CPT code 68362: Fornix reconstruction, with mucous membrane graft2026 Medicare rate & RVUs in Washington
Reconstructs a shortened or scarred conjunctival fornix using a mucous membrane graft, typically when scarring prevents adequate depth between the eyelid and globe.
CMS doesn’t publish an office rate for 68362 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.
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What 68362 covers
An ophthalmic surgeon, often an oculoplastic specialist, uses this procedure to restore the conjunctival fornix—the pocket between the eyelid and the eye—when scarring has shortened or distorted it. The operation involves releasing or addressing scarred tissue and using a mucous membrane graft to rebuild the lining and help restore fornix depth. It is generally performed in an operating room for cicatricial changes such as severe conjunctival scarring or symblepharon that compromise the fornix.
Report the code when the service includes fornix reconstruction with a mucous membrane graft, rather than a reconstruction without graft or a more limited adhesion-release procedure. The operative report should identify the affected eye, the scarring and loss of fornix depth, the reconstruction performed, and the graft used. Medicare applies a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. For same-session procedures, 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%. Assistant-at-surgery payment is restricted; 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 68362 pays more and less in Washington
| Payment locality | Office | Facility |
|---|---|---|
| King County, WA | Unavailable | $627.82 |
| Rest of Washington | Unavailable | $571.47 |
How the 68362 rate is calculated
Each of 68362’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 · 68362
RVUs × geographic indexes × conversion factor
Work8.39
8.39 RVUs× 1.000 GPCI
Practice expense7.70
7.70 RVUs× 1.000 GPCI
Malpractice0.66
0.66 RVUs× 1.000 GPCI
Adjusted RVUs
16.7500
Conversion factor
$33.4009
Medicare rate
$559.47
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 68362
68362 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 68362
Fornix reconstruction, with mucous membrane graft
| 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) | 1 | Not paid (statutory restriction). |
| 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 · 68362
Fornix reconstruction, with mucous membrane graft
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
68362 without 50 · national facility
$559.47
Fornix reconstruction, with mucous membrane graft
68362-50 · Bilateral: 150%
$839.21
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).
68362 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 68360ConjunctivoplastyCul-de-sac reconstruction
- This code involves fornix reconstruction with a mucous membrane graft. Code 68360 describes the related reconstruction without a graft.
- 68335Symblepharon repairWith graft
- Code 68335 is for symblepharon repair with graft. Choose 68362 when the documented operation reconstructs the conjunctival fornix with a mucous membrane graft.
- 68340Adhesion releaseEyelid adhesions
- Code 68340 describes severing adhesions between the conjunctiva and eyelid. It does not describe graft-based reconstruction of the fornix.
68362 billing questions
How does this differ from 68360?
68362 is for fornix reconstruction using a mucous membrane graft. Use 68360 for the related fornix reconstruction without a graft.
When is a symblepharon repair code a better fit?
Codes 68330 and 68335 describe repair of symblepharon, without and with graft, respectively. Choose based on the operation performed; use 68362 when the service is reconstruction of the conjunctival fornix with a mucous membrane graft.
What should the operative report document?
Document the eye treated, the scarring and fornix shortening, the reconstructive work, and the mucous membrane graft. These details distinguish graft-based fornix reconstruction from adhesion release or reconstruction without graft.
How are bilateral procedures reported?
For bilateral performance, modifier 50 applies, and CMS pays the procedure at 150%.
Can an assistant or co-surgeon be paid?
Assistant-at-surgery payment is restricted for this code. Co-surgeon payment is available only with supporting documentation; team surgery is not permitted.
What postoperative care is included?
The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care.
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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