Billing code 65290: Scleral wound repairMedicare rate & RVUs in Nebraska
Repair a nonperforating laceration of the sclera, typically during surgical treatment of eye trauma when the wound does not enter the globe.
CMS doesn’t publish an office rate for 65290 in Nebraska.
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 65290 covers
This service repairs a cut in the sclera, the tough outer coat of the eye, when the wound does not pass through the full thickness of the wall. An ophthalmologist generally performs the repair in an operating room, often as part of urgent treatment for blunt or penetrating-area trauma that has caused a superficial scleral wound. The operative record should identify the wound site and depth and describe the repair performed; a corneal or conjunctival wound is coded according to its own tissue and repair category.
Report the code for the nonperforating scleral repair, supported by documentation that distinguishes it from a full-thickness injury. It has a 90-day global period, including the day-before preoperative visit and related postoperative care during that period. 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 multiple-procedure reduction. Bilateral reporting with modifier 50 is paid at 150%. Medicare does not pay an assistant at surgery; co-surgeon payment requires 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.
65290 in Nebraska
| Payment locality | Office | Facility |
|---|---|---|
| Nebraska | Unavailable | $390.67 |
How the 65290 rate is calculated
Each of 65290’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 · 65290
RVUs × geographic indexes × conversion factor
Work6.37
6.37 RVUs× 1.000 GPCI
Practice expense5.57
5.57 RVUs× 1.000 GPCI
Malpractice0.49
0.49 RVUs× 1.000 GPCI
Adjusted RVUs
12.4300
Conversion factor
$33.4009
Medicare rate
$415.17
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 65290
65290 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 65290
Scleral wound repair
| 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 · 65290
Scleral wound repair
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
65290 without 50 · national facility
$415.17
Scleral wound repair
65290-50 · Bilateral: 150%
$622.76
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).
65290 compared with similar codes
Compare codes · National
5 codes, side by side
How to choose
- 65275Corneal wound repair
- This code is for a nonperforating scleral wound; 65275 is used for a nonperforating corneal laceration.
- 65280Eye wound repair
- Choose 65280 for a perforating corneal or scleral injury when iris repositioning or resection is not part of the repair. This code is for a nonperforating scleral wound.
- 65285Eye wound repair
- 65285 describes repair of a perforating corneal or scleral wound with iris repositioning or resection; this code describes a nonperforating scleral wound.
- 65270Eye wound repair
- 65270 repairs conjunctiva, not sclera. Base selection on the injured tissue documented in the operative report.
65290 billing questions
How is this code distinguished from a perforating eye-wall repair?
Use this code for a scleral wound that does not extend through the full thickness of the eye wall. A documented full-thickness injury is classified among the perforating repair codes.
Would a corneal or conjunctival laceration use this code?
No. Select the repair code for the tissue actually injured; scleral repair is distinct from repair of a corneal or conjunctival laceration.
What documentation supports reporting this repair?
Document the scleral wound's location and depth and the repair performed. The record should make clear that the wound is nonperforating.
How does the 90-day global period affect follow-up billing?
The day-before preoperative visit and related postoperative care during the 90-day period are included in the global package.
How are bilateral repairs and multiple procedures handled?
Bilateral reporting with modifier 50 is paid at 150%. For multiple procedures in one session, the highest-valued procedure is paid in full and the others are subject to the standard multiple-procedure reduction.
Can an assistant or co-surgeon be reported?
Medicare does not pay an assistant at surgery for this service. Co-surgeons are paid 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 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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