Billing code 67255: Scleral reinforcementMedicare rate & RVUs in Washington
Report scleral reinforcement with graft when an ophthalmic surgeon surgically strengthens the eye wall using graft material, rather than reinforcement without a graft.
CMS doesn’t publish an office rate for 67255 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 67255 covers
An ophthalmic surgeon uses this procedure to strengthen the sclera with graft material, such as when the eye wall is markedly thin or weakened. It is an operative service typically performed in a surgical setting, not a treatment for a retinal or choroidal lesion. The operative report should establish the reason for reinforcement and describe the graft and the work performed on the sclera.
Choose this code when graft material is used for the reinforcement; the corresponding procedure without a graft is 67250. The documentation should make that distinction clear and support the medical need for the operation. CMS assigns a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. When other procedures are performed in the same session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% multiple-procedure reduction. Bilateral reporting with modifier 50 is paid at 150%. An assistant at surgery may be paid; co-surgeon payment requires supporting documentation, and 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 67255 pays more and less in Washington
| Payment locality | Office | Facility |
|---|---|---|
| Rest Of Washington | Unavailable | $610.90 |
| Seattle (King Cnty) | Unavailable | $674.75 |
How the 67255 rate is calculated
Each of 67255’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 · 67255
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 8.17Practice expense 9.04Malpractice 0.65
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 67255
67255 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 67255
Scleral reinforcement
| 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) | 2 | Paid. |
| 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 · 67255
Scleral reinforcement
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
67255 without 50 · national facility
$596.54
Scleral reinforcement
67255-50 · Bilateral: 150%
$894.81
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).
67255 compared with similar codes
Compare codes
67255 vs 67250 vs 67107 vs 67299: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 67250Scleral reinforcement
- Both codes describe scleral reinforcement. Choose 67255 when graft material is used and 67250 when reinforcement is performed without a graft.
- 67107Retinal detachment repair
- 67107 describes retinal detachment repair using a scleral buckling approach. It is not a substitute for graft-based scleral reinforcement of a weakened eye wall.
- 67299Unlisted px posterior segmnt
- Use 67299 only when a posterior-segment procedure lacks a specific code. Graft-based scleral reinforcement has the specific code 67255.
67255 billing questions
How do I choose between 67255 and 67250?
Use 67255 when graft material is used to reinforce the sclera. Use 67250 for scleral reinforcement without a graft.
What documentation supports 67255?
Document the indication for scleral reinforcement, the operative work on the eye wall, and the use of graft material. The operative note should distinguish the procedure from reinforcement without a graft.
Does the 90-day global include postoperative visits?
It includes the day-before preoperative visit and 90 days of related postoperative care.
How is bilateral 67255 reported?
Report bilateral surgery with modifier 50. CMS pays the bilateral procedure at 150%.
Can an assistant or co-surgeon be reported?
An assistant at surgery may be paid. Co-surgeon payment requires supporting documentation; team surgery is not permitted.
How does the multiple-procedure reduction affect 67255?
When other procedures are performed in the same session, CMS pays the highest-valued procedure in full and reduces the others to 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 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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