$164.74
68100 describes conjunctival biopsy for tissue sampling. 68130 describes excision of a lesion together with adjacent sclera.
On this page
CMS RVU26D · Effective 2026-10-01
68130 Conjunctival excision Medicare reimbursement rates in Kentucky
Report this operation when an ophthalmologist removes a conjunctival lesion together with adjacent sclera, rather than excising conjunctiva alone or destroying the lesion. Compare 68130 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 68130 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
$511.68
1 of 1 localities have a supported rate.
Payment area: Kentucky
One mapped payment locality.
Facility setting
$336.79
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.
Ophthalmic surgery
About 68130: Conjunctival lesion excision with sclera
Report this operation when an ophthalmologist removes a conjunctival lesion together with adjacent sclera, rather than excising conjunctiva alone or destroying the lesion.
An ophthalmologist removes a conjunctival lesion along with adjacent sclera when the lesion involves or requires excision of that underlying tissue. This is an ocular surface operation, commonly performed for a lesion that cannot be adequately removed by excising conjunctiva alone. The operative report should identify the lesion and site and describe removal of the adjacent sclera.
Choose this code based on the tissue removed, not lesion diameter: the defining feature is excision of adjacent sclera. Conjunctival excisions without adjacent sclera are distinguished by lesion size in nearby codes, while destruction uses a different code. CMS assigns a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. In a same-session multiple-procedure case, the highest-valued procedure is paid in full and other procedures at 50%. Bilateral reporting with modifier 50 is paid at 150%. Assistant-at-surgery payment is statutorily restricted; co-surgeons and team surgery are not permitted.
CMS billing rules for 68130
- 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 RVU4.97 · 30%
- Practice expense (office) RVU11.23 · 68%
- Malpractice RVU0.40 · 2%
206
Medicare services in 2024 · #4302 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.
68130 compared with similar codes
Office rates for Kentucky, from the same CMS release.
$217.80
68110 is for excision of a conjunctival lesion under 1 cm without the adjacent-sclera feature. Use 68130 when adjacent sclera is excised.
$303.14
68115 is for excision of a conjunctival lesion over 1 cm without the adjacent-sclera feature. Use 68130 when adjacent sclera is excised.
$148.89
68135 describes destruction of a conjunctival lesion. 68130 is used when the lesion and adjacent sclera are surgically excised.
Compare 68130 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
$511.68
Facility
$336.79
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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 68130 in Kentucky.
PPRRVU2026_Oct_nonQPP.csv
7,538
- Code
- 68130
- Physician work
- 4.97
- Practice expense
- 11.23
- Malpractice
- 0.40
GPCI2026.csv
55
- Locality
- Kentucky
- Physician work
- 1.000
- Practice expense
- 0.889
- Malpractice
- 0.915
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 4.97 | × 1.000 | 4.9700 |
| Practice expense | 11.23 | × 0.889 | 9.9835 |
| Malpractice | 0.40 | × 0.915 | 0.3660 |
| Total RVUs | 15.3195 | ||
| Conversion factor | × 33.4009 | ||
Office / nonfacility rate, Kentucky$511.68
Explore RVUs, geographic factors and the full formula
Office / nonfacility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 4.97 | 1 |
| Practice expense | 11.23 | 0.889 |
| Malpractice | 0.4 | 0.915 |
(4.97 × 1 + 11.23 × 0.889 + 0.4 × 0.915) × $33.4009 = $511.68
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 4.97 | 1 |
| Practice expense | 5.34 | 0.889 |
| Malpractice | 0.4 | 0.915 |
(4.97 × 1 + 5.34 × 0.889 + 0.4 × 0.915) × $33.4009 = $336.79
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.
68130 billing questions
When should 68130 be chosen over 68110 or 68115?
Use 68130 when adjacent sclera is excised with the conjunctival lesion. The size-based codes describe conjunctival lesion excision without that scleral component.
What operative documentation supports 68130?
Document the lesion's site and the removal of adjacent sclera, along with the operative work performed. The scleral excision distinguishes this service from conjunctival excision alone.
Can modifier 50 be used for bilateral excision?
CMS identifies this as a bilateral procedure; reporting with modifier 50 is paid at 150%.
What postoperative care is included?
The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care.
How does CMS treat other procedures performed in the same session?
The highest-valued procedure is paid in full, and the other procedures are paid at 50%. Assistant-at-surgery payment is statutorily restricted, and co-surgeons and team surgery are not permitted.
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.
7,53568100,,Biopsy conjunctiva,A,,1.32,3.95,,1.00,,0.11,5.38,2.43,0,000,0.00,0.00,0.00,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,53668110,,Exc les conjunctiva <1 cm,A,,1.77,5.20,,1.95,,0.14,7.11,3.86,0,010,0.10,0.80,0.10,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,53768115,,Exc les conjunctiva >1 cm,A,,2.35,7.37,,2.16,,0.19,9.91,4.70,0,010,0.10,0.80,0.10,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,53868130,,Exc les conjunctiva adj scl,A,,4.97,11.23,,5.34,,0.40,16.60,10.71,0,090,0.10,0.70,0.20,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,53968135,,Destruction les conjunctiva,A,,1.84,2.79,,1.90,,0.15,4.78,3.89,0,010,0.10,0.80,0.10,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,54068200,,Treat eyelid by injection,A,,0.48,0.72,,0.35,,0.04,1.24,0.87,0,000,0.00,0.00,0.00,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,54168320,,Revise/graft eyelid lining,A,,6.47,15.39,,7.04,,0.51,22.37,14.02,0,090,0.10,0.70,0.20,2,1,1,1,0,9,,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