CPT code 68816: Tear duct dilation, balloon catheter2026 Medicare rate & RVUs in Merced, CA

In Merced, CA, Medicare pays $903.12 for 68816 in the office and $138.39 when it’s performed in a hospital or facility.

Check a contract rate as a % of Medicare · 68816 nationwide

Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.

What 68816 covers

This procedure treats obstruction or narrowing in the nasolacrimal duct, the passage that carries tears from the eye into the nose. The ophthalmologist passes a probe through the drainage pathway and uses a balloon catheter to expand the narrowed segment; irrigation may also be performed. It is commonly used for persistent tear-duct obstruction, including congenital obstruction in children, and may be performed in an operating room or another appropriate procedural setting.

Report this code when balloon catheter dilation is performed with probing, rather than probing alone or placement of a tube or stent. The operative note should identify the treated side, the obstruction or narrowing, and the probing and balloon-dilation work performed. The procedure has a 10-day global period, which includes related postoperative visits during that period. 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 others at 50%. Assistant-at-surgery payment is restricted; 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 Merced, CA compares for 68816

Across 109 of 109 payment localities, the office rate for 68816 runs from $722.23 in Arkansas to $1,171.71 in San Benito County, CA. Merced, CA pays $903.12. The RVUs are the same everywhere; the geographic indexes change the dollars.

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68816 rates by state

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

See 68816 in every payment locality

How the 68816 rate is calculated

Each of 68816’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.

Payment rules and modifiers for 68816

68816 has a 10-day global period: related visits in that window are included in the surgery payment.

What modifiers do to the payment

When to use modifier 50

Codes related to 68816

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

How 68816 has changed in Merced, CA

Price 68816 for an earlier date of service

Where the Merced, CA rate applies

Merced, CA is a Medicare payment area, not a city. Our Census mapping connects it to 24 cities and communities in California. Some span more than one payment area; confirm with the service ZIP.

• Merced
• Atwater
• Ballico
• Bear Creek
• Cressey
• Delhi
• Dos Palos
• Dos Palos Y

Browse all communities in California

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

Open CMS sourceHow we calculate rates