No office rate
Both codes describe scleral reinforcement; the graft distinction is the key selection point. Use 67250 when no graft material is used.
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CMS RVU26D · Effective 2026-10-01
67250 Scleral reinforcement Medicare reimbursement rates in Michigan
An ophthalmic surgeon strengthens the scleral wall without graft material, typically for progressive scleral weakness associated with pathologic myopia. Compare 67250 office and facility rates across CMS payment localities in Michigan.
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 67250 in Michigan?
Michigan has 2 payment localities in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the 2 payment areas shown below, using the same CMS release.
Office / nonfacility
No supported rate
Facility setting
$759.03–$796.78
2 of 2 localities have a supported rate.
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 67250: Scleral reinforcement without graft
An ophthalmic surgeon strengthens the scleral wall without graft material, typically for progressive scleral weakness associated with pathologic myopia.
This operation strengthens the eye’s scleral wall without using graft material. Ophthalmologists may perform it for progressive scleral weakness or ectasia, including in patients with pathologic myopia. It is generally an operating-room service, not a treatment for a retinal lesion or a retinal detachment repair. The operative report should identify the eye, the condition prompting reinforcement, and the technique used.
Choose this code when the service is scleral reinforcement without a graft; use the graft distinction to evaluate 67255 instead. Documentation should make clear what was reinforced and whether graft material was used. CMS assigns a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. For multiple procedures in one session, the highest-valued procedure is paid in full and the others at 50%. Bilateral reporting with modifier 50 is paid at 150%. Assistant-at-surgery payment is restricted; co-surgeon payment requires supporting documentation, and team surgery is not permitted.
CMS billing rules for 67250
- 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 RVU9.37 · 39%
- Practice expense (office) RVU13.70 · 58%
- Malpractice RVU0.75 · 3%
42
Medicare services in 2024 · #5473 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.
67250 compared with similar codes
Office rates for Michigan, from the same CMS release.
No office rate
This code is for retinal detachment repair using scleral buckling. It does not represent reinforcement of the scleral wall for scleral weakness.
67299
No office rateUnlisted px posterior segmnt
This is an unlisted posterior-segment procedure code. Use the specific scleral reinforcement code when the documented service matches it.
Compare 67250 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.
2 of 2 payment localities
Detroit →
Office / nonfacility
Unavailable
Facility
$796.78
Rest Of Michigan →
Office / nonfacility
Unavailable
Facility
$759.03
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67250 billing questions
How is 67250 distinguished from 67255?
67250 describes scleral reinforcement without graft material. When graft material is used for the reinforcement, evaluate 67255.
Is this the code for scleral buckling to repair a retinal detachment?
No. Scleral reinforcement is distinct from a scleral buckle performed as part of retinal detachment repair. Select the code that represents the operation actually performed.
What documentation supports reporting 67250?
Document the indication, eye treated, reinforcement technique, and whether graft material was used. The operative report should support that scleral reinforcement was performed.
How is bilateral reinforcement reported?
CMS identifies this as a bilateral procedure: report modifier 50 when both eyes are treated. Bilateral payment is 150% under the stated CMS rule.
Can an assistant or co-surgeon be paid for this operation?
Assistant-at-surgery payment is subject to a statutory restriction. Co-surgeon payment is allowed only with supporting documentation; team surgery is 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.
7,44767227,,Dstrj extensive retinopathy,A,,3.41,5.21,,2.77,,0.26,8.88,6.44,0,010,0.10,0.80,0.10,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,44867228,,Treatment x10sv retinopathy,A,,4.28,5.58,,2.97,,0.35,10.21,7.60,0,010,0.10,0.80,0.10,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,44967229,,Tr retinal les preterm inf,A,,15.89,11.88,NA,11.88,,1.27,29.04,29.04,0,090,0.10,0.70,0.20,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,45067250,,Reinforce eye wall,A,,9.37,13.70,NA,13.70,,0.75,23.82,23.82,0,090,0.10,0.70,0.20,2,1,1,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,45167255,,Reinforce/graft eye wall,A,,8.17,9.04,NA,9.04,,0.65,17.86,17.86,0,090,0.10,0.70,0.20,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,45267299,,Unlisted px posterior segmnt,C,,0.00,0.00,,0.00,,0.00,0.00,0.00,0,YYY,0.00,0.00,0.00,2,1,0,1,1,9,,33.4009,09,0,99,0.00,0.00,0.00
7,45367311,,Revise eye muscle,A,,5.78,5.48,NA,5.48,,0.45,11.71,11.71,0,090,0.10,0.70,0.20,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00