$552.81
65275 is for a nonperforating corneal laceration. Use 65280 for a perforating wound involving the cornea, sclera, or both.
On this page
CMS RVU26D · Effective 2026-10-01
65280 Eye wound repair Medicare reimbursement rates in Idaho
Surgical closure of a perforating corneal or scleral wound, reported for open-globe injuries that require repair of the eye wall. Compare 65280 office and facility rates across CMS payment localities in Idaho.
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 65280 in Idaho?
Idaho has 1 payment locality in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the payment area shown below, using the same CMS release.
Office / nonfacility
No supported rate
Facility setting
$533.80
1 of 1 localities have a supported rate.
Payment area: Idaho
One mapped payment locality.
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.
Ophthalmic surgery
About 65280: Perforating corneal or scleral wound repair
Surgical closure of a perforating corneal or scleral wound, reported for open-globe injuries that require repair of the eye wall.
An ophthalmologist uses this service to close a perforating wound involving the cornea, sclera, or both. A typical case is an open-globe injury from sharp trauma or a penetrating object that requires surgical closure to restore the integrity of the eye wall. The procedure is commonly performed in an operating room in a hospital or ambulatory surgical setting. The operative report should identify the wound site and extent, structures involved, closure method, and any management of uveal tissue.
Report the repair supported by the operative findings; distinguish a perforating injury from a nonperforating corneal laceration. The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care. 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 multiple-procedure reduction. For bilateral repair, modifier 50 is paid at 150%. Assistant-at-surgery payment requires documentation of medical necessity; co-surgeons and team surgery are not permitted.
CMS billing rules for 65280
- 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 not permitted.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU8.87 · 52%
- Practice expense (office) RVU7.37 · 44%
- Malpractice RVU0.70 · 4%
195
Medicare services in 2024 · #4346 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.
65280 compared with similar codes
Office rates for Idaho, from the same CMS release.
No office rate
Both codes concern perforating corneal or scleral wounds. Review the documented wound and uveal-tissue management to select the repair code supported by the operative details.
$262.19
65270 repairs a conjunctival laceration. It is not the code for a perforating injury of the cornea or sclera.
Compare 65280 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.
1 of 1 payment localities
Idaho →
Office / nonfacility
Unavailable
Facility
$533.80
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How this local rate is calculated
Each RVU component is multiplied by its own geographic practice cost index (GPCI). The three adjusted components are added, then multiplied by the conversion factor. These are the inputs used for 65280 in Idaho.
PPRRVU2026_Oct_nonQPP.csv
7,314
- Code
- 65280
- Physician work
- 8.87
- Practice expense
- 7.37
- Malpractice
- 0.70
GPCI2026.csv
47
- Locality
- Idaho
- Physician work
- 1.000
- Practice expense
- 0.920
- Malpractice
- 0.473
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 8.87 | × 1.000 | 8.8700 |
| Practice expense | 7.37 | × 0.920 | 6.7804 |
| Malpractice | 0.70 | × 0.473 | 0.3311 |
| Total RVUs | 15.9815 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Idaho$533.80
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 8.87 | 1 |
| Practice expense | 7.37 | 0.92 |
| Malpractice | 0.7 | 0.473 |
(8.87 × 1 + 7.37 × 0.92 + 0.7 × 0.473) × $33.4009 = $533.80
The office and facility calculations use their respective practice-expense RVUs. The facility amount here is the physician fee, not a separate hospital or facility bill.
65280 billing questions
How is this code distinguished from 65275?
This code is for a perforating wound involving the cornea, sclera, or both. Code 65275 is for a nonperforating corneal laceration.
How does 65285 differ?
Use the operative details to distinguish these perforating wound repairs, including whether uveal tissue was repositioned or resected. The report should make the wound and tissue management clear.
Does the repair include related postoperative visits?
Yes. The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care.
How is bilateral repair paid?
For bilateral repair, report modifier 50; CMS pays the bilateral procedure at 150%.
Can an assistant or co-surgeon be reported?
Assistant-at-surgery payment requires documentation of medical necessity. Co-surgeons and team surgery are 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% when performed in the same session.
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.
7,31165272,,Repair of eye wound,A,,4.50,10.90,,4.11,,0.36,15.76,8.97,0,090,0.10,0.70,0.20,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,31265273,,Repair of eye wound,A,,5.03,4.18,NA,4.18,,0.40,9.61,9.61,0,090,0.10,0.70,0.20,2,1,1,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,31365275,,Repair of eye wound,A,,6.13,11.08,,5.03,,0.48,17.69,11.64,0,090,0.10,0.70,0.20,2,1,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,31465280,,Repair of eye wound,A,,8.87,7.37,NA,7.37,,0.70,16.94,16.94,0,090,0.10,0.70,0.20,2,1,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,31565285,,Repair of eye wound,A,,14.98,11.63,NA,11.63,,1.21,27.82,27.82,0,090,0.10,0.70,0.20,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,31665286,,Repair of eye wound,A,,6.46,13.96,,5.61,,0.50,20.92,12.57,0,090,0.10,0.70,0.20,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,31765290,,Repair of eye socket wound,A,,6.37,5.57,NA,5.57,,0.49,12.43,12.43,0,090,0.10,0.70,0.20,2,1,1,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4410212,GA,01,ATLANTA,1.003,1.016,1.201
4510212,GA,99,REST OF GEORGIA,1.000,0.892,1.192
4601212,HI,01,"HAWAII, GUAM",1.000,1.137,0.579
4702202,ID,00,IDAHO,1.000,0.920,0.473
4806102,IL,16,CHICAGO,1.007,1.005,2.295
4906102,IL,12,EAST ST. LOUIS,1.000,0.920,2.014
5006102,IL,15,SUBURBAN CHICAGO,1.007,1.027,1.772