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

An ophthalmologist probes an obstructed nasolacrimal duct and dilates it with a balloon catheter to improve tear drainage.

CMS RVU26DEffective Oct 1, 2026One payment locality220 Medicare services in 2024

In Connecticut, Medicare pays $892.53 for 68816 in the office and $141.06 when it’s performed in a hospital or facility.

$892.53Office (non-facility)
$141.06Hospital or facility
+7.3%vs the national office rate ($831.68)

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.

We’ll open 68816 for the payment locality that covers the ZIP.

On this page 11 sections
  1. Rate in Connecticut
  2. What 68816 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 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 Connecticut 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. Connecticut pays $892.53. The RVUs are the same everywhere; the geographic indexes change the dollars.

68816 in Connecticut vs other payment areas
  1. Connecticut · this page$892.53
  2. Los Angeles, CA · California$971.38+$78.85
  3. Washington, DC area · District of Columbia$970.88+$78.35
  4. Miami, FL · Florida$870.93−$21.60
  5. Chicago, IL · Illinois$842.87−$49.66
  6. Manhattan, NY · New York$961.97+$69.44
  7. Alaska · Alaska$912.78+$20.25

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

Every other payment area

68816 in every other Medicare payment locality
Payment localityOfficeFacility
AlabamaAlabama$734.63$124.10
ArkansasArkansas$722.23$122.87
ArizonaArizona$807.42$131.30
Bakersfield, CACalifornia$903.65$138.92
Chico, CACalifornia$903.12$138.39
El Centro, CACalifornia$903.15$138.42
Fresno, CACalifornia$903.12$138.39
Hanford, CACalifornia$903.12$138.39

68816 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.

$722.23

$1,037.42

Color shows the midpoint of each state’s locality range.

View every state and territory as a table
68816 office rate range by state
State / territoryOffice rate rangeLocalities
AK$912.781
AL$734.631
AR$722.231
AZ$807.421
CA$903.12–$1,171.7129
CO$879.841
CT$892.531
DC$970.881
DE$822.391
FL$801.02–$870.933
GA$750.86–$845.092
GU$933.261
HI$933.261
IA$764.041
ID$768.241
IL$768.76–$856.754
IN$773.611
KS$756.281
KY$747.101
LA$744.30–$787.702
MA$871.86–$980.932
MD$841.02–$970.883
ME$769.03–$822.892
MI$766.44–$808.822
MN$849.901
MO$726.96–$795.323
MS$724.941
MT$831.671
NC$778.981
ND$828.511
NE$770.001
NH$862.091
NJ$904.66–$957.622
NM$769.851
NV$831.551
NY$792.20–$983.885
OH$765.791
OK$749.401
OR$827.06–$915.532
PA$769.24–$865.022
PR$839.941
RI$857.421
SC$773.281
SD$828.131
TN$760.241
TX$763.09–$875.178
UT$785.671
VA$817.23–$970.882
VI$839.941
VT$821.461
WA$871.46–$1,006.162
WI$796.151
WV$734.711
WY$830.291

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.

How the rate is built · 68816

RVUs × geographic indexes × conversion factor

Office or facility?

Work2.05

2.05 RVUs× 1.000 GPCI

Practice expense22.69

22.69 RVUs× 1.000 GPCI

Malpractice0.16

0.16 RVUs× 1.000 GPCI

Adjusted RVUs

24.9000

Conversion factor

$33.4009

Medicare rate

$831.68

Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.

The exact Connecticut inputs and CMS source lines

PPRRVU2026_Oct_nonQPP.csv

7,575

Code
68816
Physician work
2.05
Practice expense
22.69
Malpractice
0.16

GPCI2026.csv

38

Locality
Connecticut
Physician work
1.020
Practice expense
1.077
Malpractice
1.210
Office calculation for 68816 in Connecticut
ComponentRVULocality factorAdjusted
Physician work2.05× 1.0202.0910
Practice expense22.69× 1.07724.4371
Malpractice0.16× 1.2100.1936
Total RVUs26.7217
Conversion factor× 33.4009

Office rate, Connecticut$892.53

Office: (2.05 × 1.02 + 22.69 × 1.077 + 0.16 × 1.21) × $33.4009 = $892.53

Facility: (2.05 × 1.02 + 1.8 × 1.077 + 0.16 × 1.21) × $33.4009 = $141.06

Open 68816 in the RVU calculator

Payment rules and modifiers for 68816

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

CMS payment indicators · 68816

Tear duct dilation, balloon catheter

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 · 68816

Tear duct dilation, balloon catheter

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

68816 without 50 · national office

$831.68

Tear duct dilation, balloon catheter

68816-50 · Bilateral: 150%

$1,247.52

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 68816

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

Codes related to 68816
CodeHow it relatesOffice range, Connecticut
Used instead
68810Tear duct probing, simple probingProbing without balloon dilation is reported with the applicable probing code.$170.71
68811Tear duct probing, general anesthesiaAn alternative probing service when balloon catheter dilation is not performed.No office rate
68815Duct probing, with tube or stentProbing with tube or stent placement rather than balloon catheter dilation.$397.74
68801Punctum dilation, punctal opening, with or without irrigationUsed for dilation at the lacrimal punctum, rather than balloon dilation of the nasolacrimal duct.$100.50

How 68816 has changed in Connecticut

68816 · Office / nonfacility

$892.53

Effective 2026-10-01

The base rate is $44.72 higher than on 2025-10-01, moving from $847.81 to $892.53 (5.3%).

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

    $847.81changed to$892.53

    • Conversion factor 32.3465 changed to 33.4009
    • Work RVU 2.10 changed to 2.05
    • Practice expense RVU 21.88 changed to 22.69
    • Work GPCI 1.022 changed to 1.020
    • Practice expense GPCI 1.091 changed to 1.077
    • Malpractice GPCI 1.207 changed to 1.210

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    $914.64changed to$847.81

    • Conversion factor 33.2875 changed to 32.3465
    • Practice expense RVU 23.03 changed to 21.88
    • Malpractice RVU 0.17 changed to 0.16

    Held through RVU25B, RVU25C, RVU25D.

  3. March 9, 2024

    RVU24AR

    $899.72changed to$914.64

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $957.03changed to$899.72

    • Conversion factor 33.8872 changed to 32.7442
    • Practice expense RVU 23.49 changed to 23.03
    • Malpractice RVU 0.18 changed to 0.17
    • Work GPCI 1.030 changed to 1.022
    • Practice expense GPCI 1.102 changed to 1.091
    • Malpractice GPCI 1.070 changed to 1.207

  5. January 1, 2023

    RVU23A

    $1005.25changed to$957.03

    • Conversion factor 34.6062 changed to 33.8872
    • Practice expense RVU 23.97 changed to 23.49
    • Work GPCI 1.037 changed to 1.030
    • Practice expense GPCI 1.114 changed to 1.102
    • Malpractice GPCI 0.934 changed to 1.070

    Held through RVU23B, RVU23C, RVU23D.

  6. January 1, 2022

    RVU22A

    $986.50changed to$1005.25

    • Conversion factor 34.8931 changed to 34.6062
    • Practice expense RVU 23.29 changed to 23.97
    • Malpractice RVU 0.16 changed to 0.18

    Held through RVU22B, RVU22C, RVU22D.

  7. January 1, 2021

    RVU21A

    $887.66changed to$986.50

    • Conversion factor 36.0896 changed to 34.8931
    • Practice expense RVU 20.00 changed to 23.29
    • Work GPCI 1.029 changed to 1.037
    • Practice expense GPCI 1.113 changed to 1.114
    • Malpractice GPCI 1.094 changed to 0.934

    Held through RVU21B, RVU21C, RVU21D.

  8. January 1, 2020

    RVU20A

    $815.48changed to$887.66

    • Conversion factor 36.0391 changed to 36.0896
    • Practice expense RVU 18.24 changed to 20.00
    • Work GPCI 1.021 changed to 1.029
    • Practice expense GPCI 1.112 changed to 1.113
    • Malpractice GPCI 1.255 changed to 1.094

    Held through RVU20B, RVU20C, RVU20D.

  9. January 1, 2019

    RVU19A

    $733.33changed to$815.48

    • Conversion factor 35.9996 changed to 36.0391
    • Practice expense RVU 16.21 changed to 18.24

    Held through RVU19B, RVU19C, RVU19D.

  10. January 1, 2018

    RVU18AR1

    $723.24changed to$733.33

    • Conversion factor 35.8887 changed to 35.9996
    • Practice expense RVU 15.94 changed to 16.21
    • Work GPCI 1.023 changed to 1.021
    • Practice expense GPCI 1.117 changed to 1.112
    • Malpractice GPCI 1.244 changed to 1.255

    Held through RVU18B, RVU18C, RVU18D.

  11. January 1, 2017

    RVU17A

    $723.43changed to$723.24

    • Conversion factor 35.8043 changed to 35.8887
    • Practice expense RVU 15.93 changed to 15.94
    • Work GPCI 1.024 changed to 1.023
    • Practice expense GPCI 1.121 changed to 1.117
    • Malpractice GPCI 1.232 changed to 1.244

    Held through RVU17B, RVU17C, RVU17D.

  12. January 1, 2016

    RVU16A

    $832.13changed to$723.43

    • Conversion factor 35.9335 changed to 35.8043
    • Work RVU 3.06 changed to 2.10
    • Practice expense RVU 17.61 changed to 15.93
    • Malpractice RVU 0.23 changed to 0.16

    Held through RVU16B, RVU16C, RVU16D.

  13. July 1, 2015

    RVU15C

    $827.99changed to$832.13

    • Conversion factor 35.7547 changed to 35.9335

    Held through RVU15D.

  14. January 1, 2015

    RVU15A

    $833.47changed to$827.99

    • Conversion factor 35.8228 changed to 35.7547
    • Practice expense RVU 17.41 changed to 17.61
    • Malpractice RVU 0.57 changed to 0.23
    • Practice expense GPCI 1.116 changed to 1.121
    • Malpractice GPCI 1.234 changed to 1.232

    Held through RVU15B.

  15. January 1, 2014

    RVU14A

    $865.23changed to$833.47

    • Conversion factor 34.0230 changed to 35.8228
    • Practice expense RVU 19.42 changed to 17.41
    • Malpractice RVU 0.60 changed to 0.57
    • Practice expense GPCI 1.110 changed to 1.116
    • Malpractice GPCI 1.235 changed to 1.234

    Held through RVU14B, RVU14C, RVU14D.

  16. January 1, 2013

    RVU13AR

    Earliest loaded release: $865.23

    Held through RVU13B, RVU13C, RVU13D.

Rates in every CMS release
Effective fromOfficeFacilityCMS release
2026-10-01$892.53$141.06RVU26D
2026-07-01$892.53$141.06RVU26C
2026-04-01$892.53$141.06RVU26B
2026-01-01$892.53$141.06RVU26A
2025-10-01$847.81$160.72RVU25D
2025-07-01$847.81$160.72RVU25C
2025-04-01$847.81$160.72RVU25B
2025-01-01$847.81$160.72RVU25A
2024-10-01$914.64$165.43RVU24D
2024-07-01$914.64$165.43RVU24C
2024-04-01$914.64$165.43RVU24B
2024-03-09$914.64$165.43RVU24AR
2024-01-01$899.72$162.73RVU24A
2023-10-01$957.03$167.58RVU23D
2023-07-01$957.03$167.58RVU23C
2023-04-01$957.03$167.58RVU23B
2023-01-01$957.03$167.58RVU23A
2022-10-01$1,005.25$168.69RVU22D
2022-07-01$1,005.25$168.69RVU22C
2022-04-01$1,005.25$168.69RVU22B
2022-01-01$1,005.25$168.69RVU22A
2021-10-01$986.50$169.05RVU21D
2021-07-01$986.50$169.05RVU21C
2021-04-01$986.50$169.05RVU21B
2021-01-01$986.50$169.05RVU21A
2020-10-01$887.66$172.27RVU20D
2020-07-01$887.66$172.27RVU20C
2020-04-01$887.66$172.27RVU20B
2020-01-01$887.66$172.27RVU20A
2019-10-01$815.48$173.88RVU19D
2019-07-01$815.48$173.88RVU19C
2019-04-01$815.48$173.88RVU19B
2019-01-01$815.48$173.88RVU19A
2018-10-01$733.33$174.09RVU18D
2018-07-01$733.33$174.09RVU18C
2018-04-01$733.33$174.09RVU18B
2018-01-01$733.33$174.09RVU18AR1
2017-10-01$723.24$179.25RVU17D
2017-07-01$723.24$179.25RVU17C
2017-04-01$723.24$179.25RVU17B
2017-01-01$723.24$179.25RVU17A
2016-10-01$723.43$223.33RVU16D
2016-07-01$723.43$223.33RVU16C
2016-04-01$723.43$223.33RVU16B
2016-01-01$723.43$223.33RVU16A
2015-10-01$832.13$275.44RVU15D
2015-07-01$832.13$275.44RVU15C
2015-04-01$827.99$274.07RVU15B
2015-01-01$827.99$274.07RVU15A
2014-10-01$833.47$288.96RVU14D
2014-07-01$833.47$288.96RVU14C
2014-04-01$833.47$288.96RVU14B
2014-01-01$833.47$288.96RVU14A
2013-10-01$865.23$288.55RVU13D
2013-07-01$865.23$288.55RVU13C
2013-04-01$865.23$288.55RVU13B
2013-01-01$865.23$288.55RVU13AR

Price 68816 for an earlier date of service

Where the Connecticut rate applies

Connecticut is a Medicare payment area, not a city. Our Census mapping connects it to 215 cities and communities in Connecticut. Some span more than one payment area; confirm with the service ZIP.

  • Ansonia
  • Ball Pond
  • Baltic
  • Bantam
  • Bethel
  • Bethlehem Village
  • Bigelow Corners
  • Blue Hills

Browse all communities in Connecticut

68816 billing questions

When should I report this instead of 68810?

Use 68816 when the surgeon performs balloon catheter dilation along with probing. Probing without balloon dilation is reported with the applicable probing code.

How does 68816 differ from 68815?

68816 describes balloon catheter dilation with probing; 68815 is used when probing includes placement of a tube or stent. Select the code for the technique actually performed.

Can I report irrigation separately?

Irrigation may be performed as part of the probing service. Do not separately report a service solely for irrigation performed as part of this procedure.

How should bilateral treatment be reported?

For treatment of both nasolacrimal ducts, report modifier 50. CMS pays bilateral procedures at 150%.

What postoperative care is included?

Related postoperative visits during the 10-day global period are included in the procedure payment.

Can an assistant or co-surgeon be paid for this procedure?

CMS does not pay an assistant at surgery for this code. 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 68816PPRRVU2026_Oct_nonQPP.csv, line 7,575 (RVU26D)
Geographic factors for ConnecticutGPCI2026.csv, line 38 (RVU26D)

Open CMS sourceHow we calculate rates

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