Billing code 67250: Scleral reinforcementMedicare rate & RVUs in Guam
An ophthalmic surgeon strengthens the scleral wall without graft material, typically for progressive scleral weakness associated with pathologic myopia.
CMS doesn’t publish an office rate for 67250 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 67250 covers
This operation strengthens the eye’s scleral wall without using graft material. Ophthalmologists may perform it for progressive scleral weakness or ectasia, including in patients with pathologic myopia. It is generally an operating-room service, not a treatment for a retinal lesion or a retinal detachment repair. The operative report should identify the eye, the condition prompting reinforcement, and the technique used.
Choose this code when the service is scleral reinforcement without a graft; use the graft distinction to evaluate 67255 instead. Documentation should make clear what was reinforced and whether graft material was used. CMS assigns a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. For multiple procedures in one session, the highest-valued procedure is paid in full and the others at 50%. Bilateral reporting with modifier 50 is paid at 150%. Assistant-at-surgery payment is restricted; 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.
67250 in Hawaii, Guam
| Payment locality | Office | Facility |
|---|---|---|
| Hawaii, Guam | Unavailable | $847.75 |
How the 67250 rate is calculated
Each of 67250’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 · 67250
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 9.37Practice expense 13.70Malpractice 0.75
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 67250
67250 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 67250
Scleral reinforcement
| 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) | 1 | Permitted with supporting documentation. |
| 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 · 67250
Scleral reinforcement
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
67250 without 50 · national facility
$795.61
Scleral reinforcement
67250-50 · Bilateral: 150%
$1,193.42
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).
67250 compared with similar codes
Compare codes
67250 vs 67255 vs 67107 vs 67299: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 67255Scleral reinforcement
- Both codes describe scleral reinforcement; the graft distinction is the key selection point. Use 67250 when no graft material is used.
- 67107Retinal detachment repair
- This code is for retinal detachment repair using scleral buckling. It does not represent reinforcement of the scleral wall for scleral weakness.
- 67299Unlisted px posterior segmnt
- This is an unlisted posterior-segment procedure code. Use the specific scleral reinforcement code when the documented service matches it.
67250 billing questions
How is 67250 distinguished from 67255?
67250 describes scleral reinforcement without graft material. When graft material is used for the reinforcement, evaluate 67255.
Is this the code for scleral buckling to repair a retinal detachment?
No. Scleral reinforcement is distinct from a scleral buckle performed as part of retinal detachment repair. Select the code that represents the operation actually performed.
What documentation supports reporting 67250?
Document the indication, eye treated, reinforcement technique, and whether graft material was used. The operative report should support that scleral reinforcement was performed.
How is bilateral reinforcement reported?
CMS identifies this as a bilateral procedure: report modifier 50 when both eyes are treated. Bilateral payment is 150% under the stated CMS rule.
Can an assistant or co-surgeon be paid for this operation?
Assistant-at-surgery payment is subject to a statutory restriction. Co-surgeon payment is allowed only with 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 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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