Billing code 65865: Eye adhesion lysisMedicare rate & RVUs in Kentucky
Reports incisional division of adhesions within the eye’s anterior segment, such as iris synechiae, when the surgeon performs surgical rather than laser lysis.
CMS doesn’t publish an office rate for 65865 in Kentucky.
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 65865 covers
An ophthalmologist uses an incision and surgical instruments to divide adhesions in the anterior segment of the eye. These adhesions, or synechiae, may involve the iris and restrict normal separation or movement of anterior-segment structures. The service is typically performed in an operating room or other surgical setting when the surgeon documents that incisional lysis is needed; it is distinct from laser treatment of adhesions.
Choose this code based on the incisional technique and the documented operative work, rather than diagnosis alone. The operative note should identify the treated eye, the adhesions addressed, and the technique used. CMS assigns a 90-day global period, including 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 50% multiple-procedure reduction. Bilateral reporting with modifier 50 is paid at 150%. Assistant-at-surgery payment is restricted; co-surgeons are paid only with 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.
65865 in Kentucky
| Payment locality | Office | Facility |
|---|---|---|
| Kentucky | Unavailable | $389.16 |
How the 65865 rate is calculated
Each of 65865’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 · 65865
RVUs × geographic indexes × conversion factor
Work5.63
5.63 RVUs× 1.000 GPCI
Practice expense6.32
6.32 RVUs× 1.000 GPCI
Malpractice0.44
0.44 RVUs× 1.000 GPCI
Adjusted RVUs
12.3900
Conversion factor
$33.4009
Medicare rate
$413.84
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 65865
65865 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 65865
Eye adhesion lysis
| 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 · 65865
Eye adhesion lysis
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
65865 without 50 · national facility
$413.84
Eye adhesion lysis
65865-50 · Bilateral: 150%
$620.76
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).
65865 compared with similar codes
Compare codes · National
5 codes, side by side
How to choose
- 65860Laser adhesion release
- Use 65865 for incisional lysis of anterior-segment adhesions; 65860 describes the laser technique.
- 65870Synechiolysis
- Both are in the incisional anterior-segment adhesion family. Select the code whose descriptor matches the documented extent and operative work.
- 65875Eye adhesiolysis
- This is a related incisional adhesion code. Compare its descriptor with the operative note rather than choosing solely from the diagnosis.
- 65820Goniotomy
- 65820 describes goniotomy, an operation on the drainage angle; 65865 is for incisional division of anterior-segment adhesions.
65865 billing questions
How does this differ from 65860?
65865 describes incisional division of anterior-segment adhesions. Code 65860 is the laser-technique option, so the documented method is central to the distinction.
How should the operative note support 65865?
Document the treated eye, the anterior-segment adhesions divided, and the incisional technique performed. The note should support the actual operative work, not just the diagnosis.
Can modifier 50 be used for bilateral treatment?
CMS identifies this as a bilateral procedure. With modifier 50, payment is at 150%.
How does the multiple-procedure reduction affect same-session surgery?
When multiple procedures are performed in the same session, the highest-valued procedure is paid in full and the other procedures are subject to the standard 50% reduction.
What is included in the global period?
The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care.
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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