Billing code 66225: Scleral repairMedicare rate & RVUs in Ohio
Reports surgical repair of a scleral staphyloma using graft material to reinforce or reconstruct the weakened area of the eye wall.
CMS doesn’t publish an office rate for 66225 in Ohio.
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 66225 covers
An ophthalmic surgeon uses graft material to repair a scleral staphyloma, an abnormal outward bulging of weakened sclera. The graft reinforces or reconstructs the affected area; the specific material and technique depend on the operative findings. This is a major eye operation generally performed in a surgical setting, rather than a minor office repair.
Report this code when the operative documentation supports repair of a scleral staphyloma and use of a graft. The record should identify the affected eye, the staphyloma, the repair performed, and the graft used. CMS assigns a 90-day global period, including the day-before preoperative visit and related postoperative care during the following 90 days. For bilateral procedures, modifier 50 is paid at 150%. When multiple procedures occur in one session, the highest-valued procedure is paid in full and others at 50%. An assistant at surgery is not paid; 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.
66225 in Ohio
| Payment locality | Office | Facility |
|---|---|---|
| Ohio | Unavailable | $763.20 |
How the 66225 rate is calculated
Each of 66225’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 · 66225
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 12.31Practice expense 10.44Malpractice 1.00
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 66225
66225 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 66225
Scleral 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 · 66225
Scleral 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
66225 without 50 · national facility
$793.27
Scleral repair
66225-50 · Bilateral: 150%
$1,189.91
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).
66225 compared with similar codes
Compare codes
66225 vs 66250 vs 67255: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 66250Eye wound repair
- 66250 addresses revision or repair of an operative wound of the anterior segment, such as a leaking fistula. Use 66225 for repair of a scleral staphyloma with a graft.
- 67255Scleral reinforcement
- 67255 describes scleral reinforcement with a graft for an indication other than repair of a scleral staphyloma. The diagnosis and operative purpose distinguish it from 66225.
66225 billing questions
When should 66225 be chosen instead of 66220?
Use 66225 when the scleral staphyloma repair includes a graft. The corresponding repair without a graft is reported with 66220.
What documentation supports reporting 66225?
Document the scleral staphyloma, the eye treated, the repair performed, and the graft used. The operative note should make clear that the graft was part of the staphyloma repair.
Does the 90-day global period include routine postoperative care?
Yes. CMS includes the day-before preoperative visit and 90 days of related postoperative care in the global period.
How is bilateral repair reported?
CMS identifies this as a bilateral procedure; modifier 50 is paid at 150%. The documentation should support repair of both eyes.
Can an assistant or co-surgeon be reported?
CMS does not pay an assistant at surgery for this code. Co-surgeon payment requires supporting documentation, and team surgery is not permitted.
What happens when another procedure is performed in the same session?
Under the standard multiple procedure reduction, the highest-valued procedure is paid in full and other procedures are paid at 50%.
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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