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See a sample rate comparisonCPT 68130 Fee Schedule
Last Verified: October 2026
Healthcare providers use this code to document and receive reimbursement for visits that address moderate-level medical decision-making, often including multiple diagnoses or prescription management.
Remove Growth From The Eye, Surgery To Remove A Growth Of Abnormal Tissue From The Clear Covering Of The Eye (Conjunctiva).
| Key Fact | Detail |
|---|---|
| Service Type | Surgery Surgical Procedures on the Eye and Ocular Adnexa |
| Common Place of Service | 19 - Off Campus Outpatient Hospital 24 - Ambulatory Surgical Center |
| Common Modifiers | None RT - Right side of body LT - Left side of body |
| Complexity Level | Moderate |
| Medicare Fee Schedule | View Medicare rates for 68130 |
| Medicaid Fee Schedule | View Medicaid rates for 68130 |
National average reimbursement for CPT 68130 by major payers:
$663.34
$690.13
$752.88
$889.57
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CPT 68130
5 of 25 sample ratesHigher to lower in this preview
West Park Surgery Center, L.P., Medical City Surgery Center/Mckinney
West Park Surgery Center Lp
$3,742.00Published ratePiedmont Asc LLC
$2,307.00Published rateGlasgow Medical Center LLC, Glasgow Ambulatory Surgery Center
Glasgow Medical Center, LLC
$1,225.00Published rateAtlantic Surgery & Laser Center LLC
Atlantic Surgery Laser Center LLC
$886.00Published rateHedwig Asc, Houston Premiersurgery Center The Villages
Hedwig Asc
$544.00Published rate
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See a sample payer proposalCPT 68130 vs. Other Surgical Procedures on the Eye and Ocular Adnexa Codes
The CPT 68130 code is part of the Surgery services used for Surgical Procedures on the Eye and Ocular Adnexa. It represents a moderate-complexity encounter and is one of several codes that vary based on time spent, level of medical decision-making, and documentation requirements.
The CPT 68130 code involves more provider time and moderate medical decision-making, unlike lower-level codes that require less time and simpler assessments. It typically includes multiple diagnoses, medication management, or test interpretation, leading to higher reimbursement and more detailed documentation requirements.
| Code | Complexity | Description |
|---|---|---|
| 68100-CPT | Moderate | Biopsy Of Eye Membrane, Surgery On The Eye Membrane (Conjunctiva) To Remove A Sample Of Tissue For Testing (Biopsy). The Conjunctiva Is A Clear Membrane That Covers The Eye. |
| 68110-CPT | Moderate | Remove Growth From The Eye, Surgery To Remove A Growth Of Abnormal Tissue From The Clear Covering Of The Eye (Conjunctiva). |
| 68115-CPT | Moderate | Remove Growth From The Eye, Surgery To Remove A Growth Of Abnormal Tissue From The Clear Covering Of The Eye (Conjunctiva). |
| 68130-CPT | Moderate | Remove Growth From The Eye, Surgery To Remove A Growth Of Abnormal Tissue From The Clear Covering Of The Eye (Conjunctiva). |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 68130. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 68130 fee schedule helps patients estimate costs and providers optimize billing for accurate reimbursements.
Factors that affect fee schedules
Medicare & Medicaid Rates
Government-set reimbursement amounts
Private Insurance Rates
Negotiated rates between providers and insurance companies
Geographic Location
Costs may be higher in urban areas.
Provider Type
Hospital providers may have different rates than private practice.
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