Billing code 68801: Punctum dilationMedicare rate & RVUs
Reports dilation of a narrowed lacrimal punctum, with or without irrigation, to improve tear drainage through the opening.
Medicare pays $94.52 for 68801 nationally in the office and $71.81 in a hospital or facility. Local office rates run $84.39–$125.92.
Medicare rate · 68801
Punctum dilation
- Work RVUs
- 0.8
- Total RVUs
- 2.83
- Global days
- 010
National rate · 2026
$94.52
Office setting, before claim adjustments.
See every locality for 68801 →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
What 68801 covers
An ophthalmologist or other qualified eye-care practitioner dilates a narrowed lacrimal punctum, the small opening at the eyelid margin that drains tears. The service may include irrigation through the opened punctum. It is typically performed in an office or outpatient setting when punctal narrowing interferes with tear drainage; it addresses the punctal opening rather than probing the downstream canaliculus or nasolacrimal duct.
Report 68801 when the documented service is dilation of the punctum, and record the affected side, the narrowing treated, and whether irrigation was performed. Irrigation is included in this code. CMS assigns a 10-day global period, so related postoperative visits during that period are included. For bilateral treatment, modifier 50 is paid at 150%. When multiple procedures are performed in the same session, the highest-valued procedure is paid in full and the others at 50%. 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 68801 pays more and less
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
109 payment localities
$84.39 to $125.92
109 of 109 payment localities
68801 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.
$84.39
$113.24
Color shows the midpoint of each state’s locality range.
View every state and territory as a table
| State / territory | Office rate range | Localities |
|---|---|---|
| AK | $111.43 | 1 |
| AL | $85.53 | 1 |
| AR | $84.39 | 1 |
| AZ | $92.23 | 1 |
| CA | $100.55–$125.92 | 29 |
| CO | $98.71 | 1 |
| CT | $100.50 | 1 |
| DC | $107.93 | 1 |
| DE | $93.70 | 1 |
| FL | $92.45–$99.79 | 3 |
| GA | $87.70–$96.00 | 2 |
| GU | $102.88 | 1 |
| HI | $102.88 | 1 |
| IA | $87.90 | 1 |
| ID | $88.35 | 1 |
| IL | $89.71–$97.79 | 4 |
| IN | $88.84 | 1 |
| KS | $87.35 | 1 |
| KY | $87.04 | 1 |
| LA | $86.85–$90.85 | 2 |
| MA | $98.12–$108.27 | 2 |
| MD | $95.45–$107.93 | 3 |
| ME | $88.60–$93.31 | 2 |
| MI | $88.99–$93.36 | 2 |
| MN | $95.27 | 1 |
| MO | $85.35–$91.35 | 3 |
| MS | $84.90 | 1 |
| MT | $94.52 | 1 |
| NC | $89.49 | 1 |
| ND | $93.53 | 1 |
| NE | $88.39 | 1 |
| NH | $97.03 | 1 |
| NJ | $101.84–$106.90 | 2 |
| NM | $89.37 | 1 |
| NV | $94.31 | 1 |
| NY | $90.72–$110.17 | 5 |
| OH | $88.78 | 1 |
| OK | $87.08 | 1 |
| OR | $93.76–$101.87 | 2 |
| PA | $89.01–$98.04 | 2 |
| PR | $95.23 | 1 |
| RI | $97.03 | 1 |
| SC | $89.25 | 1 |
| SD | $93.42 | 1 |
| TN | $87.73 | 1 |
| TX | $88.45–$98.22 | 8 |
| UT | $90.39 | 1 |
| VA | $92.91–$107.93 | 2 |
| VI | $95.23 | 1 |
| VT | $93.04 | 1 |
| WA | $97.98–$110.57 | 2 |
| WI | $90.59 | 1 |
| WV | $86.58 | 1 |
| WY | $94.09 | 1 |
How the 68801 rate is calculated
Each of 68801’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 · 68801
RVUs × geographic indexes × conversion factor
Work0.80
0.80 RVUs× 1.000 GPCI
Practice expense1.98
1.98 RVUs× 1.000 GPCI
Malpractice0.05
0.05 RVUs× 1.000 GPCI
Adjusted RVUs
2.8300
Conversion factor
$33.4009
Medicare rate
$94.52
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 68801
68801 has a 10-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 68801
Punctum dilation
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 010 | Minor procedure: the day of the procedure plus 10 days after are included. |
| Multiple procedures | 2 | Standard reduction: highest-valued procedure at 100%, others at 50%. |
| Bilateral (modifier 50) | 1 | Bilateral with modifier 50 pays 150% of the fee schedule amount. |
| Assistant at surgery (80/81/82/AS) | 1 | Not paid (statutory restriction). |
| Co-surgeons (62) | 0 | Not permitted. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 0 | Physician service: no professional/technical split. |
| Split (54/55/56) | 0.10/0.80/0.10 | Share of the payment for pre-op, the procedure itself, and post-op care. |
Global surgery period · 68801
Punctum dilation
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.
What modifiers do to the payment
Modifier 50 · payment effect
With and without the modifier
68801 without 50 · national office
$94.52
Punctum dilation
68801-50 · Bilateral: 150%
$141.78
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).
68801 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 68810Tear duct probing
- Choose 68801 for dilation of a stenotic punctum. Choose 68810 when the documented service probes the nasolacrimal duct.
- 68840Tear duct probing
- 68840 involves probing the lacrimal canaliculi. 68801 is specific to dilation of the punctal opening.
- 68816Tear duct dilation
- 68816 describes balloon catheter dilation of the nasolacrimal duct with probing. 68801 treats narrowing at the punctum.
68801 billing questions
When should 68801 be chosen instead of 68810?
Use 68801 when the treated structure is a narrowed lacrimal punctum. Code 68810 describes probing the nasolacrimal duct, a different part of the tear drainage pathway.
Is irrigation separately reportable with 68801?
No. Irrigation performed with punctal dilation is included in 68801.
How is bilateral punctal dilation reported?
CMS identifies 68801 as a bilateral procedure; modifier 50 is paid at 150% when both sides are treated.
Are related postoperative visits included?
Yes. Related postoperative visits during the 10-day global period are included in the procedure.
Can an assistant or co-surgeon be paid for 68801?
Medicare does not pay an assistant at surgery for this code, and 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
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