$549.76
This code is for a nonperforating scleral wound; 65275 is used for a nonperforating corneal laceration.
On this page
CMS RVU26D · Effective 2026-10-01
65290 Scleral wound repair Medicare reimbursement rates in Tennessee
Repair a nonperforating laceration of the sclera, typically during surgical treatment of eye trauma when the wound does not enter the globe. Compare 65290 office and facility rates across CMS payment localities in Tennessee.
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 65290 in Tennessee?
Tennessee 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
No supported rate
Facility setting
$390.67
1 of 1 localities have a supported rate.
Payment area: Tennessee
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 65290: Nonperforating scleral laceration repair
Repair a nonperforating laceration of the sclera, typically during surgical treatment of eye trauma when the wound does not enter the globe.
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.
CMS billing rules for 65290
- 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 paid only with supporting documentation.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU6.37 · 51%
- Practice expense (office) RVU5.57 · 45%
- Malpractice RVU0.49 · 4%
30
Medicare services in 2024 · #5678 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.
65290 compared with similar codes
Office rates for Tennessee, from the same CMS release.
No office rate
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.
No office rate
65285 describes repair of a perforating corneal or scleral wound with iris repositioning or resection; this code describes a nonperforating scleral wound.
$260.16
65270 repairs conjunctiva, not sclera. Base selection on the injured tissue documented in the operative report.
Compare 65290 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
Tennessee →
Office / nonfacility
Unavailable
Facility
$390.67
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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 65290 in Tennessee.
PPRRVU2026_Oct_nonQPP.csv
7,317
- Code
- 65290
- Physician work
- 6.37
- Practice expense
- 5.57
- Malpractice
- 0.49
GPCI2026.csv
95
- Locality
- Tennessee
- Physician work
- 1.000
- Practice expense
- 0.909
- Malpractice
- 0.537
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 6.37 | × 1.000 | 6.3700 |
| Practice expense | 5.57 | × 0.909 | 5.0631 |
| Malpractice | 0.49 | × 0.537 | 0.2631 |
| Total RVUs | 11.6963 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Tennessee$390.67
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 6.37 | 1 |
| Practice expense | 5.57 | 0.909 |
| Malpractice | 0.49 | 0.537 |
(6.37 × 1 + 5.57 × 0.909 + 0.49 × 0.537) × $33.4009 = $390.67
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.
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 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.
7,31465280,,Repair of eye wound,A,,8.87,7.37,NA,7.37,,0.70,16.94,16.94,0,090,0.10,0.70,0.20,2,1,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,31565285,,Repair of eye wound,A,,14.98,11.63,NA,11.63,,1.21,27.82,27.82,0,090,0.10,0.70,0.20,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,31665286,,Repair of eye wound,A,,6.46,13.96,,5.61,,0.50,20.92,12.57,0,090,0.10,0.70,0.20,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,31765290,,Repair of eye socket wound,A,,6.37,5.57,NA,5.57,,0.49,12.43,12.43,0,090,0.10,0.70,0.20,2,1,1,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,31865400,,Removal of eye lesion,A,,7.31,13.00,,7.76,,0.60,20.91,15.67,0,090,0.10,0.70,0.20,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,31965410,,Biopsy of cornea,A,,1.43,2.77,,1.05,,0.11,4.31,2.59,0,000,0.00,0.00,0.00,2,1,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,32065420,,Removal of eye lesion,A,,4.25,11.58,,5.42,,0.35,16.18,10.02,0,090,0.10,0.70,0.20,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
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
9604412,TX,31,AUSTIN,1.002,1.058,0.886
9704412,TX,20,BEAUMONT,1.000,0.910,0.929
9804412,TX,09,BRAZORIA,1.008,0.991,0.780