Billing code 68770: Lacrimal fistula closureMedicare rate & RVUs

Medicare pays $535.42 for 68770 nationally in a facility.

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

What 68770 covers

An ophthalmologist, often an oculoplastic surgeon, uses this service to close an abnormal communication involving the tear drainage system. A typical presentation is persistent tear-like drainage through an opening near the eye or onto the face. The procedure is performed in an operative setting, with the operative report identifying the fistula site and describing its closure. It is distinct from closing a normal lacrimal punctum to reduce tearing.

Report 68770 when the treated problem is a lacrimal-system fistula, not a punctal opening or a damaged canaliculus. Documentation should establish the abnormal tract, its location, and the surgical work performed. CMS assigns a 90-day major-surgery global period, including the day-before preoperative visit and related postoperative care during that period. When multiple procedures occur in the same 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%. Assistant-at-surgery payment requires documented medical necessity; co-surgeon and team-surgery reporting 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 68770 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

68770 rates by state

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

How the 68770 rate is calculated

Each of 68770’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 68770

68770 has a 90-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

68770 compared with similar codes

How to choose

68760Punctal closure

This code closes the lacrimal punctum by a destructive or ligating method. Choose 68770 when the operative target is an abnormal fistula of the lacrimal system.

68761Punctal occlusion

This code closes the lacrimal punctum with a plug. It does not describe surgical closure of a fistulous tract.

68700Canaliculus repair

This code repairs the lacrimal canaliculi. Use 68770 when the documented problem is a fistula rather than canalicular damage.

68720Tear drainage surgery

This code creates a drainage route between the lacrimal sac and the nose. Code 68770 closes an abnormal lacrimal fistula.

Codes related to 68770

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