CPT code 68840: Tear duct probing, lacrimal canaliculi2026 Medicare rate & RVUs in Alaska
Probing the lacrimal canaliculi, with or without irrigation, evaluates or treats a blockage in the small tear-drainage channels near the eyelid.
In Alaska, Medicare pays $159.91 for 68840 in the office and $128.25 when it’s performed in a hospital or facility.
Check a contract rate as a % of Medicare · 68840 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 68840 covers
An ophthalmologist, often an oculoplastic surgeon, passes a probe through the lacrimal punctum into a canaliculus to assess or relieve an obstruction. Irrigation may be performed as part of the service. The procedure is used for problems such as tearing associated with suspected canalicular narrowing or blockage, and may be performed in an office procedure room or an operating room depending on the patient and clinical circumstances.
Report 68840 when the treated structure is a lacrimal canaliculus, rather than the nasolacrimal duct. Document the affected side, the clinical indication, and the probing performed; irrigation does not require a separate 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 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 Alaska compares for 68840
Across 109 of 109 payment localities, the office rate for 68840 runs from $120.29 in Arkansas to $176.81 in San Benito County, CA. Alaska pays $159.91. The RVUs are the same everywhere; the geographic indexes change the dollars.
- Alaska · this page$159.91
- Los Angeles, CA · California$151.26−$8.65
- Washington, DC area · District of Columbia$152.72−$7.19
- Miami, FL · Florida$142.51−$17.40
- Chicago, IL · Illinois$138.91−$21.00
- Manhattan, NY · New York$153.14−$6.77
- Alabama · Alabama$121.86−$38.05
Other areas in Alaska first, then benchmark localities. Bars start at $0.
Every other payment area
| Payment locality | Office | Facility |
|---|---|---|
| ArkansasArkansas | $120.29 | $94.75 |
| ArizonaArizona | $131.08 | $102.28 |
| Bakersfield, CACalifornia | $142.43 | $109.85 |
| Chico, CACalifornia | $142.13 | $109.55 |
| El Centro, CACalifornia | $142.14 | $109.56 |
| Fresno, CACalifornia | $142.13 | $109.55 |
| Hanford, CACalifornia | $142.13 | $109.55 |
| Madera, CACalifornia | $142.13 | $109.55 |
| Merced, CACalifornia | $142.13 | $109.55 |
| Modesto, CACalifornia | $142.13 | $109.55 |
| Napa, CACalifornia | $163.72 | $124.54 |
| Oxnard, CACalifornia | $150.50 | $115.36 |
| Redding, CACalifornia | $142.13 | $109.55 |
| Rest of CaliforniaCalifornia | $142.13 | $109.55 |
| Riverside, CACalifornia | $143.12 | $110.54 |
| Sacramento, CACalifornia | $148.89 | $114.31 |
| Salinas, CACalifornia | $148.32 | $113.87 |
| San Diego, CACalifornia | $151.58 | $116.03 |
| Marin County, CACalifornia | $173.10 | $131.19 |
| San Francisco, CACalifornia | $173.00 | $131.09 |
| San Benito County, CACalifornia | $176.81 | $133.95 |
| Santa Clara County, CACalifornia | $176.40 | $133.53 |
| San Luis Obispo, CACalifornia | $145.95 | $112.09 |
| Santa Cruz, CACalifornia | $152.87 | $116.75 |
| Santa Maria, CACalifornia | $148.81 | $114.15 |
| Santa Rosa, CACalifornia | $154.41 | $117.90 |
| Stockton, CACalifornia | $142.13 | $109.55 |
| Vallejo, CACalifornia | $163.57 | $124.39 |
| Visalia, CACalifornia | $142.13 | $109.55 |
| Yuba City, CACalifornia | $142.13 | $109.55 |
| ColoradoColorado | $139.81 | $108.18 |
| ConnecticutConnecticut | $142.59 | $110.58 |
| DelawareDelaware | $133.11 | $103.74 |
| Fort Lauderdale, FLFlorida | $137.86 | $107.74 |
| Rest of FloridaFlorida | $131.87 | $103.46 |
| Atlanta, GAGeorgia | $136.42 | $106.22 |
| Rest of GeorgiaGeorgia | $125.25 | $98.74 |
| Hawaii, Guam, HIHawaii | $145.18 | $111.38 |
| IowaIowa | $124.91 | $97.71 |
| IdahoIdaho | $125.58 | $98.23 |
| East St. Louis, ILIllinois | $130.21 | $102.86 |
| Rest of IllinoisIllinois | $128.23 | $101.09 |
| Suburban Chicago, ILIllinois | $139.29 | $108.76 |
| IndianaIndiana | $126.24 | $98.68 |
| KansasKansas | $124.25 | $97.38 |
| KentuckyKentucky | $124.15 | $97.73 |
| New Orleans, LALouisiana | $129.44 | $101.47 |
| Rest of LouisianaLouisiana | $123.93 | $97.62 |
| Metropolitan Boston, MAMassachusetts | $152.92 | $117.42 |
| Rest of MassachusettsMassachusetts | $139.05 | $107.75 |
| Baltimore area, MDMaryland | $142.15 | $110.25 |
| Rest of MarylandMaryland | $135.52 | $105.43 |
| Rest of MaineMaine | $126.03 | $98.68 |
| Southern Maine, MEMaine | $132.36 | $102.90 |
| Detroit, MIMichigan | $133.22 | $104.54 |
| Rest of MichiganMichigan | $126.93 | $99.79 |
| MinnesotaMinnesota | $134.73 | $104.14 |
| Metropolitan Kansas City, MOMissouri | $128.78 | $100.87 |
| Metropolitan St. Louis, MOMissouri | $130.01 | $101.71 |
| Rest of MissouriMissouri | $121.93 | $96.31 |
| MississippiMississippi | $121.14 | $95.54 |
| MontanaMontana | $134.27 | $104.54 |
| North CarolinaNorth Carolina | $127.23 | $99.50 |
| North DakotaNorth Dakota | $132.49 | $102.76 |
| NebraskaNebraska | $125.56 | $98.12 |
| New HampshireNew Hampshire | $137.54 | $106.59 |
| Northern New JerseyNew Jersey | $151.36 | $116.88 |
| Rest of New JerseyNew Jersey | $144.43 | $111.97 |
| New MexicoNew Mexico | $127.50 | $100.24 |
| NevadaNevada | $133.86 | $104.10 |
| NYC suburbs and Long Island, NYNew York | $156.35 | $121.01 |
| Poughkeepsie and northern NYC suburbs, NYNew York | $145.25 | $112.70 |
| Queens, NYNew York | $154.49 | $119.35 |
| Rest of New YorkNew York | $128.94 | $100.70 |
| OhioOhio | $126.57 | $99.43 |
| OklahomaOklahoma | $124.09 | $97.55 |
| Portland, OROregon | $144.04 | $111.02 |
| Rest of OregonOregon | $133.02 | $103.42 |
| Metropolitan Philadelphia, PAPennsylvania | $139.26 | $108.31 |
| Rest of PennsylvaniaPennsylvania | $126.82 | $99.53 |
| Puerto RicoPuerto Rico | $135.20 | $105.15 |
| Rhode IslandRhode Island | $137.68 | $106.98 |
| South CarolinaSouth Carolina | $127.07 | $99.60 |
| South DakotaSouth Dakota | $132.28 | $102.55 |
| TennesseeTennessee | $124.79 | $97.77 |
| Austin, TXTexas | $139.17 | $107.72 |
| Beaumont, TXTexas | $126.06 | $99.01 |
| Brazoria, TXTexas | $133.15 | $103.69 |
| Dallas, TXTexas | $133.87 | $104.26 |
| Fort Worth, TXTexas | $133.02 | $103.71 |
| Galveston, TXTexas | $133.47 | $103.95 |
| Houston, TXTexas | $135.12 | $105.60 |
| Rest of TexasTexas | $129.45 | $101.24 |
| UtahUtah | $128.63 | $100.69 |
| VirginiaVirginia | $131.88 | $102.66 |
| Virgin Islands, VIUnited States Virgin Islands | $135.20 | $105.15 |
| VermontVermont | $131.90 | $102.47 |
| Rest of WashingtonWashington | $138.81 | $107.51 |
| King County, WAWashington | $156.01 | $119.54 |
| WisconsinWisconsin | $128.46 | $99.98 |
| West VirginiaWest Virginia | $123.93 | $98.10 |
| WyomingWyoming | $133.49 | $103.76 |
68840 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.
$120.29
$159.91
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 | $159.91 | 1 |
| AL | $121.86 | 1 |
| AR | $120.29 | 1 |
| AZ | $131.08 | 1 |
| CA | $142.13–$176.81 | 29 |
| CO | $139.81 | 1 |
| CT | $142.59 | 1 |
| DC | $152.72 | 1 |
| DE | $133.11 | 1 |
| FL | $131.87–$142.51 | 3 |
| GA | $125.25–$136.42 | 2 |
| GU | $145.18 | 1 |
| HI | $145.18 | 1 |
| IA | $124.91 | 1 |
| ID | $125.58 | 1 |
| IL | $128.23–$139.29 | 4 |
| IN | $126.24 | 1 |
| KS | $124.25 | 1 |
| KY | $124.15 | 1 |
| LA | $123.93–$129.44 | 2 |
| MA | $139.05–$152.92 | 2 |
| MD | $135.52–$152.72 | 3 |
| ME | $126.03–$132.36 | 2 |
| MI | $126.93–$133.22 | 2 |
| MN | $134.73 | 1 |
| MO | $121.93–$130.01 | 3 |
| MS | $121.14 | 1 |
| MT | $134.27 | 1 |
| NC | $127.23 | 1 |
| ND | $132.49 | 1 |
| NE | $125.56 | 1 |
| NH | $137.54 | 1 |
| NJ | $144.43–$151.36 | 2 |
| NM | $127.50 | 1 |
| NV | $133.86 | 1 |
| NY | $128.94–$156.35 | 5 |
| OH | $126.57 | 1 |
| OK | $124.09 | 1 |
| OR | $133.02–$144.04 | 2 |
| PA | $126.82–$139.26 | 2 |
| PR | $135.20 | 1 |
| RI | $137.68 | 1 |
| SC | $127.07 | 1 |
| SD | $132.28 | 1 |
| TN | $124.79 | 1 |
| TX | $126.06–$139.17 | 8 |
| UT | $128.63 | 1 |
| VA | $131.88–$152.72 | 2 |
| VI | $135.20 | 1 |
| VT | $131.90 | 1 |
| WA | $138.81–$156.01 | 2 |
| WI | $128.46 | 1 |
| WV | $123.93 | 1 |
| WY | $133.49 | 1 |
How the 68840 rate is calculated
Each of 68840’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 · 68840
RVUs × geographic indexes × conversion factor
Work1.27
1.27 RVUs× 1.000 GPCI
Practice expense2.66
2.66 RVUs× 1.000 GPCI
Malpractice0.09
0.09 RVUs× 1.000 GPCI
Adjusted RVUs
4.0200
Conversion factor
$33.4009
Medicare rate
$134.27
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
The exact Alaska inputs and CMS source lines
PPRRVU2026_Oct_nonQPP.csv
7,576
- Code
- 68840
- Physician work
- 1.27
- Practice expense
- 2.66
- Malpractice
- 0.09
GPCI2026.csv
5
- Locality
- Alaska
- Physician work
- 1.500
- Practice expense
- 1.065
- Malpractice
- 0.551
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 1.27 | × 1.500 | 1.9050 |
| Practice expense | 2.66 | × 1.065 | 2.8329 |
| Malpractice | 0.09 | × 0.551 | 0.0496 |
| Total RVUs | 4.7875 | ||
| Conversion factor | × 33.4009 | ||
Office rate, Alaska$159.91
Office: (1.27 × 1.5 + 2.66 × 1.065 + 0.09 × 0.551) × $33.4009 = $159.91
Facility: (1.27 × 1.5 + 1.77 × 1.065 + 0.09 × 0.551) × $33.4009 = $128.25
Payment rules and modifiers for 68840
68840 has a 10-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 68840
Tear duct probing, lacrimal canaliculi
| 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 · 68840
Tear duct probing, lacrimal canaliculi
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
68840 without 50 · national office
$134.27
Tear duct probing, lacrimal canaliculi
68840-50 · Bilateral: 150%
$201.41
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 68840 has changed in Alaska
68840 · Office / nonfacility
$159.91
Effective 2026-10-01
The base rate is $5.06 higher than on 2025-10-01, moving from $154.85 to $159.91 (3.3%).
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
$154.85changed to$159.91
- Conversion factor 32.3465 changed to 33.4009
- Work RVU 1.30 changed to 1.27
- Practice expense RVU 2.57 changed to 2.66
- Malpractice RVU 0.10 changed to 0.09
- Practice expense GPCI 1.081 changed to 1.065
- Malpractice GPCI 0.592 changed to 0.551
Held through RVU26B, RVU26C, RVU26D.
January 1, 2025
RVU25A
$160.08changed to$154.85
- Conversion factor 33.2875 changed to 32.3465
- Practice expense RVU 2.59 changed to 2.57
Held through RVU25B, RVU25C, RVU25D.
March 9, 2024
RVU24AR
$157.47changed to$160.08
- Conversion factor 32.7442 changed to 33.2875
Held through RVU24B, RVU24C, RVU24D.
January 1, 2024
RVU24A
$163.55changed to$157.47
- Conversion factor 33.8872 changed to 32.7442
- Practice expense RVU 2.56 changed to 2.59
- Practice expense GPCI 1.100 changed to 1.081
- Malpractice GPCI 0.603 changed to 0.592
January 1, 2023
RVU23A
$166.33changed to$163.55
- Conversion factor 34.6062 changed to 33.8872
- Practice expense RVU 2.50 changed to 2.56
- Practice expense GPCI 1.118 changed to 1.100
- Malpractice GPCI 0.614 changed to 0.603
Held through RVU23B, RVU23C, RVU23D.
January 1, 2022
RVU22A
$166.54changed to$166.33
- Conversion factor 34.8931 changed to 34.6062
- Practice expense RVU 2.47 changed to 2.50
Held through RVU22B, RVU22C, RVU22D.
January 1, 2021
RVU21A
$165.73changed to$166.54
- Conversion factor 36.0896 changed to 34.8931
- Practice expense RVU 2.31 changed to 2.47
- Malpractice RVU 0.09 changed to 0.10
- Malpractice GPCI 0.661 changed to 0.614
Held through RVU21B, RVU21C, RVU21D.
January 1, 2020
RVU20A
$164.36changed to$165.73
- Conversion factor 36.0391 changed to 36.0896
- Practice expense RVU 2.28 changed to 2.31
- Practice expense GPCI 1.117 changed to 1.118
- Malpractice GPCI 0.708 changed to 0.661
Held through RVU20B, RVU20C, RVU20D.
January 1, 2019
RVU19A
$163.77changed to$164.36
- Conversion factor 35.9996 changed to 36.0391
- Practice expense RVU 2.27 changed to 2.28
Held through RVU19B, RVU19C, RVU19D.
January 1, 2018
RVU18AR1
$160.87changed to$163.77
- Conversion factor 35.8887 changed to 35.9996
- Practice expense RVU 2.22 changed to 2.27
- Practice expense GPCI 1.112 changed to 1.117
- Malpractice GPCI 0.710 changed to 0.708
Held through RVU18B, RVU18C, RVU18D.
January 1, 2017
RVU17A
$160.10changed to$160.87
- Conversion factor 35.8043 changed to 35.8887
- Practice expense GPCI 1.107 changed to 1.112
- Malpractice GPCI 0.712 changed to 0.710
Held through RVU17B, RVU17C, RVU17D.
January 1, 2016
RVU16A
$160.68changed to$160.10
- Conversion factor 35.9335 changed to 35.8043
Held through RVU16B, RVU16C, RVU16D.
July 1, 2015
RVU15C
$159.88changed to$160.68
- Conversion factor 35.7547 changed to 35.9335
Held through RVU15D.
January 1, 2015
RVU15A
$161.96changed to$159.88
- Conversion factor 35.8228 changed to 35.7547
- Malpractice RVU 0.23 changed to 0.09
- Practice expense GPCI 1.087 changed to 1.107
- Malpractice GPCI 0.687 changed to 0.712
Held through RVU15B.
January 1, 2014
RVU14A
$160.32changed to$161.96
- Conversion factor 34.0230 changed to 35.8228
- Practice expense RVU 2.44 changed to 2.22
- Malpractice RVU 0.24 changed to 0.23
- Practice expense GPCI 1.067 changed to 1.087
- Malpractice GPCI 0.661 changed to 0.687
Held through RVU14B, RVU14C, RVU14D.
January 1, 2013
RVU13AR
Earliest loaded release: $160.32
Held through RVU13B, RVU13C, RVU13D.
| Effective from | Office | Facility | CMS release |
|---|---|---|---|
| 2026-10-01 | $159.91 | $128.25 | RVU26D |
| 2026-07-01 | $159.91 | $128.25 | RVU26C |
| 2026-04-01 | $159.91 | $128.25 | RVU26B |
| 2026-01-01 | $159.91 | $128.25 | RVU26A |
| 2025-10-01 | $154.85 | $138.77 | RVU25D |
| 2025-07-01 | $154.85 | $138.77 | RVU25C |
| 2025-04-01 | $154.85 | $138.77 | RVU25B |
| 2025-01-01 | $154.85 | $138.77 | RVU25A |
| 2024-10-01 | $160.08 | $142.45 | RVU24D |
| 2024-07-01 | $160.08 | $142.45 | RVU24C |
| 2024-04-01 | $160.08 | $142.45 | RVU24B |
| 2024-03-09 | $160.08 | $142.45 | RVU24AR |
| 2024-01-01 | $157.47 | $140.12 | RVU24A |
| 2023-10-01 | $163.55 | $144.91 | RVU23D |
| 2023-07-01 | $163.55 | $144.91 | RVU23C |
| 2023-04-01 | $163.55 | $144.91 | RVU23B |
| 2023-01-01 | $163.55 | $144.91 | RVU23A |
| 2022-10-01 | $166.33 | $146.21 | RVU22D |
| 2022-07-01 | $166.33 | $146.21 | RVU22C |
| 2022-04-01 | $166.33 | $146.21 | RVU22B |
| 2022-01-01 | $166.33 | $146.21 | RVU22A |
| 2021-10-01 | $166.54 | $147.03 | RVU21D |
| 2021-07-01 | $166.54 | $147.03 | RVU21C |
| 2021-04-01 | $166.54 | $147.03 | RVU21B |
| 2021-01-01 | $166.54 | $147.03 | RVU21A |
| 2020-10-01 | $165.73 | $148.38 | RVU20D |
| 2020-07-01 | $165.73 | $148.38 | RVU20C |
| 2020-04-01 | $165.73 | $148.38 | RVU20B |
| 2020-01-01 | $165.73 | $148.38 | RVU20A |
| 2019-10-01 | $164.36 | $149.86 | RVU19D |
| 2019-07-01 | $164.36 | $149.86 | RVU19C |
| 2019-04-01 | $164.36 | $149.86 | RVU19B |
| 2019-01-01 | $164.36 | $149.86 | RVU19A |
| 2018-10-01 | $163.77 | $150.10 | RVU18D |
| 2018-07-01 | $163.77 | $150.10 | RVU18C |
| 2018-04-01 | $163.77 | $150.10 | RVU18B |
| 2018-01-01 | $163.77 | $150.10 | RVU18AR1 |
| 2017-10-01 | $160.87 | $148.50 | RVU17D |
| 2017-07-01 | $160.87 | $148.50 | RVU17C |
| 2017-04-01 | $160.87 | $148.50 | RVU17B |
| 2017-01-01 | $160.87 | $148.50 | RVU17A |
| 2016-10-01 | $160.10 | $148.21 | RVU16D |
| 2016-07-01 | $160.10 | $148.21 | RVU16C |
| 2016-04-01 | $160.10 | $148.21 | RVU16B |
| 2016-01-01 | $160.10 | $148.21 | RVU16A |
| 2015-10-01 | $160.68 | $148.75 | RVU15D |
| 2015-07-01 | $160.68 | $148.75 | RVU15C |
| 2015-04-01 | $159.88 | $148.01 | RVU15B |
| 2015-01-01 | $159.88 | $148.01 | RVU15A |
| 2014-10-01 | $161.96 | $150.28 | RVU14D |
| 2014-07-01 | $161.96 | $150.28 | RVU14C |
| 2014-04-01 | $161.96 | $150.28 | RVU14B |
| 2014-01-01 | $161.96 | $150.28 | RVU14A |
| 2013-10-01 | $160.32 | $147.98 | RVU13D |
| 2013-07-01 | $160.32 | $147.98 | RVU13C |
| 2013-04-01 | $160.32 | $147.98 | RVU13B |
| 2013-01-01 | $160.32 | $147.98 | RVU13AR |
Where the Alaska rate applies
Alaska is a Medicare payment area, not a city. Our Census mapping connects it to 355 cities and communities in Alaska. Some span more than one payment area; confirm with the service ZIP.
- Adak
- Akhiok
- Akiachak
- Akiak
- Akutan
- Alakanuk
- Alatna
- Alcan Border
68840 billing questions
When should 68840 be chosen over 68810?
Use 68840 when probing the lacrimal canaliculi. Code 68810 is for probing the nasolacrimal duct, a different part of the tear-drainage pathway.
Is irrigation separately reported with 68840?
No. Irrigation may be part of the canalicular probing service and is not separately reported as an additional service under this code.
How is bilateral canalicular probing reported?
Report modifier 50 for bilateral treatment. CMS pays the bilateral procedure at 150% of the single-side amount.
Are related postoperative visits included?
Yes. The 10-day global period includes related postoperative visits during those 10 days.
Can an assistant or co-surgeon be reported?
Assistant-at-surgery payment is restricted 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
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