CPT 65235
Global 090 ActiveRemove foreign body from eye
CPT 65235 Billing & Documentation Guide
CPT code 65235 (Remove foreign body from eye) is classified under Surgery (Endocrine/Nervous/Eye/Ear) with a global period indicator of 090. The 2026 Medicare Physician Fee Schedule assigns a work RVU of 8.78, a non-facility practice expense RVU of 9.54, and a malpractice RVU of 0.71, a total non-facility RVU of 19.03 and facility RVU of 19.03. With the current conversion factor of $33.4009, the national average non-facility reimbursement is approximately $652.1, though rates vary from $579.19 to $797.72 based on MAC locality and Geographic Practice Cost Indices (GPCIs).
When billing 65235, ensure documentation supports medical necessity and the specific components required for the code's level of service. For E/M codes, document MDM (medical decision-making) elements: problems addressed, data reviewed, and risk. For procedural codes, document the indication, technique, and any complications. Always verify NCCI edits before bundling 65235 with related codes; this code has 10 PTP bundling relationships on file (see table below).
Payment Status & Global Period
Active code (paid under MPFS)
90-day global period (major surgery: 1 day pre-op + procedure + 90 days post-op)
MUE Limit (Medically Unlikely Edits)
Submitting more than 1 units of 65235 for the same patient on the same date triggers automatic line denial unless an appropriate modifier and supporting documentation justify the higher quantity.
RVU Breakdown, CPT 65235
| Component | Non-Facility | Facility |
|---|---|---|
| Work RVU | 8.78 | 8.78 |
| Practice Expense RVU | 9.54 | 9.54 |
| Malpractice RVU | 0.71 | 0.71 |
| Total RVU | 19.03 | 19.03 |
| Conversion Factor | $33.4009 | |
2026 Medicare Reimbursement by State, CPT 65235
State-level averages across all MAC localities. Non-facility rates typically apply to office-based services; facility rates apply to hospital outpatient / inpatient.
| State | Non-Facility | Facility | Range (Non-Fac) | Localities |
|---|---|---|---|---|
| California | $693.67 | $693.67 | $660.19 - $797.72 | 29 |
| Florida | $659.13 | $659.13 | $633.53 - $684.94 | 3 |
| Georgia | $626.06 | $626.06 | $605.76 - $646.36 | 2 |
| Illinois | $647.5 | $647.5 | $621.25 - $669.98 | 4 |
| Michigan | $625.85 | $625.85 | $610.96 - $640.73 | 2 |
| North Carolina | $605.71 | $605.71 | $605.71 - $605.71 | 1 |
| New York | $694.88 | $694.88 | $612.64 - $734.94 | 5 |
| Ohio | $608.09 | $608.09 | $608.09 - $608.09 | 1 |
| Pennsylvania | $633.37 | $633.37 | $608.19 - $658.54 | 2 |
| Texas | $630.61 | $630.61 | $605.26 - $651.98 | 8 |
Source: CMS PFSRVU 2026 · Updated 2026-04-01. Full locality-level detail available for all 53 states, contact us for custom reports.
NCCI Bundling Edits, CPT 65235
Procedure-to-procedure (PTP) edits. If you bill any of these codes with 65235 on the same date of service, review the modifier indicator and payer policy before submission.
| Partner Code | Relationship | Modifier Allowed | Rationale |
|---|---|---|---|
| 0213T | Column 1 (primary), can be billed with modifier | No | Misuse of Column Two code with Column One code |
| 0216T | Column 1 (primary), can be billed with modifier | No | Misuse of Column Two code with Column One code |
| 0228T | Column 1 (primary), can be billed with modifier | No | Standards of medical/surgical practice |
| 0230T | Column 1 (primary), can be billed with modifier | No | Standards of medical/surgical practice |
| 0596T | Column 1 (primary), can be billed with modifier | Yes | Standards of medical/surgical practice |
| 0597T | Column 1 (primary), can be billed with modifier | Yes | Standards of medical/surgical practice |
| 0708T | Column 1 (primary), can be billed with modifier | Yes | Standards of medical/surgical practice |
| 0709T | Column 1 (primary), can be billed with modifier | Yes | Standards of medical/surgical practice |
| 0903T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 0904T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
Frequently Asked Questions, CPT 65235
What does CPT code 65235 mean? +
CPT code 65235 represents: Remove foreign body from eye. It's in the Surgery (Endocrine/Nervous/Eye/Ear) category with a global period of 090.
What is the Medicare reimbursement for CPT 65235? +
The 2026 Medicare national average non-facility payment for CPT 65235 is $652.1. Rates range from $579.19 to $797.72 across 53 states depending on MAC locality and GPCIs.
What modifiers can I use with CPT 65235? +
Surgery codes commonly use modifier 22 (increased procedural services), 50 (bilateral), 51 (multiple procedures), 52 (reduced services), 58/78/79 (staged, unplanned return, unrelated within global), 62 (co-surgeons), 80/82 (assistant surgeon), and 59 or the X{EPSU} subset for distinct procedural service.
What bundling edits apply to CPT 65235? +
This code has 10 NCCI PTP bundling relationships. See the NCCI Bundling section below for full list.
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Reviewed by the PayerReady Medical Coding Team
Verified against the CMS 2026 code set on April 17, 2026.
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