FeeBase
Log inGet started
Menu

CPT code 68801: Punctum dilation, punctal opening, with or without irrigation2026 Medicare rate & RVUs in Idaho

Reports dilation of a narrowed lacrimal punctum, with or without irrigation, to improve tear drainage through the opening.

CMS RVU26DEffective Oct 1, 2026One payment locality16K Medicare services in 2024

In Idaho, Medicare pays $88.35 for 68801 in the office and $67.46 when it’s performed in a hospital or facility.

$88.35Office (non-facility)
$67.46Hospital or facility
−6.5%vs the national office rate ($94.52)

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.

We’ll open 68801 for the payment locality that covers the ZIP.

On this page 11 sections
  1. Rate in Idaho
  2. What 68801 covers
  3. Compared with other areas
  4. Rate map
  5. How it’s calculated
  6. Payment rules
  7. Related codes
  8. Rate history
  9. Where it applies
  10. Billing questions
  11. Sources

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 Idaho 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. Idaho pays $88.35. The RVUs are the same everywhere; the geographic indexes change the dollars.

68801 in Idaho vs other payment areas
  1. Idaho · this page$88.35
  2. Los Angeles, CA · California$107.16+$18.81
  3. Washington, DC area · District of Columbia$107.93+$19.58
  4. Miami, FL · Florida$99.79+$11.44
  5. Chicago, IL · Illinois$97.20+$8.85
  6. Manhattan, NY · New York$107.93+$19.58
  7. Alaska · Alaska$111.43+$23.08

Other areas in Idaho first, then benchmark localities. Bars start at $0.

Every other payment area

68801 in every other Medicare payment locality
Payment localityOfficeFacility
AlabamaAlabama$85.53$65.66
ArkansasArkansas$84.39$64.88
ArizonaArizona$92.23$70.23
Bakersfield, CACalifornia$100.73$75.84
Chico, CACalifornia$100.55$75.66
El Centro, CACalifornia$100.56$75.67
Fresno, CACalifornia$100.55$75.66
Hanford, CACalifornia$100.55$75.66

68801 rates by state

Office rate range in each state. Select a state to see its payment localities.

MEWIVTNHMTNDMNMINYMARIWAIDWYSDIAILINOHPANJCTORNVUTCONEMOKYWVVAMDDECAAZNMKSOKARTNNCSCDCTXLAMSALGAFLAKHI

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
68801 office rate range by state
State / territoryOffice rate rangeLocalities
AK$111.431
AL$85.531
AR$84.391
AZ$92.231
CA$100.55–$125.9229
CO$98.711
CT$100.501
DC$107.931
DE$93.701
FL$92.45–$99.793
GA$87.70–$96.002
GU$102.881
HI$102.881
IA$87.901
ID$88.351
IL$89.71–$97.794
IN$88.841
KS$87.351
KY$87.041
LA$86.85–$90.852
MA$98.12–$108.272
MD$95.45–$107.933
ME$88.60–$93.312
MI$88.99–$93.362
MN$95.271
MO$85.35–$91.353
MS$84.901
MT$94.521
NC$89.491
ND$93.531
NE$88.391
NH$97.031
NJ$101.84–$106.902
NM$89.371
NV$94.311
NY$90.72–$110.175
OH$88.781
OK$87.081
OR$93.76–$101.872
PA$89.01–$98.042
PR$95.231
RI$97.031
SC$89.251
SD$93.421
TN$87.731
TX$88.45–$98.228
UT$90.391
VA$92.91–$107.932
VI$95.231
VT$93.041
WA$97.98–$110.572
WI$90.591
WV$86.581
WY$94.091

See 68801 in every payment locality

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

Office or facility?

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 Idaho 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

47

Locality
Idaho
Physician work
1.000
Practice expense
0.920
Malpractice
0.473
Office calculation for 68801 in Idaho
ComponentRVULocality factorAdjusted
Physician work0.80× 1.0000.8000
Practice expense1.98× 0.9201.8216
Malpractice0.05× 0.4730.0237
Total RVUs2.6452
Conversion factor× 33.4009

Office rate, Idaho$88.35

Office: (0.8 × 1 + 1.98 × 0.92 + 0.05 × 0.473) × $33.4009 = $88.35

Facility: (0.8 × 1 + 1.3 × 0.92 + 0.05 × 0.473) × $33.4009 = $67.46

Open 68801 in the RVU calculator

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

RuleCMS valueWhat it means
Global period010Minor procedure: the day of the procedure plus 10 days after are included.
Multiple procedures2Standard reduction: highest-valued procedure at 100%, others at 50%.
Bilateral (modifier 50)1Bilateral with modifier 50 pays 150% of the fee schedule amount.
Assistant at surgery (80/81/82/AS)1Not paid (statutory restriction).
Co-surgeons (62)0Not permitted.
Team surgery (66)0Not permitted.
Professional/technical0Physician service: no professional/technical split.
Split (54/55/56)0.10/0.80/0.10Share 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.

SurgeryVisit
Sep 28, 2026Oct 14, 2026

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).

When to use modifier 50

Codes related to 68801

Related codes aren’t interchangeable: bill the code that matches the service performed.

Codes related to 68801
CodeHow it relatesOffice range, Idaho
Used instead
68810Tear duct probing, simple probingProbing addresses the nasolacrimal duct rather than dilation of the punctal opening.$150.02
68811Tear duct probing, general anesthesiaUse for nasolacrimal duct probing requiring general anesthesia, not isolated punctal dilation.No office rate
68815Duct probing, with tube or stentDuct probing with tube or stent placement is a different intervention from punctal dilation.$347.13
68816Tear duct dilation, balloon catheterBalloon dilation treats the nasolacrimal duct rather than the lacrimal punctum.$768.24
68840Tear duct probing, lacrimal canaliculiProbing targets the lacrimal canaliculi, not the punctal opening.$125.58

How 68801 has changed in Idaho

68801 · Office / nonfacility

$88.35

Effective 2026-10-01

The base rate is $3.08 higher than on 2025-10-01, moving from $85.27 to $88.35 (3.6%).

It is unchanged from the immediately preceding available release, effective 2026-07-01.

Base rate by release · bars start at $0 · select a bar to compare

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

  1. January 1, 2026

    RVU26A

    $85.27changed to$88.35

    • Conversion factor 32.3465 changed to 33.4009
    • Work RVU 0.82 changed to 0.80
    • Malpractice RVU 0.04 changed to 0.05
    • Practice expense GPCI 0.908 changed to 0.920
    • Malpractice GPCI 0.461 changed to 0.473

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    $89.12changed to$85.27

    • 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.

  3. March 9, 2024

    RVU24AR

    $87.66changed to$89.12

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $88.91changed to$87.66

    • 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
    • Practice expense GPCI 0.893 changed to 0.908
    • Malpractice GPCI 0.439 changed to 0.461

  5. January 1, 2023

    RVU23A

    $88.58changed to$88.91

    • 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
    • Practice expense GPCI 0.877 changed to 0.893
    • Malpractice GPCI 0.416 changed to 0.439

    Held through RVU23B, RVU23C, RVU23D.

  6. January 1, 2022

    RVU22A

    $87.79changed to$88.58

    • Conversion factor 34.8931 changed to 34.6062
    • Practice expense RVU 1.91 changed to 1.96

    Held through RVU22B, RVU22C, RVU22D.

  7. January 1, 2021

    RVU21A

    $86.00changed to$87.79

    • Conversion factor 36.0896 changed to 34.8931
    • Practice expense RVU 1.73 changed to 1.91
    • Practice expense GPCI 0.890 changed to 0.877
    • Malpractice GPCI 0.464 changed to 0.416

    Held through RVU21B, RVU21C, RVU21D.

  8. January 1, 2020

    RVU20A

    $85.74changed to$86.00

    • Conversion factor 36.0391 changed to 36.0896
    • Practice expense RVU 1.70 changed to 1.73
    • Practice expense GPCI 0.902 changed to 0.890
    • Malpractice GPCI 0.512 changed to 0.464

    Held through RVU20B, RVU20C, RVU20D.

  9. January 1, 2019

    RVU19A

    $84.02changed to$85.74

    • Conversion factor 35.9996 changed to 36.0391
    • Practice expense RVU 1.65 changed to 1.70

    Held through RVU19B, RVU19C, RVU19D.

  10. January 1, 2018

    RVU18AR1

    $82.99changed to$84.02

    • Conversion factor 35.8887 changed to 35.9996
    • Practice expense RVU 1.63 changed to 1.65
    • Practice expense GPCI 0.900 changed to 0.902
    • Malpractice GPCI 0.510 changed to 0.512

    Held through RVU18B, RVU18C, RVU18D.

  11. January 1, 2017

    RVU17A

    $93.61changed to$82.99

    • Conversion factor 35.8043 changed to 35.8887
    • Practice expense RVU 1.97 changed to 1.63
    • Practice expense GPCI 0.898 changed to 0.900
    • Malpractice GPCI 0.508 changed to 0.510

    Held through RVU17B, RVU17C, RVU17D.

  12. January 1, 2016

    RVU16A

    $116.23changed to$93.61

    • Conversion factor 35.9335 changed to 35.8043
    • Work RVU 1.00 changed to 0.82
    • Practice expense RVU 2.46 changed to 1.97

    Held through RVU16B, RVU16C, RVU16D.

  13. July 1, 2015

    RVU15C

    $115.65changed to$116.23

    • Conversion factor 35.7547 changed to 35.9335

    Held through RVU15D.

  14. January 1, 2015

    RVU15A

    $116.81changed to$115.65

    • Conversion factor 35.8228 changed to 35.7547
    • Practice expense RVU 2.43 changed to 2.46
    • Malpractice RVU 0.15 changed to 0.05
    • Practice expense GPCI 0.896 changed to 0.898
    • Malpractice GPCI 0.556 changed to 0.508

    Held through RVU15B.

  15. January 1, 2014

    RVU14A

    $119.13changed to$116.81

    • Conversion factor 34.0230 changed to 35.8228
    • Practice expense RVU 2.69 changed to 2.43
    • Malpractice RVU 0.16 changed to 0.15
    • Practice expense GPCI 0.894 changed to 0.896
    • Malpractice GPCI 0.603 changed to 0.556

    Held through RVU14B, RVU14C, RVU14D.

  16. January 1, 2013

    RVU13AR

    Earliest loaded release: $119.13

    Held through RVU13B, RVU13C, RVU13D.

Rates in every CMS release
Effective fromOfficeFacilityCMS release
2026-10-01$88.35$67.46RVU26D
2026-07-01$88.35$67.46RVU26C
2026-04-01$88.35$67.46RVU26B
2026-01-01$88.35$67.46RVU26A
2025-10-01$85.27$71.47RVU25D
2025-07-01$85.27$71.47RVU25C
2025-04-01$85.27$71.47RVU25B
2025-01-01$85.27$71.47RVU25A
2024-10-01$89.12$73.70RVU24D
2024-07-01$89.12$73.70RVU24C
2024-04-01$89.12$73.70RVU24B
2024-03-09$89.12$73.70RVU24AR
2024-01-01$87.66$72.50RVU24A
2023-10-01$88.91$72.87RVU23D
2023-07-01$88.91$72.87RVU23C
2023-04-01$88.91$72.87RVU23B
2023-01-01$88.91$72.87RVU23A
2022-10-01$88.58$71.59RVU22D
2022-07-01$88.58$71.59RVU22C
2022-04-01$88.58$71.59RVU22B
2022-01-01$88.58$71.59RVU22A
2021-10-01$87.79$71.87RVU21D
2021-07-01$87.79$71.87RVU21C
2021-04-01$87.79$71.87RVU21B
2021-01-01$87.79$71.87RVU21A
2020-10-01$86.00$72.51RVU20D
2020-07-01$86.00$72.51RVU20C
2020-04-01$86.00$72.51RVU20B
2020-01-01$86.00$72.51RVU20A
2019-10-01$85.74$74.36RVU19D
2019-07-01$85.74$74.36RVU19C
2019-04-01$85.74$74.36RVU19B
2019-01-01$85.74$74.36RVU19A
2018-10-01$84.02$74.93RVU18D
2018-07-01$84.02$74.93RVU18C
2018-04-01$84.02$74.93RVU18B
2018-01-01$84.02$74.93RVU18AR1
2017-10-01$82.99$74.59RVU17D
2017-07-01$82.99$74.59RVU17C
2017-04-01$82.99$74.59RVU17B
2017-01-01$82.99$74.59RVU17A
2016-10-01$93.61$81.39RVU16D
2016-07-01$93.61$81.39RVU16C
2016-04-01$93.61$81.39RVU16B
2016-01-01$93.61$81.39RVU16A
2015-10-01$116.23$101.06RVU15D
2015-07-01$116.23$101.06RVU15C
2015-04-01$115.65$100.56RVU15B
2015-01-01$115.65$100.56RVU15A
2014-10-01$116.81$101.72RVU14D
2014-07-01$116.81$101.72RVU14C
2014-04-01$116.81$101.72RVU14B
2014-01-01$116.81$101.72RVU14A
2013-10-01$119.13$103.31RVU13D
2013-07-01$119.13$103.31RVU13C
2013-04-01$119.13$103.31RVU13B
2013-01-01$119.13$103.31RVU13AR

Price 68801 for an earlier date of service

Where the Idaho rate applies

Idaho is a Medicare payment area, not a city. Our Census mapping connects it to 235 cities and communities in Idaho. Some span more than one payment area; confirm with the service ZIP.

  • Aberdeen
  • Acequia
  • Albion
  • American Falls
  • Ammon
  • Arbon Valley
  • Arco
  • Arimo

Browse all communities in Idaho

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
RVUs for 68801PPRRVU2026_Oct_nonQPP.csv, line 7,571 (RVU26D)
Geographic factors for IdahoGPCI2026.csv, line 47 (RVU26D)

Open CMS sourceHow we calculate rates

Did this answer your question about what 68801 pays in Idaho?

Tell us what you were actually trying to work out. We’ll answer you directly, or build the page that does.

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