$256.28–$269.31
Use 68100 when tissue is sampled for diagnosis. Use 68110 when the conjunctival lesion is excised and is smaller than 1 cm.
On this page
CMS RVU26D · Effective 2026-10-01
68100 Conjunctival biopsy Medicare reimbursement rates in New Jersey
Reports sampling of conjunctival tissue for pathologic evaluation, commonly when an ocular surface abnormality requires diagnosis rather than complete removal. Compare 68100 office and facility rates across CMS payment localities in New Jersey.
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 68100 in New Jersey?
New Jersey 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
$193.95–$203.83
2 of 2 localities have a supported rate.
Facility setting
$86.36–$89.54
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.
Ophthalmology procedure
About 68100: Conjunctival tissue biopsy
Reports sampling of conjunctival tissue for pathologic evaluation, commonly when an ocular surface abnormality requires diagnosis rather than complete removal.
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.
CMS billing rules for 68100
- Global period
- Minor procedure with a 0-day global period: same-day preoperative and postoperative care is 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 RVU1.32 · 25%
- Practice expense (office) RVU3.95 · 73%
- Malpractice RVU0.11 · 2%
1.3K
Medicare services in 2024 · #2809 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.
68100 compared with similar codes
Office rates for New Jersey, from the same CMS release.
$357.41–$375.77
68115 describes excision of a conjunctival lesion larger than 1 cm; 68100 describes diagnostic tissue sampling, not lesion size.
$171.17–$178.78
68135 is for destroying a conjunctival lesion. 68100 is for obtaining tissue for diagnostic examination.
$596.90–$625.84
68130 describes excision of a conjunctival lesion adjacent to the sclera; 68100 describes a biopsy for diagnosis.
Compare 68100 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
Northern Nj →
Office / nonfacility
$203.83
Facility
$89.54
Rest Of New Jersey →
Office / nonfacility
$193.95
Facility
$86.36
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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 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.
7,53267999,,Unlisted procedure eyelids,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
7,53368020,,Incise/drain eyelid lining,A,,1.38,2.16,,1.37,,0.09,3.63,2.84,0,010,0.10,0.80,0.10,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,53468040,,Treatment of eyelid lesions,A,,0.83,0.98,,0.32,,0.04,1.85,1.19,0,000,0.00,0.00,0.00,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,53568100,,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