documentation. Team surgery is not permitted.
CMS billing rules for 65091
- Global period
- Major surgery with a 90-day global period: the day-before preoperative visit and 90 days of related postoperative care are included.
- Multiple procedures
- Standard multiple procedure reduction: the highest-valued procedure is paid in full and others at 50% when performed in the same session.
- Bilateral procedures
- Bilateral procedure with modifier 50 is paid at 150%.
- Assistant at surgery
- Assistant at surgery is paid only with documentation of medical necessity.
- Co-surgeons
- Co-surgeons paid only with supporting documentation.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU7.08 · 36%
- Practice expense (office) RVU12.20 · 61%
- Malpractice RVU0.56 · 3%
64
Medicare services in 2024 · #5203 by national volume
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.
65091 compared with similar codes
Office rates for California, from the same CMS release.
No office rate
65101 describes enucleation without an implant, removing the globe. 65091 removes intraocular contents while preserving the scleral shell.
No office rate
65103 describes enucleation with an implant. 65091 describes evisceration without implant placement.
Compare 65091 by payment locality
Find the payment area for your service address, then open its rate page for calculation inputs, release history and the percentage-of-Medicare tool. A city may cross payment-area boundaries; the ZIP lookup above helps resolve the location.
29 of 29 payment localities
| Payment locality | Office | Facility |
|---|---|---|
| Bakersfield | Office Unavailable | Facility $698.97 |
| Chico | Office Unavailable | Facility $697.13 |
| El Centro | Office Unavailable | Facility $697.23 |
| Fresno | Office Unavailable | Facility $697.13 |
| Hanford-Corcoran | Office Unavailable | Facility $697.13 |
| Los Angeles-Long Beach-Anaheim (Los Angeles/Orange Cnty) | Office Unavailable | Facility $740.66 |
| Madera | Office Unavailable | Facility $697.13 |
| Merced | Office Unavailable | Facility $697.13 |
| Modesto | Office Unavailable | Facility $697.13 |
| Napa | Office Unavailable | Facility $797.95 |
| Oxnard-Thousand Oaks-Ventura | Office Unavailable | Facility $736.41 |
| Redding | Office Unavailable | Facility $697.13 |
| Rest Of California | Office Unavailable | Facility $697.13 |
| Riverside-San Bernardino-Ontario | Office Unavailable | Facility $703.30 |
| Sacramento-Roseville-Folsom | Office Unavailable | Facility $728.93 |
| Salinas | Office Unavailable | Facility $726.12 |
| San Diego-Chula Vista-Carlsbad | Office Unavailable | Facility $741.07 |
| San Francisco-Oakland-Berkeley (Marin Cnty) | Office Unavailable | Facility $842.09 |
| San Francisco-Oakland-Berkeley (San Francisco/San Mateo/Alameda/Contra Costa Cnty) | Office Unavailable | Facility $841.46 |
| San Jose-Sunnyvale-Santa Clara (San Benito Cnty) | Office Unavailable | Facility $860.12 |
| San Jose-Sunnyvale-Santa Clara (Santa Clara Cnty) | Office Unavailable | Facility $857.52 |
| San Luis Obispo-Paso Robles | Office Unavailable | Facility $714.66 |
| Santa Cruz-Watsonville | Office Unavailable | Facility $746.57 |
| Santa Maria-Santa Barbara | Office Unavailable | Facility $728.26 |
| Santa Rosa-Petaluma | Office Unavailable | Facility $754.00 |
| Stockton | Office Unavailable | Facility $697.13 |
| Vallejo | Office Unavailable | Facility $797.03 |
| Visalia | Office Unavailable | Facility $697.13 |
| Yuba City | Office Unavailable | Facility $697.13 |
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65091 billing questions
How is 65091 distinguished from 65093?
65091 describes evisceration without an implant. Use 65093 when an implant is placed as part of the evisceration.
When is enucleation reported instead?
Enucleation removes the globe rather than emptying its contents while leaving the scleral shell. Select the enucleation code when that is the operation documented.
Can an orbital implant be billed separately with 65091?
65091 describes the procedure without implant placement. If an implant is placed during evisceration, the with-implant code 65093 distinguishes that service.
What postoperative care is included?
The 90-day global period includes the day-before preoperative visit and related postoperative care for 90 days.
How does Medicare handle bilateral reporting?
Bilateral reporting with modifier 50 is paid at 150% under the CMS facts for this code.
What documentation supports assistant or co-surgeon payment?
Assistant-at-surgery payment requires documentation of medical necessity. Co-surgeon payment requires supporting documentation; 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 indices and the applicable conversion factor. Unavailable or separately priced services are labeled rather than assigned a made-up amount.
Source: RVU26D. Effective 2026-10-01 through the day before 2027-01-01.
7,28564912,,Nrv rpr w/nrv algrft 1st,A,,11.70,10.56,NA,10.56,,2.26,24.52,24.52,0,090,0.11,0.76,0.13,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,28664913,,Nrv rpr w/nrv algrft ea addl,A,,2.93,0.92,NA,0.92,,0.54,4.39,4.39,0,ZZZ,0.00,0.00,0.00,0,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,28764999,,Unlisted px nervous system,C,,0.00,0.00,,0.00,,0.00,0.00,0.00,0,YYY,0.00,0.00,0.00,2,0,0,1,1,9,,33.4009,09,0,99,0.00,0.00,0.00
7,28865091,,Revise eye,A,,7.08,12.20,NA,12.20,,0.56,19.84,19.84,0,090,0.10,0.70,0.20,2,1,0,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,28965093,,Revise eye with implant,A,,6.86,12.34,NA,12.34,,0.55,19.75,19.75,0,090,0.10,0.70,0.20,2,1,1,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,29065101,,Removal of eye,A,,8.09,14.01,NA,14.01,,0.64,22.74,22.74,0,090,0.10,0.70,0.20,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,29165103,,Remove eye/insert implant,A,,8.62,14.07,NA,14.07,,0.68,23.37,23.37,0,090,0.10,0.70,0.20,2,1,1,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00