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

In North Carolina, Medicare pays $179.93 for 69420 in the office and $104.21 when it’s performed in a hospital or facility.

Check a contract rate as a % of Medicare · 69420 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 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.

How North Carolina compares for 69420

Across 109 of 109 payment localities, the office rate for 69420 runs from $168.75 in Arkansas to $255.44 in San Benito County, CA. North Carolina pays $179.93. The RVUs are the same everywhere; the geographic indexes change the dollars.

Every other payment area

69420 rates by state

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

See 69420 in every payment locality

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

Codes related to 69420

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

How 69420 has changed in North Carolina

Price 69420 for an earlier date of service

Where the North Carolina rate applies

North Carolina is a Medicare payment area, not a city. Our Census mapping connects it to 785 cities and communities in North Carolina. Some span more than one payment area; confirm with the service ZIP.

• Aberdeen
• Advance
• Ahoskie
• Alamance
• Albemarle
• Alexis
• Alliance
• Altamahaw

Browse all communities in North Carolina

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