CPT code 68801: Punctum dilation, punctal opening, with or without irrigation2026 Medicare rate & RVUs in Fresno, CA
Reports dilation of a narrowed lacrimal punctum, with or without irrigation, to improve tear drainage through the opening.
In Fresno, CA, Medicare pays $100.55 for 68801 in the office and $75.66 when it’s performed in a hospital or facility.
Check a contract rate as a % of Medicare · 68801 nationwide
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 11 sections
What 68801 covers
An ophthalmologist or other qualified eye-care practitioner dilates a narrowed lacrimal punctum, the small opening at the eyelid margin that drains tears. The service may include irrigation through the opened punctum. It is typically performed in an office or outpatient setting when punctal narrowing interferes with tear drainage; it addresses the punctal opening rather than probing the downstream canaliculus or nasolacrimal duct.
Report 68801 when the documented service is dilation of the punctum, and record the affected side, the narrowing treated, and whether irrigation was performed. Irrigation is included in this code. CMS assigns a 10-day global period, so related postoperative visits during that period are included. For bilateral treatment, modifier 50 is paid at 150%. When multiple procedures are performed in the same session, the highest-valued procedure is paid in full and the others at 50%. Medicare does not pay an assistant at surgery for this service; 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.
How Fresno, CA compares for 68801
Across 109 of 109 payment localities, the office rate for 68801 runs from $84.39 in Arkansas to $125.92 in San Benito County, CA. Fresno, CA pays $100.55. The RVUs are the same everywhere; the geographic indexes change the dollars.
- Fresno, CA · this page$100.55
- Bakersfield, CA · California$100.73+$0.18
- Chico, CA · California$100.55
- El Centro, CA · California$100.56+$0.01
- Hanford, CA · California$100.55
- Los Angeles, CA · California$107.16+$6.61
- Madera, CA · California$100.55
Other areas in California first, then benchmark localities. Bars start at $0.
Every other payment area
| Payment locality | Office | Facility |
|---|---|---|
| Merced, CACalifornia | $100.55 | $75.66 |
| Modesto, CACalifornia | $100.55 | $75.66 |
| Napa, CACalifornia | $116.42 | $86.48 |
| Oxnard, CACalifornia | $106.68 | $79.83 |
| Redding, CACalifornia | $100.55 | $75.66 |
| Rest of CaliforniaCalifornia | $100.55 | $75.66 |
| Riverside, CACalifornia | $101.11 | $76.22 |
| Sacramento, CACalifornia | $105.49 | $79.08 |
| Salinas, CACalifornia | $105.09 | $78.77 |
| San Diego, CACalifornia | $107.52 | $80.36 |
| Marin County, CACalifornia | $123.27 | $91.25 |
| San Francisco, CACalifornia | $123.22 | $91.19 |
| San Benito County, CACalifornia | $125.92 | $93.17 |
| Santa Clara County, CACalifornia | $125.69 | $92.94 |
| San Luis Obispo, CACalifornia | $103.40 | $77.53 |
| Santa Cruz, CACalifornia | $108.53 | $80.93 |
| Santa Maria, CACalifornia | $105.48 | $78.99 |
| Santa Rosa, CACalifornia | $109.63 | $81.74 |
| Stockton, CACalifornia | $100.55 | $75.66 |
| Vallejo, CACalifornia | $116.34 | $86.40 |
| Visalia, CACalifornia | $100.55 | $75.66 |
| Yuba City, CACalifornia | $100.55 | $75.66 |
| Washington, DC areaDistrict of Columbia | $107.93 | $81.17 |
| Miami, FLFlorida | $99.79 | $76.15 |
| Chicago, ILIllinois | $97.20 | $74.38 |
| Manhattan, NYNew York | $107.93 | $81.53 |
| AlaskaAlaska | $111.43 | $87.24 |
| AlabamaAlabama | $85.53 | $65.66 |
| ArkansasArkansas | $84.39 | $64.88 |
| ArizonaArizona | $92.23 | $70.23 |
| ColoradoColorado | $98.71 | $74.55 |
| ConnecticutConnecticut | $100.50 | $76.04 |
| DelawareDelaware | $93.70 | $71.26 |
| Fort Lauderdale, FLFlorida | $96.73 | $73.73 |
| Rest of FloridaFlorida | $92.45 | $70.74 |
| Atlanta, GAGeorgia | $96.00 | $72.92 |
| Rest of GeorgiaGeorgia | $87.70 | $67.44 |
| Hawaii, Guam, HIHawaii | $102.88 | $77.06 |
| IowaIowa | $87.90 | $67.11 |
| IdahoIdaho | $88.35 | $67.46 |
| East St. Louis, ILIllinois | $90.93 | $70.03 |
| Rest of IllinoisIllinois | $89.71 | $68.97 |
| Suburban Chicago, ILIllinois | $97.79 | $74.46 |
| IndianaIndiana | $88.84 | $67.78 |
| KansasKansas | $87.35 | $66.82 |
| KentuckyKentucky | $87.04 | $66.85 |
| New Orleans, LALouisiana | $90.85 | $69.48 |
| Rest of LouisianaLouisiana | $86.85 | $66.75 |
| Metropolitan Boston, MAMassachusetts | $108.27 | $81.15 |
| Rest of MassachusettsMassachusetts | $98.12 | $74.20 |
| Baltimore area, MDMaryland | $100.18 | $75.81 |
| Rest of MarylandMaryland | $95.45 | $72.46 |
| Rest of MaineMaine | $88.60 | $67.71 |
| Southern Maine, MEMaine | $93.31 | $70.80 |
| Detroit, MIMichigan | $93.36 | $71.44 |
| Rest of MichiganMichigan | $88.99 | $68.25 |
| MinnesotaMinnesota | $95.27 | $71.90 |
| Metropolitan Kansas City, MOMissouri | $90.45 | $69.12 |
| Metropolitan St. Louis, MOMissouri | $91.35 | $69.73 |
| Rest of MissouriMissouri | $85.35 | $65.78 |
| MississippiMississippi | $84.90 | $65.34 |
| MontanaMontana | $94.52 | $71.81 |
| North CarolinaNorth Carolina | $89.49 | $68.30 |
| North DakotaNorth Dakota | $93.53 | $70.82 |
| NebraskaNebraska | $88.39 | $67.43 |
| New HampshireNew Hampshire | $97.03 | $73.38 |
| Northern New JerseyNew Jersey | $106.90 | $80.56 |
| Rest of New JerseyNew Jersey | $101.84 | $77.04 |
| New MexicoNew Mexico | $89.37 | $68.54 |
| NevadaNevada | $94.31 | $71.58 |
| NYC suburbs and Long Island, NYNew York | $110.17 | $83.16 |
| Poughkeepsie and northern NYC suburbs, NYNew York | $102.36 | $77.49 |
| Queens, NYNew York | $109.01 | $82.16 |
| Rest of New YorkNew York | $90.72 | $69.14 |
| OhioOhio | $88.78 | $68.05 |
| OklahomaOklahoma | $87.08 | $66.79 |
| Portland, OROregon | $101.87 | $76.63 |
| Rest of OregonOregon | $93.76 | $71.14 |
| Metropolitan Philadelphia, PAPennsylvania | $98.04 | $74.40 |
| Rest of PennsylvaniaPennsylvania | $89.01 | $68.16 |
| Puerto RicoPuerto Rico | $95.23 | $72.26 |
| Rhode IslandRhode Island | $97.03 | $73.57 |
| South CarolinaSouth Carolina | $89.25 | $68.26 |
| South DakotaSouth Dakota | $93.42 | $70.70 |
| TennesseeTennessee | $87.73 | $67.09 |
| Austin, TXTexas | $98.22 | $74.19 |
| Beaumont, TXTexas | $88.45 | $67.79 |
| Brazoria, TXTexas | $93.78 | $71.27 |
| Dallas, TXTexas | $94.26 | $71.64 |
| Fort Worth, TXTexas | $93.62 | $71.23 |
| Galveston, TXTexas | $93.99 | $71.43 |
| Houston, TXTexas | $94.90 | $72.35 |
| Rest of TexasTexas | $90.99 | $69.44 |
| UtahUtah | $90.39 | $69.04 |
| VirginiaVirginia | $92.91 | $70.58 |
| Virgin Islands, VIUnited States Virgin Islands | $95.23 | $72.26 |
| VermontVermont | $93.04 | $70.55 |
| Rest of WashingtonWashington | $97.98 | $74.06 |
| King County, WAWashington | $110.57 | $82.70 |
| WisconsinWisconsin | $90.59 | $68.83 |
| West VirginiaWest Virginia | $86.58 | $66.84 |
| WyomingWyoming | $94.09 | $71.38 |
68801 rates by state
Office rate range in each state. Select a state to see its payment localities.
Explore a state
Local rates. Clear comparisons.
Hover or focus a tile to see its rate range. Select it to open the state’s fee schedule.
$84.39
$113.24
Color shows the midpoint of each state’s locality range.
View every state and territory as a table
| State / territory | Office rate range | Localities |
|---|---|---|
| AK | $111.43 | 1 |
| AL | $85.53 | 1 |
| AR | $84.39 | 1 |
| AZ | $92.23 | 1 |
| CA | $100.55–$125.92 | 29 |
| CO | $98.71 | 1 |
| CT | $100.50 | 1 |
| DC | $107.93 | 1 |
| DE | $93.70 | 1 |
| FL | $92.45–$99.79 | 3 |
| GA | $87.70–$96.00 | 2 |
| GU | $102.88 | 1 |
| HI | $102.88 | 1 |
| IA | $87.90 | 1 |
| ID | $88.35 | 1 |
| IL | $89.71–$97.79 | 4 |
| IN | $88.84 | 1 |
| KS | $87.35 | 1 |
| KY | $87.04 | 1 |
| LA | $86.85–$90.85 | 2 |
| MA | $98.12–$108.27 | 2 |
| MD | $95.45–$107.93 | 3 |
| ME | $88.60–$93.31 | 2 |
| MI | $88.99–$93.36 | 2 |
| MN | $95.27 | 1 |
| MO | $85.35–$91.35 | 3 |
| MS | $84.90 | 1 |
| MT | $94.52 | 1 |
| NC | $89.49 | 1 |
| ND | $93.53 | 1 |
| NE | $88.39 | 1 |
| NH | $97.03 | 1 |
| NJ | $101.84–$106.90 | 2 |
| NM | $89.37 | 1 |
| NV | $94.31 | 1 |
| NY | $90.72–$110.17 | 5 |
| OH | $88.78 | 1 |
| OK | $87.08 | 1 |
| OR | $93.76–$101.87 | 2 |
| PA | $89.01–$98.04 | 2 |
| PR | $95.23 | 1 |
| RI | $97.03 | 1 |
| SC | $89.25 | 1 |
| SD | $93.42 | 1 |
| TN | $87.73 | 1 |
| TX | $88.45–$98.22 | 8 |
| UT | $90.39 | 1 |
| VA | $92.91–$107.93 | 2 |
| VI | $95.23 | 1 |
| VT | $93.04 | 1 |
| WA | $97.98–$110.57 | 2 |
| WI | $90.59 | 1 |
| WV | $86.58 | 1 |
| WY | $94.09 | 1 |
How the 68801 rate is calculated
Each of 68801’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 · 68801
RVUs × geographic indexes × conversion factor
Work0.80
0.80 RVUs× 1.000 GPCI
Practice expense1.98
1.98 RVUs× 1.000 GPCI
Malpractice0.05
0.05 RVUs× 1.000 GPCI
Adjusted RVUs
2.8300
Conversion factor
$33.4009
Medicare rate
$94.52
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
The exact Fresno, CA inputs and CMS source lines
PPRRVU2026_Oct_nonQPP.csv
7,571
- Code
- 68801
- Physician work
- 0.80
- Practice expense
- 1.98
- Malpractice
- 0.05
GPCI2026.csv
11
- Locality
- Fresno, CA
- Physician work
- 1.017
- Practice expense
- 1.096
- Malpractice
- 0.536
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 0.80 | × 1.017 | 0.8136 |
| Practice expense | 1.98 | × 1.096 | 2.1701 |
| Malpractice | 0.05 | × 0.536 | 0.0268 |
| Total RVUs | 3.0105 | ||
| Conversion factor | × 33.4009 | ||
Office rate, Fresno, CA$100.55
Office: (0.8 × 1.017 + 1.98 × 1.096 + 0.05 × 0.536) × $33.4009 = $100.55
Facility: (0.8 × 1.017 + 1.3 × 1.096 + 0.05 × 0.536) × $33.4009 = $75.66
Payment rules and modifiers for 68801
68801 has a 10-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 68801
Punctum dilation, punctal opening, with or without irrigation
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 010 | Minor procedure: the day of the procedure plus 10 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) | 0 | Not permitted. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 0 | Physician service: no professional/technical split. |
| Split (54/55/56) | 0.10/0.80/0.10 | Share of the payment for pre-op, the procedure itself, and post-op care. |
Global surgery period · 68801
Punctum dilation, punctal opening, with or without irrigation
10-day global period ends
Oct 11, 2026
Covers Oct 1, 2026 through Oct 11, 2026 (11 days).
Visit on Oct 31, 2026
After the global period ends: visits and procedures are billed normally.
What modifiers do to the payment
Modifier 50 · payment effect
With and without the modifier
68801 without 50 · national office
$94.52
Punctum dilation, punctal opening, with or without irrigation
68801-50 · Bilateral: 150%
$141.78
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).
How 68801 has changed in Fresno, CA
68801 · Office / nonfacility
$100.55
Effective 2026-10-01
The base rate is $2.93 higher than on 2025-10-01, moving from $97.62 to $100.55 (3.0%).
It is unchanged from the immediately preceding available release, effective 2026-07-01.
One bar per available release, ordered by effective date. Missing rates remain gaps. These comparisons hold the code, setting and locality identifiers constant; they do not isolate which policy or input caused a change.
What changed, release by release
January 1, 2026
RVU26A
$97.62changed to$100.55
- Conversion factor 32.3465 changed to 33.4009
- Work RVU 0.82 changed to 0.80
- Malpractice RVU 0.04 changed to 0.05
- Work GPCI 1.014 changed to 1.017
- Practice expense GPCI 1.093 changed to 1.096
- Malpractice GPCI 0.560 changed to 0.536
Held through RVU26B, RVU26C, RVU26D.
January 1, 2025
RVU25A
$102.10changed to$97.62
- Conversion factor 33.2875 changed to 32.3465
- Practice expense RVU 2.02 changed to 1.98
- Malpractice RVU 0.05 changed to 0.04
Held through RVU25B, RVU25C, RVU25D.
March 9, 2024
RVU24AR
$100.44changed to$102.10
- Conversion factor 32.7442 changed to 33.2875
Held through RVU24B, RVU24C, RVU24D.
January 1, 2024
RVU24A
$102.28changed to$100.44
- Conversion factor 33.8872 changed to 32.7442
- Practice expense RVU 2.00 changed to 2.02
- Malpractice RVU 0.04 changed to 0.05
- Work GPCI 1.021 changed to 1.014
- Practice expense GPCI 1.079 changed to 1.093
- Malpractice GPCI 0.579 changed to 0.560
January 1, 2023
RVU23A
$102.41changed to$102.28
- Conversion factor 34.6062 changed to 33.8872
- Practice expense RVU 1.96 changed to 2.00
- Malpractice RVU 0.05 changed to 0.04
- Work GPCI 1.027 changed to 1.021
- Practice expense GPCI 1.065 changed to 1.079
- Malpractice GPCI 0.597 changed to 0.579
Held through RVU23B, RVU23C, RVU23D.
January 1, 2022
RVU22A
$101.40changed to$102.41
- Conversion factor 34.8931 changed to 34.6062
- Practice expense RVU 1.91 changed to 1.96
Held through RVU22B, RVU22C, RVU22D.
January 1, 2021
RVU21A
$98.16changed to$101.40
- Conversion factor 36.0896 changed to 34.8931
- Practice expense RVU 1.73 changed to 1.91
- Work GPCI 1.024 changed to 1.027
- Practice expense GPCI 1.070 changed to 1.065
- Malpractice GPCI 0.580 changed to 0.597
Held through RVU21B, RVU21C, RVU21D.
January 1, 2020
RVU20A
$96.96changed to$98.16
- Conversion factor 36.0391 changed to 36.0896
- Practice expense RVU 1.70 changed to 1.73
- Work GPCI 1.020 changed to 1.024
- Practice expense GPCI 1.074 changed to 1.070
- Malpractice GPCI 0.562 changed to 0.580
Held through RVU20B, RVU20C, RVU20D.
January 1, 2019
RVU19A
$94.92changed to$96.96
- Conversion factor 35.9996 changed to 36.0391
- Practice expense RVU 1.65 changed to 1.70
Held through RVU19B, RVU19C, RVU19D.
January 1, 2018
RVU18AR1
$94.35changed to$94.92
- Conversion factor 35.8887 changed to 35.9996
- Practice expense RVU 1.63 changed to 1.65
- Work GPCI 1.024 changed to 1.020
- Practice expense GPCI 1.079 changed to 1.074
- Malpractice GPCI 0.610 changed to 0.562
Held through RVU18B, RVU18C, RVU18D.
January 1, 2017
RVU17A
No ratechanged to$94.35
Held through RVU17B, RVU17C, RVU17D.
January 1, 2013
RVU13AR
Earliest loaded release: No rate
Held through RVU13B, RVU13C, RVU13D, RVU14A, RVU14B, RVU14C, RVU14D, RVU15A, RVU15B, RVU15C, RVU15D, RVU16A, RVU16B, RVU16C, RVU16D.
| Effective from | Office | Facility | CMS release |
|---|---|---|---|
| 2026-10-01 | $100.55 | $75.66 | RVU26D |
| 2026-07-01 | $100.55 | $75.66 | RVU26C |
| 2026-04-01 | $100.55 | $75.66 | RVU26B |
| 2026-01-01 | $100.55 | $75.66 | RVU26A |
| 2025-10-01 | $97.62 | $81.01 | RVU25D |
| 2025-07-01 | $97.62 | $81.01 | RVU25C |
| 2025-04-01 | $97.62 | $81.01 | RVU25B |
| 2025-01-01 | $97.62 | $81.01 | RVU25A |
| 2024-10-01 | $102.10 | $83.55 | RVU24D |
| 2024-07-01 | $102.10 | $83.55 | RVU24C |
| 2024-04-01 | $102.10 | $83.55 | RVU24B |
| 2024-03-09 | $102.10 | $83.55 | RVU24AR |
| 2024-01-01 | $100.44 | $82.18 | RVU24A |
| 2023-10-01 | $102.28 | $82.91 | RVU23D |
| 2023-07-01 | $102.28 | $82.91 | RVU23C |
| 2023-04-01 | $102.28 | $82.91 | RVU23B |
| 2023-01-01 | $102.28 | $82.91 | RVU23A |
| 2022-10-01 | $102.41 | $81.77 | RVU22D |
| 2022-07-01 | $102.41 | $81.77 | RVU22C |
| 2022-04-01 | $102.41 | $81.77 | RVU22B |
| 2022-01-01 | $102.41 | $81.77 | RVU22A |
| 2021-10-01 | $101.40 | $82.08 | RVU21D |
| 2021-07-01 | $101.40 | $82.08 | RVU21C |
| 2021-04-01 | $101.40 | $82.08 | RVU21B |
| 2021-01-01 | $101.40 | $82.08 | RVU21A |
| 2020-10-01 | $98.16 | $81.94 | RVU20D |
| 2020-07-01 | $98.16 | $81.94 | RVU20C |
| 2020-04-01 | $98.16 | $81.94 | RVU20B |
| 2020-01-01 | $98.16 | $81.94 | RVU20A |
| 2019-10-01 | $96.96 | $83.41 | RVU19D |
| 2019-07-01 | $96.96 | $83.41 | RVU19C |
| 2019-04-01 | $96.96 | $83.41 | RVU19B |
| 2019-01-01 | $96.96 | $83.41 | RVU19A |
| 2018-10-01 | $94.92 | $84.09 | RVU18D |
| 2018-07-01 | $94.92 | $84.09 | RVU18C |
| 2018-04-01 | $94.92 | $84.09 | RVU18B |
| 2018-01-01 | $94.92 | $84.09 | RVU18AR1 |
| 2017-10-01 | $94.35 | $84.28 | RVU17D |
| 2017-07-01 | $94.35 | $84.28 | RVU17C |
| 2017-04-01 | $94.35 | $84.28 | RVU17B |
| 2017-01-01 | $94.35 | $84.28 | RVU17A |
| 2016-10-01 | Rate data unavailable | Rate data unavailable | RVU16D |
| 2016-07-01 | Rate data unavailable | Rate data unavailable | RVU16C |
| 2016-04-01 | Rate data unavailable | Rate data unavailable | RVU16B |
| 2016-01-01 | Rate data unavailable | Rate data unavailable | RVU16A |
| 2015-10-01 | Rate data unavailable | Rate data unavailable | RVU15D |
| 2015-07-01 | Rate data unavailable | Rate data unavailable | RVU15C |
| 2015-04-01 | Rate data unavailable | Rate data unavailable | RVU15B |
| 2015-01-01 | Rate data unavailable | Rate data unavailable | RVU15A |
| 2014-10-01 | Rate data unavailable | Rate data unavailable | RVU14D |
| 2014-07-01 | Rate data unavailable | Rate data unavailable | RVU14C |
| 2014-04-01 | Rate data unavailable | Rate data unavailable | RVU14B |
| 2014-01-01 | Rate data unavailable | Rate data unavailable | RVU14A |
| 2013-10-01 | Rate data unavailable | Rate data unavailable | RVU13D |
| 2013-07-01 | Rate data unavailable | Rate data unavailable | RVU13C |
| 2013-04-01 | Rate data unavailable | Rate data unavailable | RVU13B |
| 2013-01-01 | Rate data unavailable | Rate data unavailable | RVU13AR |
Where the Fresno, CA rate applies
Fresno, CA is a Medicare payment area, not a city. Our Census mapping connects it to 45 cities and communities in California. Some span more than one payment area; confirm with the service ZIP.
- Fresno
- Auberry
- Big Creek
- Biola
- Bowles
- Calwa
- Cantua Creek
- Caruthers
68801 billing questions
When should 68801 be chosen instead of 68810?
Use 68801 when the treated structure is a narrowed lacrimal punctum. Code 68810 describes probing the nasolacrimal duct, a different part of the tear drainage pathway.
Is irrigation separately reportable with 68801?
No. Irrigation performed with punctal dilation is included in 68801.
How is bilateral punctal dilation reported?
CMS identifies 68801 as a bilateral procedure; modifier 50 is paid at 150% when both sides are treated.
Are related postoperative visits included?
Yes. Related postoperative visits during the 10-day global period are included in the procedure.
Can an assistant or co-surgeon be paid for 68801?
Medicare does not pay an assistant at surgery for this code, and co-surgeons and team surgery are not permitted.
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
Fee sheets · Coming soon
Put 68801 and the rest of your codes on one sheet
Your codes at your locality, with payer contracts beside Medicare.
Join the waitlist