CPT code 69209: Earwax removal, irrigation or lavage2026 Medicare rate & RVUs in Puerto Rico
Report this code for irrigation or lavage to remove impacted cerumen from one ear canal, rather than instrumentation or routine ear cleaning.
In Puerto Rico, Medicare pays $17.21 for 69209 in the office.
Check a contract rate as a % of Medicare · 69209 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 69209 covers
This service uses irrigation or lavage to dislodge and remove impacted cerumen from one external ear canal. It is commonly performed in an office or clinic when wax obstructs the canal; clinical staff may perform the irrigation under physician supervision. It describes wax removal, not routine ear cleaning or extraction of a foreign body. The instrumentation method for impacted cerumen is reported with a different code.
Report one unit for one ear; report bilateral treatment with modifier 50. CMS applies a 0-day global period, so same-day preoperative and postoperative care is included. When multiple procedures are performed in one session, the highest-valued procedure is paid in full and the others at 50%. As an incident-to service, this code is billed only when performed under physician supervision. Assistant-at-surgery services are not paid, and co-surgeon and team-surgery billing 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 Puerto Rico compares for 69209
Across 109 of 109 payment localities, the office rate for 69209 runs from $14.52 in Arkansas to $24.26 in San Benito County, CA. Puerto Rico pays $17.21. The RVUs are the same everywhere; the geographic indexes change the dollars.
- Puerto Rico · this page$17.21
- Los Angeles, CA · California$19.98+$2.77
- Washington, DC area · District of Columbia$20.04+$2.83
- Miami, FL · Florida$18.23+$1.02
- Chicago, IL · Illinois$17.55+$0.34
- Manhattan, NY · New York$19.94+$2.73
- Alaska · Alaska$17.97+$0.76
Other areas in Puerto Rico first, then benchmark localities. Bars start at $0.
Every other payment area
| Payment locality | Office | Facility |
|---|---|---|
| AlabamaAlabama | $14.80 | — |
| ArkansasArkansas | $14.52 | — |
| ArizonaArizona | $16.47 | — |
| Bakersfield, CACalifornia | $18.51 | — |
| Chico, CACalifornia | $18.48 | — |
| El Centro, CACalifornia | $18.48 | — |
| Fresno, CACalifornia | $18.48 | — |
| Hanford, CACalifornia | $18.48 | — |
| Madera, CACalifornia | $18.48 | — |
| Merced, CACalifornia | $18.48 | — |
| Modesto, CACalifornia | $18.48 | — |
| Napa, CACalifornia | $22.18 | — |
| Oxnard, CACalifornia | $19.95 | — |
| Redding, CACalifornia | $18.48 | — |
| Rest of CaliforniaCalifornia | $18.48 | — |
| Riverside, CACalifornia | $18.59 | — |
| Sacramento, CACalifornia | $19.60 | — |
| Salinas, CACalifornia | $19.53 | — |
| San Diego, CACalifornia | $20.15 | — |
| Marin County, CACalifornia | $23.70 | — |
| San Francisco, CACalifornia | $23.69 | — |
| San Benito County, CACalifornia | $24.26 | — |
| Santa Clara County, CACalifornia | $24.21 | — |
| San Luis Obispo, CACalifornia | $19.20 | — |
| Santa Cruz, CACalifornia | $20.47 | — |
| Santa Maria, CACalifornia | $19.65 | — |
| Santa Rosa, CACalifornia | $20.69 | — |
| Stockton, CACalifornia | $18.48 | — |
| Vallejo, CACalifornia | $22.16 | — |
| Visalia, CACalifornia | $18.48 | — |
| Yuba City, CACalifornia | $18.48 | — |
| ColoradoColorado | $18.03 | — |
| ConnecticutConnecticut | $18.39 | — |
| DelawareDelaware | $16.80 | — |
| Fort Lauderdale, FLFlorida | $17.52 | — |
| Rest of FloridaFlorida | $16.47 | — |
| Atlanta, GAGeorgia | $17.37 | — |
| Rest of GeorgiaGeorgia | $15.29 | — |
| Hawaii, Guam, HIHawaii | $19.18 | — |
| IowaIowa | $15.41 | — |
| IdahoIdaho | $15.52 | — |
| East St. Louis, ILIllinois | $16.04 | — |
| Rest of IllinoisIllinois | $15.77 | — |
| Suburban Chicago, ILIllinois | $17.74 | — |
| IndianaIndiana | $15.64 | — |
| KansasKansas | $15.27 | — |
| KentuckyKentucky | $15.15 | — |
| New Orleans, LALouisiana | $16.09 | — |
| Rest of LouisianaLouisiana | $15.10 | — |
| Metropolitan Boston, MAMassachusetts | $20.24 | — |
| Rest of MassachusettsMassachusetts | $17.85 | — |
| Baltimore area, MDMaryland | $18.33 | — |
| Rest of MarylandMaryland | $17.21 | — |
| Rest of MaineMaine | $15.57 | — |
| Southern Maine, MEMaine | $16.76 | — |
| Detroit, MIMichigan | $16.68 | — |
| Rest of MichiganMichigan | $15.62 | — |
| MinnesotaMinnesota | $17.28 | — |
| Metropolitan Kansas City, MOMissouri | $16.01 | — |
| Metropolitan St. Louis, MOMissouri | $16.23 | — |
| Rest of MissouriMissouri | $14.72 | — |
| MississippiMississippi | $14.63 | — |
| MontanaMontana | $17.03 | — |
| North CarolinaNorth Carolina | $15.79 | — |
| North DakotaNorth Dakota | $16.84 | — |
| NebraskaNebraska | $15.54 | — |
| New HampshireNew Hampshire | $17.68 | — |
| Northern New JerseyNew Jersey | $19.73 | — |
| Rest of New JerseyNew Jersey | $18.60 | — |
| New MexicoNew Mexico | $15.72 | — |
| NevadaNevada | $17.00 | — |
| NYC suburbs and Long Island, NYNew York | $20.48 | — |
| Poughkeepsie and northern NYC suburbs, NYNew York | $18.69 | — |
| Queens, NYNew York | $20.22 | — |
| Rest of New YorkNew York | $16.10 | — |
| OhioOhio | $15.58 | — |
| OklahomaOklahoma | $15.17 | — |
| Portland, OROregon | $18.80 | — |
| Rest of OregonOregon | $16.87 | — |
| Metropolitan Philadelphia, PAPennsylvania | $17.78 | — |
| Rest of PennsylvaniaPennsylvania | $15.65 | — |
| Rhode IslandRhode Island | $17.55 | — |
| South CarolinaSouth Carolina | $15.72 | — |
| South DakotaSouth Dakota | $16.81 | — |
| TennesseeTennessee | $15.36 | — |
| Austin, TXTexas | $17.97 | — |
| Beaumont, TXTexas | $15.51 | — |
| Brazoria, TXTexas | $16.81 | — |
| Dallas, TXTexas | $16.92 | — |
| Fort Worth, TXTexas | $16.76 | — |
| Galveston, TXTexas | $16.86 | — |
| Houston, TXTexas | $17.04 | — |
| Rest of TexasTexas | $16.15 | — |
| UtahUtah | $16.00 | — |
| VirginiaVirginia | $16.65 | — |
| Virgin Islands, VIUnited States Virgin Islands | $17.21 | — |
| VermontVermont | $16.70 | — |
| Rest of WashingtonWashington | $17.84 | — |
| King County, WAWashington | $20.76 | — |
| WisconsinWisconsin | $16.10 | — |
| West VirginiaWest Virginia | $14.99 | — |
| WyomingWyoming | $16.95 | — |
69209 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.
$14.52
$21.37
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 | $17.97 | 1 |
| AL | $14.80 | 1 |
| AR | $14.52 | 1 |
| AZ | $16.47 | 1 |
| CA | $18.48–$24.26 | 29 |
| CO | $18.03 | 1 |
| CT | $18.39 | 1 |
| DC | $20.04 | 1 |
| DE | $16.80 | 1 |
| FL | $16.47–$18.23 | 3 |
| GA | $15.29–$17.37 | 2 |
| GU | $19.18 | 1 |
| HI | $19.18 | 1 |
| IA | $15.41 | 1 |
| ID | $15.52 | 1 |
| IL | $15.77–$17.74 | 4 |
| IN | $15.64 | 1 |
| KS | $15.27 | 1 |
| KY | $15.15 | 1 |
| LA | $15.10–$16.09 | 2 |
| MA | $17.85–$20.24 | 2 |
| MD | $17.21–$20.04 | 3 |
| ME | $15.57–$16.76 | 2 |
| MI | $15.62–$16.68 | 2 |
| MN | $17.28 | 1 |
| MO | $14.72–$16.23 | 3 |
| MS | $14.63 | 1 |
| MT | $17.03 | 1 |
| NC | $15.79 | 1 |
| ND | $16.84 | 1 |
| NE | $15.54 | 1 |
| NH | $17.68 | 1 |
| NJ | $18.60–$19.73 | 2 |
| NM | $15.72 | 1 |
| NV | $17.00 | 1 |
| NY | $16.10–$20.48 | 5 |
| OH | $15.58 | 1 |
| OK | $15.17 | 1 |
| OR | $16.87–$18.80 | 2 |
| PA | $15.65–$17.78 | 2 |
| PR | $17.21 | 1 |
| RI | $17.55 | 1 |
| SC | $15.72 | 1 |
| SD | $16.81 | 1 |
| TN | $15.36 | 1 |
| TX | $15.51–$17.97 | 8 |
| UT | $16.00 | 1 |
| VA | $16.65–$20.04 | 2 |
| VI | $17.21 | 1 |
| VT | $16.70 | 1 |
| WA | $17.84–$20.76 | 2 |
| WI | $16.10 | 1 |
| WV | $14.99 | 1 |
| WY | $16.95 | 1 |
How the 69209 rate is calculated
Each of 69209’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 · 69209
RVUs × geographic indexes × conversion factor
Work0.00
0.00 RVUs× 1.000 GPCI
Practice expense0.50
0.50 RVUs× 1.000 GPCI
Malpractice0.01
0.01 RVUs× 1.000 GPCI
Adjusted RVUs
0.5100
Conversion factor
$33.4009
Medicare rate
$17.03
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
The exact Puerto Rico inputs and CMS source lines
PPRRVU2026_Oct_nonQPP.csv
7,594
- Code
- 69209
- Physician work
- 0.00
- Practice expense
- 0.50
- Malpractice
- 0.01
GPCI2026.csv
91
- Locality
- Puerto Rico
- Physician work
- 1.000
- Practice expense
- 1.011
- Malpractice
- 0.985
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 0.00 | × 1.000 | 0.0000 |
| Practice expense | 0.50 | × 1.011 | 0.5055 |
| Malpractice | 0.01 | × 0.985 | 0.0098 |
| Total RVUs | 0.5153 | ||
| Conversion factor | × 33.4009 | ||
Office rate, Puerto Rico$17.21
Office: (0 × 1 + 0.5 × 1.011 + 0.01 × 0.985) × $33.4009 = $17.21
Payment rules and modifiers for 69209
The CMS indicators that decide how 69209 is paid alongside other services.
CMS payment indicators · 69209
Earwax removal, irrigation or lavage
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 000 | Same-day global: pre- and post-op care on the day of the procedure is 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 | 5 | Incident-to service. |
What modifiers do to the payment
Modifier 50 · payment effect
With and without the modifier
69209 without 50 · national office
$17.03
Earwax removal, irrigation or lavage
69209-50 · Bilateral: 150%
$25.55
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 69209 has changed in Puerto Rico
69209 · Office / nonfacility
$17.21
Effective 2026-10-01
The base rate is $1.91 higher than on 2025-10-01, moving from $15.30 to $17.21 (12.5%).
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
$15.30changed to$17.21
- Conversion factor 32.3465 changed to 33.4009
- Practice expense RVU 0.46 changed to 0.50
- Practice expense GPCI 1.007 changed to 1.011
- Malpractice GPCI 0.982 changed to 0.985
Held through RVU26B, RVU26C, RVU26D.
January 1, 2025
RVU25A
$16.08changed to$15.30
- Conversion factor 33.2875 changed to 32.3465
- Practice expense RVU 0.47 changed to 0.46
Held through RVU25B, RVU25C, RVU25D.
March 9, 2024
RVU24AR
$15.82changed to$16.08
- Conversion factor 32.7442 changed to 33.2875
Held through RVU24B, RVU24C, RVU24D.
January 1, 2024
RVU24A
$15.70changed to$15.82
- Conversion factor 33.8872 changed to 32.7442
- Practice expense RVU 0.45 changed to 0.47
- Practice expense GPCI 1.008 changed to 1.007
- Malpractice GPCI 0.984 changed to 0.982
October 1, 2023
RVU23D
$15.59changed to$15.70
- Practice expense GPCI 1.000 changed to 1.008
- Malpractice GPCI 1.000 changed to 0.984
January 1, 2023
RVU23A
$15.69changed to$15.59
- Conversion factor 34.6062 changed to 33.8872
- Practice expense RVU 0.44 changed to 0.45
- Practice expense GPCI 1.008 changed to 1.000
- Malpractice GPCI 0.986 changed to 1.000
Held through RVU23B, RVU23C.
January 1, 2022
RVU22A
$15.47changed to$15.69
- Conversion factor 34.8931 changed to 34.6062
- Practice expense RVU 0.43 changed to 0.44
Held through RVU22B, RVU22C, RVU22D.
January 1, 2021
RVU21A
$14.54changed to$15.47
- Conversion factor 36.0896 changed to 34.8931
- Practice expense RVU 0.39 changed to 0.43
- Malpractice GPCI 0.988 changed to 0.986
Held through RVU21B, RVU21C, RVU21D.
January 1, 2020
RVU20A
$14.51changed to$14.54
- Conversion factor 36.0391 changed to 36.0896
- Practice expense GPCI 1.007 changed to 1.008
- Malpractice GPCI 0.990 changed to 0.988
Held through RVU20B, RVU20C, RVU20D.
January 1, 2019
RVU19A
$14.49changed to$14.51
- Conversion factor 35.9996 changed to 36.0391
Held through RVU19B, RVU19C, RVU19D.
January 1, 2018
RVU18AR1
$10.98changed to$14.49
- Conversion factor 35.8887 changed to 35.9996
- Practice expense RVU 0.35 changed to 0.39
- Practice expense GPCI 0.856 changed to 1.007
- Malpractice GPCI 0.642 changed to 0.990
Held through RVU18B, RVU18C, RVU18D.
January 1, 2017
RVU17A
$8.94changed to$10.98
- Conversion factor 35.8043 changed to 35.8887
- Practice expense GPCI 0.705 changed to 0.856
- Malpractice GPCI 0.293 changed to 0.642
Held through RVU17B, RVU17C, RVU17D.
January 1, 2016
RVU16A
No ratechanged to$8.94
Held through RVU16B, RVU16C, RVU16D.
January 1, 2013
RVU13AR
Earliest loaded release: No rate
Held through RVU13B, RVU13C, RVU13D, RVU14A, RVU14B, RVU14C, RVU14D, RVU15A, RVU15B, RVU15C, RVU15D.
| Effective from | Office | Facility | CMS release |
|---|---|---|---|
| 2026-10-01 | $17.21 | Not available in this setting | RVU26D |
| 2026-07-01 | $17.21 | Not available in this setting | RVU26C |
| 2026-04-01 | $17.21 | Not available in this setting | RVU26B |
| 2026-01-01 | $17.21 | Not available in this setting | RVU26A |
| 2025-10-01 | $15.30 | Not available in this setting | RVU25D |
| 2025-07-01 | $15.30 | Not available in this setting | RVU25C |
| 2025-04-01 | $15.30 | Not available in this setting | RVU25B |
| 2025-01-01 | $15.30 | Not available in this setting | RVU25A |
| 2024-10-01 | $16.08 | Not available in this setting | RVU24D |
| 2024-07-01 | $16.08 | Not available in this setting | RVU24C |
| 2024-04-01 | $16.08 | Not available in this setting | RVU24B |
| 2024-03-09 | $16.08 | Not available in this setting | RVU24AR |
| 2024-01-01 | $15.82 | Not available in this setting | RVU24A |
| 2023-10-01 | $15.70 | Not available in this setting | RVU23D |
| 2023-07-01 | $15.59 | Not available in this setting | RVU23C |
| 2023-04-01 | $15.59 | Not available in this setting | RVU23B |
| 2023-01-01 | $15.59 | Not available in this setting | RVU23A |
| 2022-10-01 | $15.69 | Not available in this setting | RVU22D |
| 2022-07-01 | $15.69 | Not available in this setting | RVU22C |
| 2022-04-01 | $15.69 | Not available in this setting | RVU22B |
| 2022-01-01 | $15.69 | Not available in this setting | RVU22A |
| 2021-10-01 | $15.47 | Not available in this setting | RVU21D |
| 2021-07-01 | $15.47 | Not available in this setting | RVU21C |
| 2021-04-01 | $15.47 | Not available in this setting | RVU21B |
| 2021-01-01 | $15.47 | Not available in this setting | RVU21A |
| 2020-10-01 | $14.54 | Not available in this setting | RVU20D |
| 2020-07-01 | $14.54 | Not available in this setting | RVU20C |
| 2020-04-01 | $14.54 | Not available in this setting | RVU20B |
| 2020-01-01 | $14.54 | Not available in this setting | RVU20A |
| 2019-10-01 | $14.51 | Not available in this setting | RVU19D |
| 2019-07-01 | $14.51 | Not available in this setting | RVU19C |
| 2019-04-01 | $14.51 | Not available in this setting | RVU19B |
| 2019-01-01 | $14.51 | Not available in this setting | RVU19A |
| 2018-10-01 | $14.49 | Not available in this setting | RVU18D |
| 2018-07-01 | $14.49 | Not available in this setting | RVU18C |
| 2018-04-01 | $14.49 | Not available in this setting | RVU18B |
| 2018-01-01 | $14.49 | Not available in this setting | RVU18AR1 |
| 2017-10-01 | $10.98 | Not available in this setting | RVU17D |
| 2017-07-01 | $10.98 | Not available in this setting | RVU17C |
| 2017-04-01 | $10.98 | Not available in this setting | RVU17B |
| 2017-01-01 | $10.98 | Not available in this setting | RVU17A |
| 2016-10-01 | $8.94 | Not available in this setting | RVU16D |
| 2016-07-01 | $8.94 | Not available in this setting | RVU16C |
| 2016-04-01 | $8.94 | Not available in this setting | RVU16B |
| 2016-01-01 | $8.94 | Not available in this setting | RVU16A |
| 2015-10-01 | Not in this release | Not in this release | RVU15D |
| 2015-07-01 | Not in this release | Not in this release | RVU15C |
| 2015-04-01 | Not in this release | Not in this release | RVU15B |
| 2015-01-01 | Not in this release | Not in this release | RVU15A |
| 2014-10-01 | Not in this release | Not in this release | RVU14D |
| 2014-07-01 | Not in this release | Not in this release | RVU14C |
| 2014-04-01 | Not in this release | Not in this release | RVU14B |
| 2014-01-01 | Not in this release | Not in this release | RVU14A |
| 2013-10-01 | Not in this release | Not in this release | RVU13D |
| 2013-07-01 | Not in this release | Not in this release | RVU13C |
| 2013-04-01 | Not in this release | Not in this release | RVU13B |
| 2013-01-01 | Not in this release | Not in this release | RVU13AR |
Where the Puerto Rico rate applies
Puerto Rico is a Medicare payment area, not a city. Our Census mapping connects it to 292 cities and communities in Puerto Rico. Some span more than one payment area; confirm with the service ZIP.
- Aceitunas
- Adjuntas
- Aguada
- Aguadilla
- Aguas Buenas
- Aguas Claras
- Aguilita
- Aibonito
69209 billing questions
How is this different from 69210?
Use 69209 when impacted cerumen is removed by irrigation or lavage. Use 69210 when removal requires instrumentation.
Can the code be reported for both ears?
Yes. The code is unilateral; report bilateral treatment with modifier 50. CMS pays a bilateral procedure reported with modifier 50 at 150%.
Can clinical staff perform the irrigation?
The service may be performed as an incident-to service, but it may be billed only when performed under physician supervision.
Is this the right code for a foreign object in the ear canal?
No. This code is for impacted cerumen removed by irrigation or lavage. Foreign-body removal is reported with 69200 or 69205, depending on the circumstances.
What happens when another procedure is performed in the same session?
CMS pays the highest-valued procedure in full and the other procedure at 50% under the standard multiple procedure reduction.
Is same-day follow-up care included?
Yes. The code has a 0-day global period, which includes same-day preoperative and postoperative care.
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 69209 and the rest of your codes on one sheet
Your codes at your locality, with payer contracts beside Medicare.
Join the waitlist