Billing code 65101: Eye removalMedicare rate & RVUs in Virginia
Reports surgical removal of the entire globe without placement of an orbital implant, such as for an eye with a painful blind condition or intraocular disease.
CMS doesn’t publish an office rate for 65101 in Virginia.
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 65101 covers
This procedure removes the entire eyeball while leaving the surrounding orbital tissues in place; no orbital implant is placed during the operation. An ophthalmologist, often an oculoplastic surgeon, typically performs it in an operating room. Clinical situations may include a painful, blind eye or an eye affected by disease requiring removal. The operative note should establish that the globe was removed intact rather than its contents evacuated, and document that no implant was placed.
Report the code for the eye treated and support the service with the indication, operative findings, and implant status. The major-surgery global period includes the day-before preoperative visit and 90 days of related postoperative care. When multiple procedures are performed in the same session, the highest-valued procedure is paid in full and the others are subject to the standard multiple-procedure reduction. For bilateral surgery, modifier 50 is paid at 150%. Medicare does not pay an assistant at surgery for this code; co-surgeons and team surgery are 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.
Where 65101 pays more and less in Virginia
| Payment locality | Office | Facility |
|---|---|---|
| Dc + Md/Va Suburbs | Unavailable | $859.84 |
| Virginia | Unavailable | $745.30 |
How the 65101 rate is calculated
Each of 65101’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 · 65101
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 8.09Practice expense 14.01Malpractice 0.64
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 65101
65101 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 65101
Eye removal
| 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) | 0 | Not permitted. |
| 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 · 65101
Eye removal
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
65101 without 50 · national facility
$759.54
Eye removal
65101-50 · Bilateral: 150%
$1,139.31
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).
65101 compared with similar codes
Compare codes
65101 vs 65103 vs 65105 vs 65110: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 65103Eye removal
- Both codes describe enucleation, but 65103 includes placement of an orbital implant with muscles attached to it; 65101 is for removal without an implant.
- 65105Eye removal
- Use 65105 for enucleation with an orbital implant and its specified muscle-management approach. Use 65101 when no implant is placed.
- 65110Eye removal
- 65110 describes evisceration, which removes the ocular contents but leaves the scleral shell. Code 65101 represents removal of the entire globe.
65101 billing questions
How does this differ from enucleation with an implant?
Use 65101 when the entire globe is removed and no orbital implant is placed during the operation. Codes 65103 and 65105 describe enucleation with an implant.
How do I distinguish this from evisceration?
Enucleation removes the entire globe. Evisceration removes the contents while retaining the scleral shell, so it is not reported with 65101.
Is routine postoperative care separately billable?
Related postoperative care during the 90-day global period is included, as is the day-before preoperative visit.
What is the bilateral payment rule?
When both eyes are treated, report modifier 50; CMS pays the bilateral procedure at 150% under the supplied rule.
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.
What documentation supports choosing 65101?
Document removal of the entire globe, the clinical indication, the eye treated, and that no orbital implant was placed.
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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