CPT 65260
Global 090 ActiveRemove foreign body from eye
CPT 65260 Billing & Documentation Guide
CPT code 65260 (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 12.23, a non-facility practice expense RVU of 11.93, and a malpractice RVU of 0.99, a total non-facility RVU of 25.15 and facility RVU of 25.15. With the current conversion factor of $33.4009, the national average non-facility reimbursement is approximately $861.01, though rates vary from $767.81 to $1055.33 based on MAC locality and Geographic Practice Cost Indices (GPCIs).
When billing 65260, 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 65260 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 65260 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 65260
| Component | Non-Facility | Facility |
|---|---|---|
| Work RVU | 12.23 | 12.23 |
| Practice Expense RVU | 11.93 | 11.93 |
| Malpractice RVU | 0.99 | 0.99 |
| Total RVU | 25.15 | 25.15 |
| Conversion Factor | $33.4009 | |
2026 Medicare Reimbursement by State, CPT 65260
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 | $912.57 | $912.57 | $869.89 - $1045.75 | 29 |
| Florida | $872.66 | $872.66 | $839.13 - $906.93 | 3 |
| Georgia | $828.82 | $828.82 | $803.35 - $854.28 | 2 |
| Illinois | $858.14 | $858.14 | $823.98 - $887.71 | 4 |
| Michigan | $829.2 | $829.2 | $809.63 - $848.77 | 2 |
| North Carolina | $801.4 | $801.4 | $801.4 - $801.4 | 1 |
| New York | $917.35 | $917.35 | $810.29 - $969.83 | 5 |
| Ohio | $805.63 | $805.63 | $805.63 - $805.63 | 1 |
| Pennsylvania | $837.82 | $837.82 | $805.54 - $870.1 | 2 |
| Texas | $833.75 | $833.75 | $801.82 - $860.19 | 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 65260
Procedure-to-procedure (PTP) edits. If you bill any of these codes with 65260 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 65260
What does CPT code 65260 mean? +
CPT code 65260 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 65260? +
The 2026 Medicare national average non-facility payment for CPT 65260 is $861.01. Rates range from $767.81 to $1055.33 across 53 states depending on MAC locality and GPCIs.
What modifiers can I use with CPT 65260? +
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 65260? +
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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