Billing code 65135: Ocular implantMedicare rate & RVUs in Guam
Reports placement of an orbital implant with extraocular muscles attached, generally to restore socket volume and support movement of an external eye prosthesis.
CMS doesn’t publish an office rate for 65135 in Guam.
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 9 sections
What 65135 covers
An ophthalmic or oculoplastic surgeon places an orbital implant in the socket and attaches the extraocular muscles to the implant. This may be part of reconstruction after loss or removal of an eye. The implant is internal; an external prosthetic eye is a separate device. Code selection turns on whether the muscles are attached to the implant, rather than simply placed over or around it. If the eye is removed during the same operation and the applicable enucleation code includes implant placement, that combined service is represented by the enucleation code rather than a separate insertion code.
The operative report should identify the implant placement and describe the muscle attachment. CMS assigns a 90-day global period: the day-before preoperative visit and 90 days of related postoperative care are included. When multiple 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. For bilateral reporting with modifier 50, CMS pays 150%. Assistant-at-surgery payment is restricted; 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.
65135 in Hawaii, Guam
| Payment locality | Office | Facility |
|---|---|---|
| Hawaii, Guam | Unavailable | $825.05 |
How the 65135 rate is calculated
Each of 65135’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 · 65135
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 8.39Practice expense 14.01Malpractice 0.66
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 65135
65135 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 65135
Ocular implant
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 090 | Major surgery: the day before, the day of, and 90 days after are included. |
| Multiple procedures | 2 | Standard reduction: highest-valued procedure at 100%, others at 50%. |
| Bilateral (modifier 50) | 1 | Bilateral with modifier 50 pays 150% of the fee schedule amount. |
| Assistant at surgery (80/81/82/AS) | 1 | Not paid (statutory restriction). |
| Co-surgeons (62) | 0 | Not permitted. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 0 | Physician service: no professional/technical split. |
| Split (54/55/56) | 0.10/0.70/0.20 | Share of the payment for pre-op, the procedure itself, and post-op care. |
Global surgery period · 65135
Ocular implant
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.
Pre-op dayGlobal period
What modifiers do to the payment
Modifier 50 · payment effect
With and without the modifier
65135 without 50 · national facility
$770.22
Ocular implant
65135-50 · Bilateral: 150%
$1,155.33
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).
65135 compared with similar codes
Compare codes
65135 vs 65130 vs 65103 vs 65140 vs 65125: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 65130Ocular implant insertion
- Choose 65135 when the extraocular muscles are attached to the implant; choose 65130 when they are not.
- 65103Eye removal
- 65103 represents eye removal with implant placement in the same operation. 65135 describes implant insertion with muscle attachment, without that combined enucleation service.
- 65140Ocular implant
- 65140 concerns attachment of muscles to an ocular implant; 65135 describes insertion of the implant with the muscles attached.
- 65125Ocular implant revision
- 65125 describes revision of an existing ocular implant, not placement of an implant with muscle attachment.
65135 billing questions
How is 65135 different from 65130?
65135 is selected when the extraocular muscles are attached to the implant. 65130 is the related insertion service when the muscles are not attached to it.
Can 65135 be reported with an enucleation code?
When the eye is removed and implant placement is included in the applicable enucleation service, report that combined service rather than separately reporting 65135. Code 65103 is the nearby enucleation option that includes implant placement.
What documentation supports 65135?
The operative report should document implant placement and attachment of the extraocular muscles to the implant. Documentation of implant placement alone does not establish the distinction from 65130.
How does the global period affect postoperative visits?
The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care. Those related visits are included in the surgical service.
How are bilateral and multiple procedures handled?
For bilateral reporting, modifier 50 is paid at 150%. When multiple procedures are performed in the same session, the highest-valued procedure is paid in full and the others 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
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