Billing code 67560: Socket implant revisionMedicare rate & RVUs in Washington
Reports surgical correction of an existing orbital implant, such as for displacement or exposure, in a patient with an anophthalmic socket.
CMS doesn’t publish an office rate for 67560 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 67560 covers
An ophthalmologist, often an oculoplastic surgeon, reports this service when surgically correcting an implant already present in the socket after enucleation or evisceration. Clinical situations may include implant displacement, exposure, or an unsatisfactory socket contour related to the implant. The work is typically performed in an operating room, including a hospital outpatient department or ambulatory surgery center.
The operative report should identify the existing implant, the side, the problem being corrected, and the revision performed. Distinguish correction of an existing implant from initial implant placement or removal without revision. This major surgery has a 90-day global period: the day-before preoperative visit and 90 days of related postoperative care are included. For bilateral work, modifier 50 is paid at 150%. When multiple procedures are performed in the same session, the highest-valued procedure is paid in full and other procedures at 50%. Assistant-at-surgery payment requires documented medical necessity; 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 67560 pays more and less in Washington
| Payment locality | Office | Facility |
|---|---|---|
| Rest Of Washington | Unavailable | $1,001.14 |
| Seattle (King Cnty) | Unavailable | $1,112.36 |
How the 67560 rate is calculated
Each of 67560’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 · 67560
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 11.88Practice expense 16.27Malpractice 1.06
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 67560
67560 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 67560
Socket implant revision
| 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) | 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 · 67560
Socket implant revision
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
67560 without 50 · national facility
$975.64
Socket implant revision
67560-50 · Bilateral: 150%
$1,463.46
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).
67560 compared with similar codes
Compare codes
67560 vs 67550 vs 65175 vs 67599: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 67550Orbital implant
- 67550 is for placing an orbital implant. Choose 67560 when the patient already has an implant and the surgeon revises it.
- 65175Ocular implant removal
- 65175 describes removal of an ocular implant. Use 67560 when the service includes surgical correction of the existing socket implant rather than removal alone.
- 67599Unlisted procedure orbit
- 67599 is for orbital work without a specific listed code. Use 67560 when the documented service is revision of an existing socket implant.
67560 billing questions
When should 67560 be chosen instead of 67550?
Use 67560 for surgical correction of an implant already in the socket. Code 67550 describes placing an orbital implant, not revising an existing one.
Does removing an implant alone support 67560?
No. If the service is removal without revision, consider 65175; the operative report should make clear whether the implant was corrected or removed.
What documentation supports the revision?
Document the implant's presence and side, the clinical problem such as displacement or exposure, and the corrective work performed.
How is bilateral revision reported?
For revision on both sides, report modifier 50; CMS pays the bilateral procedure at 150%.
How are other procedures in the same session paid?
The highest-valued procedure is paid in full and other procedures are paid at 50% under the standard multiple-procedure reduction.
Can an assistant or co-surgeon be reported?
Assistant-at-surgery payment requires documentation of medical necessity. Co-surgeons and team surgery are not permitted for this code.
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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