No office rate
Both codes describe enucleation, but 65103 includes placement of an orbital implant with muscles attached to it; 65101 is for removal without an implant.
On this page
CMS RVU26D · Effective 2026-10-01
65101 Eye removal Medicare reimbursement rates in Indiana
Reports surgical removal of the entire globe without placement of an orbital implant, such as for an eye with a painful blind condition or intraocular disease. Compare 65101 office and facility rates across CMS payment localities in Indiana.
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 65101 in Indiana?
Indiana 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
$714.39
1 of 1 localities have a supported rate.
Payment area: Indiana
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.
Ophthalmology surgery
About 65101: Enucleation without orbital implant
Reports surgical removal of the entire globe without placement of an orbital implant, such as for an eye with a painful blind condition or intraocular disease.
This procedure removes the entire eyeball while leaving the surrounding orbital tissues in place; no orbital implant is placed during the operation. An ophthalmologist, often an oculoplastic surgeon, typically performs it in an operating room. Clinical situations may include a painful, blind eye or an eye affected by disease requiring removal. The operative note should establish that the globe was removed intact rather than its contents evacuated, and document that no implant was placed.
Report the code for the eye treated and support the service with the indication, operative findings, and implant status. The major-surgery 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 the others are subject to the standard multiple-procedure reduction. For bilateral surgery, modifier 50 is paid at 150%. Medicare does not pay an assistant at surgery for this code; co-surgeons and team surgery are not permitted.
CMS billing rules for 65101
- 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
- Statutory restriction: assistant at surgery is not paid.
- Co-surgeons
- Co-surgeons not permitted.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU8.09 · 36%
- Practice expense (office) RVU14.01 · 62%
- Malpractice RVU0.64 · 3%
78
Medicare services in 2024 · #5079 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.
65101 compared with similar codes
Office rates for Indiana, from the same CMS release.
No office rate
Use 65105 for enucleation with an orbital implant and its specified muscle-management approach. Use 65101 when no implant is placed.
No office rate
65110 describes evisceration, which removes the ocular contents but leaves the scleral shell. Code 65101 represents removal of the entire globe.
Compare 65101 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
Indiana →
Office / nonfacility
Unavailable
Facility
$714.39
Need rates for a whole code list?
Fee-sheet and API access are in early access. Tell us which codes and locations your team needs.
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 65101 in Indiana.
PPRRVU2026_Oct_nonQPP.csv
7,290
- Code
- 65101
- Physician work
- 8.09
- Practice expense
- 14.01
- Malpractice
- 0.64
GPCI2026.csv
52
- Locality
- Indiana
- Physician work
- 1.000
- Practice expense
- 0.927
- Malpractice
- 0.486
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 8.09 | × 1.000 | 8.0900 |
| Practice expense | 14.01 | × 0.927 | 12.9873 |
| Malpractice | 0.64 | × 0.486 | 0.3110 |
| Total RVUs | 21.3883 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Indiana$714.39
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 8.09 | 1 |
| Practice expense | 14.01 | 0.927 |
| Malpractice | 0.64 | 0.486 |
(8.09 × 1 + 14.01 × 0.927 + 0.64 × 0.486) × $33.4009 = $714.39
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.
65101 billing questions
How does this differ from enucleation with an implant?
Use 65101 when the entire globe is removed and no orbital implant is placed during the operation. Codes 65103 and 65105 describe enucleation with an implant.
How do I distinguish this from evisceration?
Enucleation removes the entire globe. Evisceration removes the contents while retaining the scleral shell, so it is not reported with 65101.
Is routine postoperative care separately billable?
Related postoperative care during the 90-day global period is included, as is the day-before preoperative visit.
What is the bilateral payment rule?
When both eyes are treated, report modifier 50; CMS pays the bilateral procedure at 150% under the supplied rule.
Can an assistant or co-surgeon be reported?
Medicare does not pay an assistant at surgery for this code. Co-surgeons and team surgery are not permitted.
What documentation supports choosing 65101?
Document removal of the entire globe, the clinical indication, the eye treated, and that no orbital implant was placed.
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.
7,28764999,,Unlisted px nervous system,C,,0.00,0.00,,0.00,,0.00,0.00,0.00,0,YYY,0.00,0.00,0.00,2,0,0,1,1,9,,33.4009,09,0,99,0.00,0.00,0.00
7,28865091,,Revise eye,A,,7.08,12.20,NA,12.20,,0.56,19.84,19.84,0,090,0.10,0.70,0.20,2,1,0,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,28965093,,Revise eye with implant,A,,6.86,12.34,NA,12.34,,0.55,19.75,19.75,0,090,0.10,0.70,0.20,2,1,1,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,29065101,,Removal of eye,A,,8.09,14.01,NA,14.01,,0.64,22.74,22.74,0,090,0.10,0.70,0.20,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,29165103,,Remove eye/insert implant,A,,8.62,14.07,NA,14.07,,0.68,23.37,23.37,0,090,0.10,0.70,0.20,2,1,1,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,29265105,,Remove eye/attach implant,A,,9.68,14.91,NA,14.91,,0.79,25.38,25.38,0,090,0.10,0.70,0.20,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,29365110,,Removal of eye,A,,15.31,17.77,NA,17.77,,1.23,34.31,34.31,0,090,0.10,0.70,0.20,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4906102,IL,12,EAST ST. LOUIS,1.000,0.920,2.014
5006102,IL,15,SUBURBAN CHICAGO,1.007,1.027,1.772
5106102,IL,99,REST OF ILLINOIS,1.000,0.913,1.563
5208102,IN,00,INDIANA,1.000,0.927,0.486
5305102,IA,00,IOWA,1.000,0.915,0.397
5405202,KS,00,KANSAS,1.000,0.904,0.504
5515102,KY,00,KENTUCKY,1.000,0.889,0.915