Billing code 68100: Conjunctival biopsyMedicare rate & RVUs in Nebraska
Reports sampling of conjunctival tissue for pathologic evaluation, commonly when an ocular surface abnormality requires diagnosis rather than complete removal.
Medicare pays $167.25 for 68100 in the office in Nebraska (Nebraska). Which amount applies depends on the service address.
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 68100 covers
Code 68100 represents removal of a conjunctival tissue sample for diagnostic examination rather than treatment by complete lesion removal. Ophthalmologists commonly use it for a suspicious conjunctival growth, pigmented area, or persistent abnormal tissue when histology is needed. The biopsy may be performed in an office or facility, and the specimen is submitted for pathologic evaluation.
Choose this service when tissue is sampled to establish a diagnosis; do not select an excision code solely because the sampled area has a particular size. The procedure note should identify the eye and conjunctival site, the tissue sampled, and the diagnostic purpose; document both eyes when bilateral. CMS assigns a 0-day global period, so same-day preoperative and postoperative care is included. In a session with multiple procedures, the highest-valued procedure is paid in full and the others at 50%. Bilateral reporting with modifier 50 is paid at 150%. Medicare does not pay assistant-at-surgery services; co-surgeons and team surgery are 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.
68100 in Nebraska
| Payment locality | Office | Facility |
|---|---|---|
| Nebraska | $167.25 | $76.31 |
How the 68100 rate is calculated
Each of 68100’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 · 68100
RVUs × geographic indexes × conversion factor
Work1.32
1.32 RVUs× 1.000 GPCI
Practice expense3.95
3.95 RVUs× 1.000 GPCI
Malpractice0.11
0.11 RVUs× 1.000 GPCI
Adjusted RVUs
5.3800
Conversion factor
$33.4009
Medicare rate
$179.70
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 68100
The CMS indicators that decide how 68100 is paid alongside other services.
CMS payment indicators · 68100
Conjunctival biopsy
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 000 | Same-day global: pre- and post-op care on the day of the procedure is 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) | 0 | Not permitted. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 0 | Physician service: no professional/technical split. |
What modifiers do to the payment
Modifier 50 · payment effect
With and without the modifier
68100 without 50 · national office
$179.70
Conjunctival biopsy
68100-50 · Bilateral: 150%
$269.55
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).
68100 compared with similar codes
Compare codes · National
5 codes, side by side
How to choose
- 68110Conjunctival excision
- Use 68100 when tissue is sampled for diagnosis. Use 68110 when the conjunctival lesion is excised and is smaller than 1 cm.
- 68115Conjunctival excision
- 68115 describes excision of a conjunctival lesion larger than 1 cm; 68100 describes diagnostic tissue sampling, not lesion size.
- 68135Lesion destruction
- 68135 is for destroying a conjunctival lesion. 68100 is for obtaining tissue for diagnostic examination.
- 68130Conjunctival excision
- 68130 describes excision of a conjunctival lesion adjacent to the sclera; 68100 describes a biopsy for diagnosis.
68100 billing questions
How does 68100 differ from 68110?
68100 represents sampling tissue to establish a diagnosis. 68110 represents excision of a conjunctival lesion smaller than 1 cm, when the service is lesion removal rather than a diagnostic sample.
Can the pathology examination be billed separately?
68100 represents obtaining the conjunctival specimen. The pathologist’s examination is a separate service and may be reported under the applicable surgical pathology code when performed.
How is a biopsy performed on both eyes reported?
Report modifier 50 when the service is bilateral and document the biopsy on each eye. CMS pays the bilateral procedure at 150%.
Is same-day preoperative or postoperative care included?
Yes. The 0-day global period includes same-day preoperative and postoperative care for the biopsy.
What happens when 68100 is performed with other procedures?
For procedures performed in the same session, CMS pays the highest-valued procedure in full and the other procedures at 50%. Assistant-at-surgery payment is 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 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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