CPT code 69420: Eardrum incision, no ventilating tube2026 Medicare rate & RVUs in California

Medicare pays $202.82–$255.44 for 69420 in the office in California, from Chico, CA to San Benito County, CA. Which amount applies depends on the service address.

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

What 69420 covers

An otolaryngologist typically makes a small incision in the tympanic membrane to access or drain middle-ear fluid. The service may include aspiration and/or eustachian tube inflation; no ventilating tube is placed. It is commonly performed in an office or outpatient setting for selected middle-ear conditions, such as fluid behind the eardrum. The incision may be performed on one or both ears.

Select this code for the incision service without tube insertion, rather than a code for tympanostomy with a tube. Document the clinical reason, the ear treated, the procedure performed, and whether fluid was aspirated. Medicare includes related postoperative visits during the 10-day global period. When multiple procedures are performed in the same session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% multiple-procedure reduction. Bilateral reporting with modifier 50 is paid at 150%. 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.

Where 69420 pays more and less in California

The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.

29 of 29 payment localities

How the 69420 rate is calculated

Each of 69420’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 69420

69420 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

69420 compared with similar codes

How to choose

69421MyringotomyGeneral anesthesia, no tube

Both involve an eardrum incision without tube placement; 69421 applies when general anesthesia is required.

69433Ear tube placementLocal or topical anesthesia

This code includes placement of a ventilating tube under local or topical anesthesia; 69420 describes incision without tube insertion.

69436TympanostomyTube insertion, general anesthesia

This code includes ventilating tube placement when general anesthesia is required; 69420 is for incision without a tube.

Codes related to 69420

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

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