No office rate
Both codes describe scleral reinforcement. Choose 67255 when graft material is used and 67250 when reinforcement is performed without a graft.
On this page
CMS RVU26D · Effective 2026-10-01
67255 Scleral reinforcement Medicare reimbursement rates in California
Report scleral reinforcement with graft when an ophthalmic surgeon surgically strengthens the eye wall using graft material, rather than reinforcement without a graft. Compare 67255 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 67255 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
$620.09–$749.94
29 of 29 localities have a supported rate.
Lowest: Chico
Highest: San Jose-Sunnyvale-Santa Clara (San Benito Cnty)
A spread of $129.85 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 67255 pays more and less in California
Ophthalmic surgery
About 67255: Scleral reinforcement with graft
Report scleral reinforcement with graft when an ophthalmic surgeon surgically strengthens the eye wall using graft material, rather than reinforcement without a graft.
An ophthalmic surgeon uses this procedure to strengthen the sclera with graft material, such as when the eye wall is markedly thin or weakened. It is an operative service typically performed in a surgical setting, not a treatment for a retinal or choroidal lesion. The operative report should establish the reason for reinforcement and describe the graft and the work performed on the sclera.
Choose this code when graft material is used for the reinforcement; the corresponding procedure without a graft is 67250. The documentation should make that distinction clear and support the medical need for the operation. CMS assigns a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. When other procedures are performed 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%. An assistant at surgery may be paid; co-surgeon payment requires supporting documentation, and team surgery is not permitted.
CMS billing rules for 67255
- 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 may be paid.
- Co-surgeons
- Co-surgeons paid only with supporting documentation.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU8.17 · 46%
- Practice expense (office) RVU9.04 · 51%
- Malpractice RVU0.65 · 4%
1.3K
Medicare services in 2024 · #2751 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.
67255 compared with similar codes
Office rates for California, from the same CMS release.
No office rate
67107 describes retinal detachment repair using a scleral buckling approach. It is not a substitute for graft-based scleral reinforcement of a weakened eye wall.
67299
No office rateUnlisted px posterior segmnt
Use 67299 only when a posterior-segment procedure lacks a specific CPT code. Graft-based scleral reinforcement has the specific code 67255.
Compare 67255 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 $622.22 |
| Chico | Office Unavailable | Facility $620.09 |
| El Centro | Office Unavailable | Facility $620.20 |
| Fresno | Office Unavailable | Facility $620.09 |
| Hanford-Corcoran | Office Unavailable | Facility $620.09 |
| Los Angeles-Long Beach-Anaheim (Los Angeles/Orange Cnty) | Office Unavailable | Facility $655.69 |
| Madera | Office Unavailable | Facility $620.09 |
| Merced | Office Unavailable | Facility $620.09 |
| Modesto | Office Unavailable | Facility $620.09 |
| Napa | Office Unavailable | Facility $699.07 |
| Oxnard-Thousand Oaks-Ventura | Office Unavailable | Facility $650.95 |
| Redding | Office Unavailable | Facility $620.09 |
| Rest Of California | Office Unavailable | Facility $620.09 |
| Riverside-San Bernardino-Ontario | Office Unavailable | Facility $627.25 |
| Sacramento-Roseville-Folsom | Office Unavailable | Facility $645.51 |
| Salinas | Office Unavailable | Facility $642.93 |
| San Diego-Chula Vista-Carlsbad | Office Unavailable | Facility $653.96 |
| San Francisco-Oakland-Berkeley (Marin Cnty) | Office Unavailable | Facility $734.52 |
| San Francisco-Oakland-Berkeley (San Francisco/San Mateo/Alameda/Contra Costa Cnty) | Office Unavailable | Facility $733.78 |
| San Jose-Sunnyvale-Santa Clara (San Benito Cnty) | Office Unavailable | Facility $749.94 |
| San Jose-Sunnyvale-Santa Clara (Santa Clara Cnty) | Office Unavailable | Facility $746.93 |
| San Luis Obispo-Paso Robles | Office Unavailable | Facility $633.08 |
| Santa Cruz-Watsonville | Office Unavailable | Facility $657.11 |
| Santa Maria-Santa Barbara | Office Unavailable | Facility $644.23 |
| Santa Rosa-Petaluma | Office Unavailable | Facility $663.50 |
| Stockton | Office Unavailable | Facility $620.09 |
| Vallejo | Office Unavailable | Facility $698.00 |
| Visalia | Office Unavailable | Facility $620.09 |
| Yuba City | Office Unavailable | Facility $620.09 |
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67255 billing questions
How do I choose between 67255 and 67250?
Use 67255 when graft material is used to reinforce the sclera. Use 67250 for scleral reinforcement without a graft.
What documentation supports 67255?
Document the indication for scleral reinforcement, the operative work on the eye wall, and the use of graft material. The operative note should distinguish the procedure from reinforcement without a graft.
Does the 90-day global include postoperative visits?
It includes the day-before preoperative visit and 90 days of related postoperative care.
How is bilateral 67255 reported?
Report bilateral surgery with modifier 50. CMS pays the bilateral procedure at 150%.
Can an assistant or co-surgeon be reported?
An assistant at surgery may be paid. Co-surgeon payment requires supporting documentation; team surgery is not permitted.
How does the multiple-procedure reduction affect 67255?
When other procedures are performed in the same session, CMS pays the highest-valued procedure in full and reduces the others to 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 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.
7,44867228,,Treatment x10sv retinopathy,A,,4.28,5.58,,2.97,,0.35,10.21,7.60,0,010,0.10,0.80,0.10,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,44967229,,Tr retinal les preterm inf,A,,15.89,11.88,NA,11.88,,1.27,29.04,29.04,0,090,0.10,0.70,0.20,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,45067250,,Reinforce eye wall,A,,9.37,13.70,NA,13.70,,0.75,23.82,23.82,0,090,0.10,0.70,0.20,2,1,1,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,45167255,,Reinforce/graft eye wall,A,,8.17,9.04,NA,9.04,,0.65,17.86,17.86,0,090,0.10,0.70,0.20,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,45267299,,Unlisted px posterior segmnt,C,,0.00,0.00,,0.00,,0.00,0.00,0.00,0,YYY,0.00,0.00,0.00,2,1,0,1,1,9,,33.4009,09,0,99,0.00,0.00,0.00
7,45367311,,Revise eye muscle,A,,5.78,5.48,NA,5.48,,0.45,11.71,11.71,0,090,0.10,0.70,0.20,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,45467312,,Revise two eye muscles,A,,9.26,6.72,NA,6.72,,0.73,16.71,16.71,0,090,0.10,0.70,0.20,2,1,1,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00