No office rate
Choose 65285 for repair of a perforating corneal or scleral laceration. Choose 66250 when the wound being corrected is from prior surgery in the anterior segment.
On this page
CMS RVU26D · Effective 2026-10-01
66250 Eye wound repair Medicare reimbursement rates in Rhode Island
Reports surgical revision or repair of a prior operative wound in the eye’s anterior segment, such as a leaking incision after cataract surgery. Compare 66250 office and facility rates across CMS payment localities in Rhode Island.
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 66250 in Rhode Island?
Rhode Island has 1 payment locality in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the payment area shown below, using the same CMS release.
Office / nonfacility
$770.49
1 of 1 localities have a supported rate.
Payment area: Rhode Island
One mapped payment locality.
Facility setting
$487.91
1 of 1 localities have a supported rate.
Payment area: Rhode Island
One mapped payment locality.
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 66250: Anterior segment operative wound repair
Reports surgical revision or repair of a prior operative wound in the eye’s anterior segment, such as a leaking incision after cataract surgery.
66250 is used when a surgeon revises or repairs a prior surgical wound in the anterior segment, rather than performing a new primary operation or repairing a traumatic laceration. Typical cases include correcting a leaking or poorly healing incision after cataract or glaucoma surgery. An ophthalmologist performs the work in a surgical setting. The operative report should identify the prior procedure, the anterior-segment wound problem, and the corrective work performed.
CMS classifies this as major surgery with a 90-day global period: the day-before preoperative visit and related postoperative care during the 90 days are included. When other 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. For bilateral surgery reported with modifier 50, CMS pays 150%. Assistant-at-surgery payment is restricted; co-surgeons and team surgery are not permitted.
CMS billing rules for 66250
- 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 not permitted.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU6.92 · 31%
- Practice expense (office) RVU15.03 · 67%
- Malpractice RVU0.55 · 2%
8.7K
Medicare services in 2024 · #1550 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.
66250 compared with similar codes
Office rates for Rhode Island, from the same CMS release.
No office rate
66172 describes glaucoma filtration surgery in an eye with scarring from prior surgery or trauma. 66250 is for correcting a prior operative wound, not performing that glaucoma procedure.
Compare 66250 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.
1 of 1 payment localities
Rhode Island →
Office / nonfacility
$770.49
Facility
$487.91
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How this local rate is calculated
Each RVU component is multiplied by its own geographic practice cost index (GPCI). The three adjusted components are added, then multiplied by the conversion factor. These are the inputs used for 66250 in Rhode Island.
PPRRVU2026_Oct_nonQPP.csv
7,376
- Code
- 66250
- Physician work
- 6.92
- Practice expense
- 15.03
- Malpractice
- 0.55
GPCI2026.csv
92
- Locality
- Rhode Island
- Physician work
- 1.019
- Practice expense
- 1.033
- Malpractice
- 0.892
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 6.92 | × 1.019 | 7.0515 |
| Practice expense | 15.03 | × 1.033 | 15.5260 |
| Malpractice | 0.55 | × 0.892 | 0.4906 |
| Total RVUs | 23.0681 | ||
| Conversion factor | × 33.4009 | ||
Office / nonfacility rate, Rhode Island$770.49
Explore RVUs, geographic factors and the full formula
Office / nonfacility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 6.92 | 1.019 |
| Practice expense | 15.03 | 1.033 |
| Malpractice | 0.55 | 0.892 |
(6.92 × 1.019 + 15.03 × 1.033 + 0.55 × 0.892) × $33.4009 = $770.49
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 6.92 | 1.019 |
| Practice expense | 6.84 | 1.033 |
| Malpractice | 0.55 | 0.892 |
(6.92 × 1.019 + 6.84 × 1.033 + 0.55 × 0.892) × $33.4009 = $487.91
The office and facility calculations use their respective practice-expense RVUs. The facility amount here is the physician fee, not a separate hospital or facility bill.
66250 billing questions
When should 66250 be chosen instead of a traumatic wound repair code?
Use 66250 for revision or repair of a prior operative wound in the anterior segment. Traumatic corneal or scleral lacerations are reported with the applicable injury-repair code.
Are routine postoperative visits separately reported?
Related postoperative care during the 90-day global period is included, as is the preoperative visit on the day before surgery.
How is bilateral repair handled?
When both eyes are treated and the service is reported with modifier 50, CMS pays 150%.
Can an assistant surgeon or co-surgeon be billed?
CMS does not pay an assistant at surgery for this code. Co-surgeons and team surgery are not permitted.
What if another procedure is performed in the same session?
CMS pays the highest-valued procedure in full and applies the standard multiple-procedure reduction to the other procedures.
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.
7,37366184,,Revision of aqueous shunt,A,,9.34,10.47,NA,10.47,,0.75,20.56,20.56,0,090,0.10,0.70,0.20,2,1,2,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,37466185,,Revise aqueous shunt eye,A,,10.32,10.81,NA,10.81,,0.83,21.96,21.96,0,090,0.10,0.70,0.20,2,1,2,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,37566225,,Repair/graft eye lesion,A,,12.31,10.44,NA,10.44,,1.00,23.75,23.75,0,090,0.10,0.70,0.20,2,1,1,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,37666250,,Follow-up surgery of eye,A,,6.92,15.03,,6.84,,0.55,22.50,14.31,0,090,0.10,0.70,0.20,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,37766500,,Incision of iris,A,,3.73,6.53,NA,6.53,,0.29,10.55,10.55,0,090,0.10,0.70,0.20,2,1,1,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,37866505,,Incision of iris,A,,4.11,7.01,NA,7.01,,0.34,11.46,11.46,0,090,0.10,0.70,0.20,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,37966600,,Remove iris and lesion,A,,9.87,13.03,NA,13.03,,0.79,23.69,23.69,0,090,0.10,0.70,0.20,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
8912502,PA,01,METROPOLITAN PHILADELPHIA,1.018,1.041,1.193
9012502,PA,99,REST OF PENNSYLVANIA,1.000,0.918,0.945
9109202,PR,20,PUERTO RICO,1.000,1.011,0.985
9214412,RI,01,RHODE ISLAND,1.019,1.033,0.892
9311202,SC,01,SOUTH CAROLINA,1.000,0.924,0.850
9403402,SD,02,SOUTH DAKOTA**,1.000,1.000,0.336
9510312,TN,35,TENNESSEE,1.000,0.909,0.537