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Billing code 68550: Lacrimal sac lesionMedicare rate & RVUs

Reports surgical removal of a focal lesion involving the lacrimal sac, the tear-drainage structure at the inner corner of the eye.

CMS RVU26DEffective Oct 1, 2026109 payment localities

Medicare pays $1,053.46 for 68550 nationally in a facility.

Medicare rate · 68550

Lacrimal sac lesion

Swap in your local Medicare rate.

Work RVUs
14.78
Total RVUs
31.54
Global days
090

National rate · 2026

$1,053.46

Facility setting, before claim adjustments.

See every locality for 68550 → · Billed by an NP, PA or therapist? →

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 10 sections
  1. Medicare rate
  2. What 68550 covers
  3. By payment locality
  4. Rate map
  5. How it’s calculated
  6. Payment rules
  7. Similar codes
  8. Related codes
  9. Billing questions
  10. Sources

What 68550 covers

This service removes a focal abnormal growth involving the lacrimal sac, which collects tears near the inner corner of the eye before they drain into the nose. An ophthalmologist, often an oculoplastic surgeon, performs the operation when the lesion requires excision rather than diagnostic sampling alone. The removed tissue may be sent for pathology. The operative report should identify the affected side, the lesion’s location and extent, and what tissue was removed.

Choose this code for excision of a lesion of the lacrimal sac, not removal of the entire sac or treatment of a lesion in the lacrimal gland. Medicare assigns a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. For multiple procedures in one session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% reduction. Bilateral reporting with modifier 50 is paid at 150%. Medicare does not pay an assistant at surgery; 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 68550 pays more and less

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

109 of 109 payment localities

68550 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$971.21
Alaska*Unavailable$1,316.25
ArizonaUnavailable$1,031.62
ArkansasUnavailable$960.86
AtlantaUnavailable$1,071.26
AustinUnavailable$1,080.08
BakersfieldUnavailable$1,097.23
Baltimore/Surr. CntysUnavailable$1,108.75
BeaumontUnavailable$1,003.84
BrazoriaUnavailable$1,043.99

68550 rates by state

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

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Local rates. Clear comparisons.

Hover or focus a tile to see its rate range. Select it to open the state’s fee schedule.

View every state and territory as a table
68550 office rate range by state
State / territoryOffice rate rangeLocalities
AKNo published base rate1
ALNo published base rate1
ARNo published base rate1
AZNo published base rate1
CANo published base rate29
CONo published base rate1
CTNo published base rate1
DCNo published base rate1
DENo published base rate1
FLNo published base rate3
GANo published base rate2
GUNo published base rate1
HINo published base rate1
IANo published base rate1
IDNo published base rate1
ILNo published base rate4
INNo published base rate1
KSNo published base rate1
KYNo published base rate1
LANo published base rate2
MANo published base rate2
MDNo published base rate3
MENo published base rate2
MINo published base rate2
MNNo published base rate1
MONo published base rate3
MSNo published base rate1
MTNo published base rate1
NCNo published base rate1
NDNo published base rate1
NENo published base rate1
NHNo published base rate1
NJNo published base rate2
NMNo published base rate1
NVNo published base rate1
NYNo published base rate5
OHNo published base rate1
OKNo published base rate1
ORNo published base rate2
PANo published base rate2
PRNo published base rate1
RINo published base rate1
SCNo published base rate1
SDNo published base rate1
TNNo published base rate1
TXNo published base rate8
UTNo published base rate1
VANo published base rate2
VINo published base rate1
VTNo published base rate1
WANo published base rate2
WINo published base rate1
WVNo published base rate1
WYNo published base rate1

How the 68550 rate is calculated

Each of 68550’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 · 68550

RVUs × geographic indexes × conversion factor

Swap in your local Medicare rate.

Work 14.78Practice expense 15.57Malpractice 1.19

31.5400 adjusted RVUs×$33.4009 conversion factor=$1,053.46

All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.

Payment rules and modifiers for 68550

68550 has a 90-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 68550

Lacrimal sac lesion

RuleCMS valueWhat it means
Global period090Major surgery: the day before, the day of, and 90 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)0.10/0.70/0.20Share of the payment for pre-op, the procedure itself, and post-op care.

Global surgery period · 68550

Lacrimal sac lesion

90-day global period ends

Dec 30, 2026

Covers Sep 30, 2026 through Dec 30, 2026 (92 days, including the day before surgery).

Visit on Oct 31, 2026

Day 30 of the 90-day post-op period: related follow-up care is included in the surgical payment.

  • 24 Unrelated E/M visit by the same physician
  • 79 Unrelated procedure (starts its own global period)
  • 58 Staged, more extensive, or therapy procedure that was planned
  • 78 Unplanned return to the operating room for a related complication
SurgeryVisit
Sep 23, 2026Jan 10, 2027

Pre-op dayGlobal period

What modifiers do to the payment

Modifier 50 · payment effect

With and without the modifier

68550 without 50 · national facility

$1,053.46

Lacrimal sac lesion

68550-50 · Bilateral: 150%

$1,580.19

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

68550 compared with similar codes

Compare codes

68550 vs 68520 vs 68525 vs 68540: national Medicare rates

Swap in your local Medicare rate.

  • 68550
    Lacrimal sac lesion · 14.78 wRVU
    —
  • 68520
    Tear sac surgery · 8.56 wRVU
    —
  • 68525
    Tear sac biopsy · 4.31 wRVU
    —
  • 68540
    Lacrimal lesion excision · 11.88 wRVU
    —

How to choose

68520Tear sac surgery
68520 represents removal of the lacrimal sac itself. Use 68550 when the operation targets a focal lesion involving the sac.
68525Tear sac biopsy
68525 is for diagnostic tissue sampling from the lacrimal sac. Use 68550 when the operative intent is to excise a focal sac lesion.
68540Lacrimal lesion excision
68540 concerns a lesion of the lacrimal gland, which produces tears. Code 68550 concerns a lesion of the tear-drainage sac.

Codes related to 68550

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

Codes related to 68550
CodeHow it relatesNational office range
Used instead
68520Tear sac surgeryUsed when the operation removes the lacrimal sac itself rather than a focal lesion.No office rate
68525Tear sac biopsyBiopsy of the lacrimal sac for tissue sampling rather than lesion excision.No office rate
68540Lacrimal lesion excisionFor a lesion in the lacrimal gland, not the lacrimal sac.No office rate

68550 billing questions

How is this different from excision of the lacrimal sac?

This code is for removing a focal lesion involving the sac. Choose the whole-sac excision code when the operation removes the lacrimal sac itself.

When would a lacrimal sac biopsy code be more appropriate?

Use the biopsy code when tissue is sampled for diagnosis without an operation intended to excise the lesion. The operative note should make the procedure’s intent and extent clear.

Can modifier 50 be used when lesions are excised on both sides?

CMS identifies this as a bilateral procedure; bilateral reporting with modifier 50 is paid at 150%. Document the work performed on each side.

Is an assistant surgeon payable for this procedure?

No. CMS lists a statutory restriction on assistant-at-surgery payment for this code. Co-surgeons and team surgery are also not permitted.

What postoperative care is included in the global period?

The 90-day global period includes the day-before preoperative visit and 90 days of related 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
RVUs for 68550PPRRVU2026_Oct_nonQPP.csv, line 7,562 (RVU26D)

Open CMS sourceHow we calculate rates

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