CPT code 66130: Scleral lesion excision2026 Medicare rate & RVUs in Illinois
Reports surgical removal of a lesion arising from the sclera, such as a scleral cyst, rather than a lesion confined to the conjunctiva.
Medicare pays $680.60–$737.18 for 66130 in the office in Illinois, from Rest Of Illinois to Chicago. Which amount applies depends on the service address.
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 66130 covers
An ophthalmologist uses this service to remove an abnormal growth arising from the sclera, the eye’s outer supporting coat. A scleral cyst is a representative example. The surgeon exposes the lesion through the overlying conjunctiva and removes it; conjunctival closure or advancement may be part of the operative approach. The procedure is generally performed in a surgical setting, with the site of service determined by the clinical circumstances.
Report the code when the operative documentation identifies the lesion as scleral and describes its removal. Documentation should distinguish the lesion’s origin from a growth confined to the conjunctiva and describe the surgical work performed. CMS assigns a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. When multiple procedures occur 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%. Assistant-at-surgery payment requires documented medical necessity; 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.
Where 66130 pays more and less in Illinois
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
4 payment localities
$680.60 to $737.18
| Payment locality | Office | Facility |
|---|---|---|
| Chicago | $737.18 | $506.24 |
| East St. Louis | $692.96 | $481.54 |
| Rest Of Illinois | $680.60 | $470.80 |
| Suburban Chicago | $735.83 | $499.83 |
How the 66130 rate is calculated
Each of 66130’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 · 66130
RVUs × geographic indexes × conversion factor
Work7.63
7.63 RVUs× 1.000 GPCI
Practice expense12.90
12.90 RVUs× 1.000 GPCI
Malpractice0.62
0.62 RVUs× 1.000 GPCI
Adjusted RVUs
21.1500
Conversion factor
$33.4009
Medicare rate
$706.43
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 66130
66130 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 66130
Scleral lesion excision
| 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) | 0 | Not paid without supporting documentation. |
| 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 · 66130
Scleral lesion excision
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
66130 without 50 · national office
$706.43
Scleral lesion excision
66130-50 · Bilateral: 150%
$1,059.64
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).
66130 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 68100Conjunctival biopsy
- This code is for removing a scleral lesion. 68100 describes a conjunctival biopsy, which samples conjunctival tissue rather than excising a scleral lesion.
- 68110Conjunctival excision
- Choose based on the lesion’s site: this code is for a lesion arising from the sclera, while 68110 is for a conjunctival lesion up to 1 cm.
- 68115Conjunctival excision
- This code addresses a scleral lesion. 68115 is used for excision of a conjunctival lesion over 1 cm.
66130 billing questions
How is this different from conjunctival lesion excision?
Use this code when the lesion arises from the sclera. A lesion confined to the conjunctiva is considered under the conjunctival excision codes, with the applicable code depending on the procedure and lesion size.
What documentation supports reporting this service?
The operative note should identify the lesion as scleral and describe its removal, including the approach through the conjunctiva and any closure or advancement performed.
Are related postoperative visits included?
Yes. The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care.
How is a bilateral procedure reported?
CMS identifies this as a bilateral procedure; modifier 50 is paid at 150%. Document the work performed on both eyes.
Can an assistant surgeon be reported?
Assistant-at-surgery payment is allowed only when medical necessity is documented. Co-surgeons and team surgery are not permitted under the listed CMS rules.
What happens when another procedure is performed in the same session?
The highest-valued procedure is paid in full, and other procedures are subject to the standard multiple-procedure reduction.
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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