$165.21
This code is for removing a scleral lesion. 68100 describes a conjunctival biopsy, which samples conjunctival tissue rather than excising a scleral lesion.
On this page
CMS RVU26D · Effective 2026-10-01
66130 Scleral lesion excision Medicare reimbursement rates in Kansas
Reports surgical removal of a lesion arising from the sclera, such as a scleral cyst, rather than a lesion confined to the conjunctiva. Compare 66130 office and facility rates across CMS payment localities in Kansas.
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 66130 in Kansas?
Kansas 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
$654.79
1 of 1 localities have a supported rate.
Payment area: Kansas
One mapped payment locality.
Facility setting
$447.06
1 of 1 localities have a supported rate.
Payment area: Kansas
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 66130: Excision of scleral lesion
Reports surgical removal of a lesion arising from the sclera, such as a scleral cyst, rather than a lesion confined to the conjunctiva.
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.
CMS billing rules for 66130
- 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 RVU7.63 · 36%
- Practice expense (office) RVU12.90 · 61%
- Malpractice RVU0.62 · 3%
136
Medicare services in 2024 · #4633 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.
66130 compared with similar codes
Office rates for Kansas, from the same CMS release.
$218.49
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.
$304.22
This code addresses a scleral lesion. 68115 is used for excision of a conjunctival lesion over 1 cm.
Compare 66130 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
Kansas →
Office / nonfacility
$654.79
Facility
$447.06
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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 66130 in Kansas.
PPRRVU2026_Oct_nonQPP.csv
7,362
- Code
- 66130
- Physician work
- 7.63
- Practice expense
- 12.90
- Malpractice
- 0.62
GPCI2026.csv
54
- Locality
- Kansas
- Physician work
- 1.000
- Practice expense
- 0.904
- Malpractice
- 0.504
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 7.63 | × 1.000 | 7.6300 |
| Practice expense | 12.90 | × 0.904 | 11.6616 |
| Malpractice | 0.62 | × 0.504 | 0.3125 |
| Total RVUs | 19.6041 | ||
| Conversion factor | × 33.4009 | ||
Office / nonfacility rate, Kansas$654.79
Explore RVUs, geographic factors and the full formula
Office / nonfacility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 7.63 | 1 |
| Practice expense | 12.9 | 0.904 |
| Malpractice | 0.62 | 0.504 |
(7.63 × 1 + 12.9 × 0.904 + 0.62 × 0.504) × $33.4009 = $654.79
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 7.63 | 1 |
| Practice expense | 6.02 | 0.904 |
| Malpractice | 0.62 | 0.504 |
(7.63 × 1 + 6.02 × 0.904 + 0.62 × 0.504) × $33.4009 = $447.06
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.
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 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.
7,35965930,,Remove blood clot from eye,A,,8.18,7.58,NA,7.58,,0.64,16.40,16.40,0,090,0.10,0.70,0.20,2,1,1,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,36066020,,Injection treatment of eye,A,,1.60,4.16,,1.68,,0.13,5.89,3.41,0,010,0.10,0.80,0.10,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,36166030,,Injection treatment of eye,A,,1.27,3.93,,1.56,,0.09,5.29,2.92,0,010,0.10,0.80,0.10,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,36266130,,Remove eye lesion,A,,7.63,12.90,,6.02,,0.62,21.15,14.27,0,090,0.10,0.70,0.20,2,1,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,36366150,,Glaucoma surgery,A,,10.27,11.70,NA,11.70,,0.82,22.79,22.79,0,090,0.10,0.70,0.20,2,1,1,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,36466155,,Glaucoma surgery,A,,10.26,11.70,NA,11.70,,0.82,22.78,22.78,0,090,0.10,0.70,0.20,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,36566160,,Glaucoma surgery,A,,12.08,12.34,NA,12.34,,0.98,25.40,25.40,0,090,0.10,0.70,0.20,2,1,1,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
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
5607202,LA,01,NEW ORLEANS,1.000,0.941,1.136
5707202,LA,99,REST OF LOUISIANA,1.000,0.885,0.958