No office rate
Both address perforating corneal or scleral wounds. Report 65285 when uveal tissue is repositioned or resected; 65280 describes a wound without uveal tissue involvement.
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CMS RVU26D · Effective 2026-10-01
65285 Eye wound repair Medicare reimbursement rates in Utah
Repair a full-thickness corneal or scleral wound when uveal tissue must be repositioned or resected, typically after a penetrating eye injury. Compare 65285 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 65285 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
$901.78
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.
Ophthalmic surgery
About 65285: Perforating corneoscleral laceration repair with uveal tissue
Repair a full-thickness corneal or scleral wound when uveal tissue must be repositioned or resected, typically after a penetrating eye injury.
An ophthalmologist uses this code to repair a perforating wound through the cornea, sclera, or both when uveal tissue, such as iris or ciliary tissue, has prolapsed into the wound and must be repositioned or removed. This is typically urgent surgery for an open-globe injury, performed in an operating room. The operative report should identify the wound site and full-thickness nature, describe the uveal tissue involvement, and document whether tissue was repositioned or resected.
Choose this level based on the perforating wound and the operative management of uveal tissue, rather than wound size alone. The day-before preoperative visit and 90 days of related postoperative care are included in the global period. When multiple procedures occur in the same session, the highest-valued procedure is paid in full and the others at 50%. For bilateral procedures reported with modifier 50, payment is 150%. Medicare does not pay an assistant at surgery for this service; co-surgeons and team surgery are not permitted.
CMS billing rules for 65285
- 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 RVU14.98 · 54%
- Practice expense (office) RVU11.63 · 42%
- Malpractice RVU1.21 · 4%
673
Medicare services in 2024 · #3294 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.
65285 compared with similar codes
Office rates for Utah, from the same CMS release.
$567.02
65275 is for a perforating corneal laceration that does not involve the iris or lens. Use 65285 when uveal tissue involvement requires repositioning or resection.
No office rate
65273 addresses a nonperforating corneal laceration. A full-thickness corneal or scleral wound with uveal tissue management supports 65285.
Compare 65285 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
$901.78
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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 65285 in Utah.
PPRRVU2026_Oct_nonQPP.csv
7,315
- Code
- 65285
- Physician work
- 14.98
- Practice expense
- 11.63
- Malpractice
- 1.21
GPCI2026.csv
104
- Locality
- Utah
- Physician work
- 1.000
- Practice expense
- 0.940
- Malpractice
- 0.898
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 14.98 | × 1.000 | 14.9800 |
| Practice expense | 11.63 | × 0.940 | 10.9322 |
| Malpractice | 1.21 | × 0.898 | 1.0866 |
| Total RVUs | 26.9988 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Utah$901.78
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 14.98 | 1 |
| Practice expense | 11.63 | 0.94 |
| Malpractice | 1.21 | 0.898 |
(14.98 × 1 + 11.63 × 0.94 + 1.21 × 0.898) × $33.4009 = $901.78
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.
65285 billing questions
How does this differ from 65280?
Use 65285 when the perforating corneal or scleral wound involves uveal tissue that is repositioned or resected. Code 65280 is for a perforating wound without uveal tissue involvement.
Can a nonperforating corneal wound be reported with 65285?
No. This code describes repair of a perforating wound with uveal tissue management; a nonperforating corneal laceration belongs to a different repair level.
What documentation supports the code?
Document the corneal or scleral wound as perforating, describe the uveal tissue involvement, and state whether that tissue was repositioned or resected.
Is related postoperative care separately reported?
The day-before preoperative visit and 90 days of related postoperative care are included in the 90-day global period.
Can an assistant or co-surgeon be reported?
Medicare does not pay an assistant at surgery for this code. Co-surgeons and team surgery are not permitted.
How is bilateral repair handled?
When the procedure is performed bilaterally and reported with modifier 50, CMS pays at 150%.
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.
7,31265273,,Repair of eye wound,A,,5.03,4.18,NA,4.18,,0.40,9.61,9.61,0,090,0.10,0.70,0.20,2,1,1,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,31365275,,Repair of eye wound,A,,6.13,11.08,,5.03,,0.48,17.69,11.64,0,090,0.10,0.70,0.20,2,1,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,31465280,,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
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