No office rate
Both report ocular implant insertion. Choose 65130 when the extraocular muscles are attached to the implant; choose 65135 when they are not.
On this page
CMS RVU26D · Effective 2026-10-01
65130 Ocular implant insertion Medicare reimbursement rates in Utah
Reports insertion of an ocular implant with extraocular muscles attached, typically when placing an implant in an anophthalmic socket. Compare 65130 office and facility rates across CMS payment localities in Utah.
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 65130 in Utah?
Utah 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
$731.39
1 of 1 localities have a supported rate.
Payment area: Utah
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.
Ophthalmology surgery
About 65130: Ocular implant insertion with muscle attachment
Reports insertion of an ocular implant with extraocular muscles attached, typically when placing an implant in an anophthalmic socket.
An ophthalmic or oculoplastic surgeon inserts an implant into an anophthalmic socket and attaches the extraocular muscles to the implant. This is distinct from removing the eye and placing an implant during the same operation. The service is generally performed in an operating room when a patient needs implant placement in a socket after a prior eye removal or other circumstance leaving the socket without an implant.
Select this code when the operative report supports both implant insertion and attachment of the muscles; use the sibling code when the muscles are not attached. Document the socket and implant work, the muscle attachment, and whether another procedure was performed in the same session. Medicare includes the day-before preoperative visit and 90 days of related postoperative care in the global period. For multiple procedures in one session, the highest-valued procedure is paid in full and other procedures are reduced. Modifier 50 bilateral reporting is paid at 150%. Assistant-at-surgery payment is restricted; co-surgeon payment requires supporting documentation, and team surgery is not permitted.
CMS billing rules for 65130
- 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 RVU8.21 · 36%
- Practice expense (office) RVU13.94 · 61%
- Malpractice RVU0.65 · 3%
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.
65130 compared with similar codes
Office rates for Utah, from the same CMS release.
No office rate
65103 combines enucleation with implant placement. 65130 reports implant insertion into a socket without the eye-removal service.
No office rate
65140 concerns attachment of extraocular muscles to an implant. 65130 includes insertion of the implant with muscle attachment.
$434.30
65125 is for revision of an existing ocular implant, not insertion of an implant into the socket.
Compare 65130 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
Utah →
Office / nonfacility
Unavailable
Facility
$731.39
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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 65130 in Utah.
PPRRVU2026_Oct_nonQPP.csv
7,297
- Code
- 65130
- Physician work
- 8.21
- Practice expense
- 13.94
- Malpractice
- 0.65
GPCI2026.csv
104
- Locality
- Utah
- Physician work
- 1.000
- Practice expense
- 0.940
- Malpractice
- 0.898
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 8.21 | × 1.000 | 8.2100 |
| Practice expense | 13.94 | × 0.940 | 13.1036 |
| Malpractice | 0.65 | × 0.898 | 0.5837 |
| Total RVUs | 21.8973 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Utah$731.39
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 8.21 | 1 |
| Practice expense | 13.94 | 0.94 |
| Malpractice | 0.65 | 0.898 |
(8.21 × 1 + 13.94 × 0.94 + 0.65 × 0.898) × $33.4009 = $731.39
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.
65130 billing questions
How does this differ from 65135?
Use 65130 when the extraocular muscles are attached to the inserted implant. Use 65135 when the implant is inserted without attaching the muscles.
Is this the code for implant placement during enucleation?
No. When the eye is removed and an implant is placed during that operation, consider the enucleation code that includes implant placement, such as 65103 when its requirements are met.
What documentation supports reporting 65130?
The operative report should establish that an ocular implant was inserted and that the extraocular muscles were attached to it. Document the socket and any other procedures performed in the same session.
Can the surgeon report routine postoperative visits separately?
Related postoperative care during the 90-day global period is included. The day-before preoperative visit is also included.
How are bilateral procedures and assistant surgeons handled?
CMS pays bilateral reporting with modifier 50 at 150%. Assistant-at-surgery payment is restricted; 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 the 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 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.
7,29465112,,Remove eye/revise socket,A,,18.05,19.63,NA,19.63,,1.44,39.12,39.12,0,090,0.10,0.70,0.20,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,29565114,,Remove eye/revise socket,A,,19.16,20.02,NA,20.02,,1.51,40.69,40.69,0,090,0.10,0.70,0.20,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,29665125,,Revise ocular implant,A,,3.19,10.20,,4.37,,0.25,13.64,7.81,0,090,0.10,0.70,0.20,2,1,1,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,29765130,,Insert ocular implant,A,,8.21,13.94,NA,13.94,,0.65,22.80,22.80,0,090,0.10,0.70,0.20,2,1,1,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,29865135,,Insert ocular implant,A,,8.39,14.01,NA,14.01,,0.66,23.06,23.06,0,090,0.10,0.70,0.20,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,29965140,,Attach ocular implant,A,,9.22,14.74,NA,14.74,,0.73,24.69,24.69,0,090,0.10,0.70,0.20,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,30065150,,Revise ocular implant,A,,6.27,12.11,NA,12.11,,0.48,18.86,18.86,0,090,0.10,0.70,0.20,2,1,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
10104412,TX,15,GALVESTON,1.008,0.993,0.828
10204412,TX,18,HOUSTON,1.008,0.993,1.376
10304412,TX,99,REST OF TEXAS,1.000,0.949,0.903
10403502,UT,09,UTAH,1.000,0.940,0.898
10514512,VT,50,VERMONT,1.000,0.990,0.506
10611302,VA,00,VIRGINIA,1.000,0.983,0.706
10709202,VI,50,VIRGIN ISLANDS,1.000,1.011,0.985