Billing code 65091: Eye eviscerationMedicare rate & RVUs in Washington
Reports removal of intraocular contents while preserving the scleral shell, without placing an orbital implant during the procedure.
CMS doesn’t publish an office rate for 65091 in Washington.
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 65091 covers
An ophthalmologist removes the contents of the eye while preserving its outer scleral shell; no orbital implant is placed during this procedure. It may be performed in an operating room for a blind, painful eye or a severely infected or traumatized eye when removal is selected. Evisceration differs from enucleation, which removes the globe itself.
Report this code when the operative record supports evisceration without implant placement, rather than evisceration with an implant or enucleation. Documentation should identify the eye, the procedure performed, and whether an implant was placed. Medicare assigns a 90-day global period, including the day-before preoperative visit and related postoperative care. For multiple procedures in one session, the highest-valued procedure is paid in full and others at 50%; bilateral reporting with modifier 50 is paid at 150%. Assistant-at-surgery payment requires medical-necessity documentation, and co-surgeon payment requires supporting documentation. Team surgery is 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 65091 pays more and less in Washington
| Payment locality | Office | Facility |
|---|---|---|
| Rest Of Washington | Unavailable | $682.87 |
| Seattle (King Cnty) | Unavailable | $763.58 |
How the 65091 rate is calculated
Each of 65091’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 · 65091
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 7.08Practice expense 12.20Malpractice 0.56
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 65091
65091 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 65091
Eye evisceration
| 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) | 0 | Not paid without supporting documentation. |
| Co-surgeons (62) | 1 | Permitted with supporting documentation. |
| 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 · 65091
Eye evisceration
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
65091 without 50 · national facility
$662.67
Eye evisceration
65091-50 · Bilateral: 150%
$994.01
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).
65091 compared with similar codes
Compare codes
65091 vs 65093 vs 65101 vs 65103: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 65093Eye evisceration
- Both describe evisceration, but 65093 includes placement of an orbital implant; 65091 is for the procedure without an implant.
- 65101Eye removal
- 65101 describes enucleation without an implant, removing the globe. 65091 removes intraocular contents while preserving the scleral shell.
- 65103Eye removal
- 65103 describes enucleation with an implant. 65091 describes evisceration without implant placement.
65091 billing questions
How is 65091 distinguished from 65093?
65091 describes evisceration without an implant. Use 65093 when an implant is placed as part of the evisceration.
When is enucleation reported instead?
Enucleation removes the globe rather than emptying its contents while leaving the scleral shell. Select the enucleation code when that is the operation documented.
Can an orbital implant be billed separately with 65091?
65091 describes the procedure without implant placement. If an implant is placed during evisceration, the with-implant code 65093 distinguishes that service.
What postoperative care is included?
The 90-day global period includes the day-before preoperative visit and related postoperative care for 90 days.
How does Medicare handle bilateral reporting?
Bilateral reporting with modifier 50 is paid at 150% under the CMS facts for this code.
What documentation supports assistant or co-surgeon payment?
Assistant-at-surgery payment requires documentation of medical necessity. Co-surgeon payment requires 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 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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