No office rate
Both involve mechanical adhesiolysis in the anterior segment. Use 65875 when the documented work is extensive; 65865 represents less extensive work.
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CMS RVU26D · Effective 2026-10-01
65875 Eye adhesiolysis Medicare reimbursement rates in Kentucky
An ophthalmic surgeon mechanically releases extensive adhesions within the eye’s anterior segment, excluding synechiae, when the operative work meets this service’s scope. Compare 65875 office and facility rates across CMS payment localities in Kentucky.
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 65875 in Kentucky?
Kentucky 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
$516.00
1 of 1 localities have a supported rate.
Payment area: Kentucky
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 65875: Extensive mechanical anterior segment adhesiolysis
An ophthalmic surgeon mechanically releases extensive adhesions within the eye’s anterior segment, excluding synechiae, when the operative work meets this service’s scope.
This service involves surgically cutting extensive adhesions within the eye’s anterior segment, excluding synechiae. Adhesions may involve structures such as the iris, cornea, or lens. An ophthalmologist typically performs the procedure in an operating room when adhesions require mechanical release; the operative report should identify the affected structures and describe the extent and technique. This code distinguishes extensive mechanical treatment from less extensive work and laser treatment in the related anterior-segment adhesiolysis codes.
Report the code when the documented procedure supports extensive mechanical adhesiolysis, rather than a different method or extent. Medicare 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% reduction. For bilateral reporting with modifier 50, payment is at 150%. Assistant-at-surgery payment is restricted; co-surgeons require supporting documentation, and team surgery is not permitted.
CMS billing rules for 65875
- 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 paid only with supporting documentation.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU7.61 · 46%
- Practice expense (office) RVU8.20 · 50%
- Malpractice RVU0.60 · 4%
924
Medicare services in 2024 · #3028 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.
65875 compared with similar codes
Office rates for Kentucky, from the same CMS release.
No office rate
65870 uses laser treatment for anterior-segment adhesions, whereas 65875 represents extensive mechanical release.
No office rate
Both represent extensive anterior-segment adhesiolysis; 65880 is the laser approach, while 65875 is the mechanical approach.
Compare 65875 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
Kentucky →
Office / nonfacility
Unavailable
Facility
$516.00
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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 65875 in Kentucky.
PPRRVU2026_Oct_nonQPP.csv
7,355
- Code
- 65875
- Physician work
- 7.61
- Practice expense
- 8.20
- Malpractice
- 0.60
GPCI2026.csv
55
- Locality
- Kentucky
- Physician work
- 1.000
- Practice expense
- 0.889
- Malpractice
- 0.915
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 7.61 | × 1.000 | 7.6100 |
| Practice expense | 8.20 | × 0.889 | 7.2898 |
| Malpractice | 0.60 | × 0.915 | 0.5490 |
| Total RVUs | 15.4488 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Kentucky$516.00
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 7.61 | 1 |
| Practice expense | 8.2 | 0.889 |
| Malpractice | 0.6 | 0.915 |
(7.61 × 1 + 8.2 × 0.889 + 0.6 × 0.915) × $33.4009 = $516.00
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.
65875 billing questions
How does this code differ from 65865?
Both describe mechanical release of anterior-segment adhesions, but 65875 is for extensive work. The operative report should support the greater extent of adhesiolysis.
When would 65870 or 65880 be considered instead?
Those related codes describe laser treatment rather than the mechanical release reported with 65875. The documented method and extent guide selection.
Can 65865 and 65875 both be reported for the same adhesiolysis?
Do not report both for the same work merely to represent its extent. Report the code that matches the documented procedure.
What documentation supports reporting 65875?
Document the adhesions’ location and extent, the structures involved, and the mechanical technique used. The record should support extensive treatment and distinguish the work from synechiae treatment.
What does the 90-day global period include?
It includes the day-before preoperative visit and 90 days of related postoperative care.
How is bilateral treatment handled?
When the procedure is performed bilaterally and reported with modifier 50, Medicare pays at 150%.
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.
7,35265860,,Severing ads ant sgm laser,A,,3.50,5.51,,2.49,,0.27,9.28,6.26,0,090,0.10,0.70,0.20,2,1,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,35365865,,Incise inner eye adhesions,A,,5.63,6.32,NA,6.32,,0.44,12.39,12.39,0,090,0.10,0.70,0.20,2,1,1,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,35465870,,Incise inner eye adhesions,A,,7.21,7.58,NA,7.58,,0.57,15.36,15.36,0,090,0.10,0.70,0.20,2,1,1,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,35565875,,Incise inner eye adhesions,A,,7.61,8.20,NA,8.20,,0.60,16.41,16.41,0,090,0.10,0.70,0.20,2,1,1,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,35665880,,Incise inner eye adhesions,A,,8.15,8.38,NA,8.38,,0.64,17.17,17.17,0,090,0.10,0.70,0.20,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,35765900,,Remove eye lesion,A,,12.20,12.25,NA,12.25,,0.99,25.44,25.44,0,090,0.10,0.70,0.20,2,1,2,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,35865920,,Remove implant of eye,A,,9.74,9.86,NA,9.86,,0.79,20.39,20.39,0,090,0.10,0.70,0.20,2,1,1,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
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
5814112,ME,03,SOUTHERN MAINE,1.000,0.991,0.631