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

Report this service when a clinician makes an opening in the eardrum to drain middle-ear fluid or perform related myringotomy care without placing a tube.

CMS RVU26DEffective Oct 1, 2026One payment locality13.4K Medicare services in 2024

In Utah, Medicare pays $182.64 for 69420 in the office and $106.35 when it’s performed in a hospital or facility.

$182.64Office (non-facility)
$106.35Hospital or facility
−4.7%vs the national office rate ($191.72)

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.

We’ll open 69420 for the payment locality that covers the ZIP.

On this page 11 sections
  1. Rate in Utah
  2. What 69420 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 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 Utah 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. Utah pays $182.64. The RVUs are the same everywhere; the geographic indexes change the dollars.

69420 in Utah vs other payment areas
  1. Utah · this page$182.64
  2. Los Angeles, CA · California$216.94+$34.30
  3. Washington, DC area · District of Columbia$219.82+$37.18
  4. Miami, FL · Florida$207.67+$25.03
  5. Chicago, IL · Illinois$201.39+$18.75
  6. Manhattan, NY · New York$221.19+$38.55
  7. Alaska · Alaska$220.36+$37.72

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

Every other payment area

69420 in every other Medicare payment locality
Payment localityOfficeFacility
AlabamaAlabama$171.33$100.31
ArkansasArkansas$168.75$99.03
ArizonaArizona$186.42$107.77
Bakersfield, CACalifornia$203.40$114.45
Chico, CACalifornia$202.82$113.87
El Centro, CACalifornia$202.86$113.90
Fresno, CACalifornia$202.82$113.87
Hanford, CACalifornia$202.82$113.87

69420 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.

$168.75

$229.13

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

View every state and territory as a table
69420 office rate range by state
State / territoryOffice rate rangeLocalities
AK$220.361
AL$171.331
AR$168.751
AZ$186.421
CA$202.82–$255.4429
CO$199.761
CT$204.801
DC$219.821
DE$189.591
FL$188.92–$207.673
GA$177.89–$195.442
GU$208.081
HI$208.081
IA$175.801
ID$177.001
IL$183.31–$201.394
IN$178.071
KS$174.971
KY$175.621
LA$175.35–$184.372
MA$198.50–$219.992
MD$193.30–$219.823
ME$178.00–$188.002
MI$180.41–$191.412
MN$191.081
MO$172.23–$185.023
MS$170.521
MT$191.711
NC$179.931
ND$187.751
NE$176.791
NH$196.621
NJ$207.05–$217.412
NM$181.451
NV$190.751
NY$182.74–$226.785
OH$179.601
OK$175.261
OR$189.18–$206.272
PA$179.88–$199.562
PR$193.161
RI$196.471
SC$180.081
SD$187.291
TN$175.891
TX$178.65–$199.178
UT$182.641
VA$187.38–$219.822
VI$193.161
VT$187.021
WA$198.13–$224.522
WI$181.221
WV$176.271
WY$189.981

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.

How the rate is built · 69420

RVUs × geographic indexes × conversion factor

Office or facility?

Work1.35

1.35 RVUs× 1.000 GPCI

Practice expense4.19

4.19 RVUs× 1.000 GPCI

Malpractice0.20

0.20 RVUs× 1.000 GPCI

Adjusted RVUs

5.7400

Conversion factor

$33.4009

Medicare rate

$191.72

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

The exact Utah inputs and CMS source lines

PPRRVU2026_Oct_nonQPP.csv

7,602

Code
69420
Physician work
1.35
Practice expense
4.19
Malpractice
0.20

GPCI2026.csv

104

Locality
Utah
Physician work
1.000
Practice expense
0.940
Malpractice
0.898
Office calculation for 69420 in Utah
ComponentRVULocality factorAdjusted
Physician work1.35× 1.0001.3500
Practice expense4.19× 0.9403.9386
Malpractice0.20× 0.8980.1796
Total RVUs5.4682
Conversion factor× 33.4009

Office rate, Utah$182.64

Office: (1.35 × 1 + 4.19 × 0.94 + 0.2 × 0.898) × $33.4009 = $182.64

Facility: (1.35 × 1 + 1.76 × 0.94 + 0.2 × 0.898) × $33.4009 = $106.35

Open 69420 in the RVU calculator

Payment rules and modifiers for 69420

69420 has a 10-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 69420

Eardrum incision, no ventilating tube

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 · 69420

Eardrum incision, no ventilating tube

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

69420 without 50 · national office

$191.72

Eardrum incision, no ventilating tube

69420-50 · Bilateral: 150%

$287.58

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 69420

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

Codes related to 69420
CodeHow it relatesOffice range, Utah
Same family
69421Myringotomy, general anesthesia, no tubeEardrum incision sibling for cases requiring general anesthesia.No office rate
Used instead
69433Ear tube placement, local or topical anesthesiaUse for tympanostomy with ventilating tube placement under local or topical anesthesia.$193.04
69436Tympanostomy, tube insertion, general anesthesiaUse for tympanostomy with ventilating tube placement requiring general anesthesia.No office rate

How 69420 has changed in Utah

69420 · Office / nonfacility

$182.64

Effective 2026-10-01

The base rate is $7.34 higher than on 2025-10-01, moving from $175.30 to $182.64 (4.2%).

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

    $175.30changed to$182.64

    • Conversion factor 32.3465 changed to 33.4009
    • Work RVU 1.38 changed to 1.35
    • Practice expense RVU 4.13 changed to 4.19
    • Practice expense GPCI 0.933 changed to 0.940
    • Malpractice GPCI 0.930 changed to 0.898

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    $182.26changed to$175.30

    • Conversion factor 33.2875 changed to 32.3465
    • Practice expense RVU 4.19 changed to 4.13

    Held through RVU25B, RVU25C, RVU25D.

  3. March 9, 2024

    RVU24AR

    $179.28changed to$182.26

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $184.44changed to$179.28

    • Conversion factor 33.8872 changed to 32.7442
    • Practice expense RVU 4.21 changed to 4.19
    • Malpractice RVU 0.19 changed to 0.20
    • Practice expense GPCI 0.926 changed to 0.933
    • Malpractice GPCI 0.865 changed to 0.930

  5. January 1, 2023

    RVU23A

    $184.95changed to$184.44

    • Conversion factor 34.6062 changed to 33.8872
    • Practice expense RVU 4.14 changed to 4.21
    • Malpractice RVU 0.20 changed to 0.19
    • Practice expense GPCI 0.919 changed to 0.926
    • Malpractice GPCI 0.799 changed to 0.865

    Held through RVU23B, RVU23C, RVU23D.

  6. January 1, 2022

    RVU22A

    $183.92changed to$184.95

    • Conversion factor 34.8931 changed to 34.6062
    • Practice expense RVU 4.06 changed to 4.14

    Held through RVU22B, RVU22C, RVU22D.

  7. January 1, 2021

    RVU21A

    $181.12changed to$183.92

    • Conversion factor 36.0896 changed to 34.8931
    • Practice expense RVU 3.74 changed to 4.06
    • Malpractice RVU 0.19 changed to 0.20
    • Practice expense GPCI 0.923 changed to 0.919
    • Malpractice GPCI 0.982 changed to 0.799

    Held through RVU21B, RVU21C, RVU21D.

  8. January 1, 2020

    RVU20A

    $184.41changed to$181.12

    • Conversion factor 36.0391 changed to 36.0896
    • Practice expense RVU 3.78 changed to 3.74
    • Malpractice RVU 0.20 changed to 0.19
    • Practice expense GPCI 0.927 changed to 0.923
    • Malpractice GPCI 1.165 changed to 0.982

    Held through RVU20B, RVU20C, RVU20D.

  9. January 1, 2019

    RVU19A

    $185.21changed to$184.41

    • Conversion factor 35.9996 changed to 36.0391
    • Practice expense RVU 3.81 changed to 3.78

    Held through RVU19B, RVU19C, RVU19D.

  10. January 1, 2018

    RVU18AR1

    $185.38changed to$185.21

    • Conversion factor 35.8887 changed to 35.9996
    • Practice expense RVU 3.84 changed to 3.81
    • Practice expense GPCI 0.925 changed to 0.927
    • Malpractice GPCI 1.167 changed to 1.165

    Held through RVU18B, RVU18C, RVU18D.

  11. January 1, 2017

    RVU17A

    $187.19changed to$185.38

    • Conversion factor 35.8043 changed to 35.8887
    • Practice expense RVU 3.92 changed to 3.84
    • Practice expense GPCI 0.922 changed to 0.925
    • Malpractice GPCI 1.169 changed to 1.167

    Held through RVU17B, RVU17C, RVU17D.

  12. January 1, 2016

    RVU16A

    $186.96changed to$187.19

    • Conversion factor 35.9335 changed to 35.8043
    • Practice expense RVU 3.88 changed to 3.92
    • Malpractice RVU 0.21 changed to 0.20

    Held through RVU16B, RVU16C, RVU16D.

  13. July 1, 2015

    RVU15C

    $186.03changed to$186.96

    • Conversion factor 35.7547 changed to 35.9335

    Held through RVU15D.

  14. January 1, 2015

    RVU15A

    $186.06changed to$186.03

    • Conversion factor 35.8228 changed to 35.7547
    • Practice expense RVU 3.94 changed to 3.88
    • Malpractice RVU 0.17 changed to 0.21
    • Practice expense GPCI 0.919 changed to 0.922
    • Malpractice GPCI 1.136 changed to 1.169

    Held through RVU15B.

  15. January 1, 2014

    RVU14A

    $190.20changed to$186.06

    • Conversion factor 34.0230 changed to 35.8228
    • Practice expense RVU 4.38 changed to 3.94
    • Malpractice RVU 0.18 changed to 0.17
    • Practice expense GPCI 0.916 changed to 0.919
    • Malpractice GPCI 1.102 changed to 1.136

    Held through RVU14B, RVU14C, RVU14D.

  16. January 1, 2013

    RVU13AR

    Earliest loaded release: $190.20

    Held through RVU13B, RVU13C, RVU13D.

Rates in every CMS release
Effective fromOfficeFacilityCMS release
2026-10-01$182.64$106.35RVU26D
2026-07-01$182.64$106.35RVU26C
2026-04-01$182.64$106.35RVU26B
2026-01-01$182.64$106.35RVU26A
2025-10-01$175.30$113.73RVU25D
2025-07-01$175.30$113.73RVU25C
2025-04-01$175.30$113.73RVU25B
2025-01-01$175.30$113.73RVU25A
2024-10-01$182.26$116.73RVU24D
2024-07-01$182.26$116.73RVU24C
2024-04-01$182.26$116.73RVU24B
2024-03-09$182.26$116.73RVU24AR
2024-01-01$179.28$114.82RVU24A
2023-10-01$184.44$116.66RVU23D
2023-07-01$184.44$116.66RVU23C
2023-04-01$184.44$116.66RVU23B
2023-01-01$184.44$116.66RVU23A
2022-10-01$184.95$115.94RVU22D
2022-07-01$184.95$115.94RVU22C
2022-04-01$184.95$115.94RVU22B
2022-01-01$184.95$115.94RVU22A
2021-10-01$183.92$114.98RVU21D
2021-07-01$183.92$114.98RVU21C
2021-04-01$183.92$114.98RVU21B
2021-01-01$183.92$114.98RVU21A
2020-10-01$181.12$117.16RVU20D
2020-07-01$181.12$117.16RVU20C
2020-04-01$181.12$117.16RVU20B
2020-01-01$181.12$117.16RVU20A
2019-10-01$184.41$119.27RVU19D
2019-07-01$184.41$119.27RVU19C
2019-04-01$184.41$119.27RVU19B
2019-01-01$184.41$119.27RVU19A
2018-10-01$185.21$118.80RVU18D
2018-07-01$185.21$118.80RVU18C
2018-04-01$185.21$118.80RVU18B
2018-01-01$185.21$118.80RVU18AR1
2017-10-01$185.38$119.65RVU17D
2017-07-01$185.38$119.65RVU17C
2017-04-01$185.38$119.65RVU17B
2017-01-01$185.38$119.65RVU17A
2016-10-01$187.19$120.50RVU16D
2016-07-01$187.19$120.50RVU16C
2016-04-01$187.19$120.50RVU16B
2016-01-01$187.19$120.50RVU16A
2015-10-01$186.96$121.03RVU15D
2015-07-01$186.96$121.03RVU15C
2015-04-01$186.03$120.42RVU15B
2015-01-01$186.03$120.42RVU15A
2014-10-01$186.06$119.56RVU14D
2014-07-01$186.06$119.56RVU14C
2014-04-01$186.06$119.56RVU14B
2014-01-01$186.06$119.56RVU14A
2013-10-01$190.20$120.08RVU13D
2013-07-01$190.20$120.08RVU13C
2013-04-01$190.20$120.08RVU13B
2013-01-01$190.20$120.08RVU13AR

Price 69420 for an earlier date of service

Where the Utah rate applies

Utah is a Medicare payment area, not a city. Our Census mapping connects it to 334 cities and communities in Utah. Some span more than one payment area; confirm with the service ZIP.

  • Alpine
  • Alta
  • Altamont
  • Alton
  • Amalga
  • American Fork
  • Aneth
  • Annabella

Browse all communities in Utah

69420 billing questions

How is 69420 different from 69421?

Both describe an eardrum incision without tube placement. Code 69421 is for the procedure requiring general anesthesia; 69420 is used when general anesthesia is not required.

Can aspiration be billed separately?

Aspiration associated with the myringotomy is included in 69420. The procedure may also include eustachian tube inflation.

When should a tube-placement code be used instead?

Use a tympanostomy code when a ventilating tube is inserted through the eardrum. Codes 69433 and 69436 distinguish tube placement by anesthesia circumstances.

How is the procedure reported when both ears are treated?

Report bilateral treatment with modifier 50. CMS pays the bilateral procedure 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 billed?

Medicare does not pay an assistant at surgery for 69420. 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 69420PPRRVU2026_Oct_nonQPP.csv, line 7,602 (RVU26D)
Geographic factors for UtahGPCI2026.csv, line 104 (RVU26D)

Open CMS sourceHow we calculate rates

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