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Billing code 69436: TympanostomyMedicare rate & RVUs

ENT surgeons report this service when they create an eardrum opening and place a ventilating tube under general anesthesia, typically for middle-ear disease.

CMS RVU26DEffective Oct 1, 2026109 payment localities11.4K Medicare services in 2024

Medicare pays $144.63 for 69436 nationally in a facility.

Medicare rate · 69436

Tympanostomy

Swap in your local Medicare rate.

Work RVUs
1.96
Total RVUs
4.33
Global days
010

National rate · 2026

$144.63

Facility setting, before claim adjustments.

See every locality for 69436 → · 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 69436 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 69436 covers

An otolaryngologist makes a small opening in the tympanic membrane and places a ventilating tube to help air reach the middle ear and fluid drain. The service is performed under general anesthesia, commonly for children with persistent middle-ear fluid or recurrent ear infections when ventilation is clinically indicated. It may be performed in a hospital outpatient department or ambulatory surgery setting, and may involve one or both ears.

Report this code when the procedure includes tube placement under general anesthesia; documentation should support the clinical indication, ear or ears treated, and tube insertion. The 10-day global period includes related postoperative visits during that 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% reduction. For bilateral treatment, modifier 50 is paid at 150%. An assistant at surgery is not paid, and co-surgeon and team-surgery payment 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 69436 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

69436 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$131.84
Alaska*Unavailable$177.70
ArizonaUnavailable$141.12
ArkansasUnavailable$130.25
AtlantaUnavailable$147.82
AustinUnavailable$147.74
BakersfieldUnavailable$148.91
Baltimore/Surr. CntysUnavailable$152.99
BeaumontUnavailable$137.68
BrazoriaUnavailable$142.46

69436 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.

View every state and territory as a table
69436 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 69436 rate is calculated

Each of 69436’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 · 69436

RVUs × geographic indexes × conversion factor

Swap in your local Medicare rate.

Work 1.96Practice expense 2.09Malpractice 0.28

4.3300 adjusted RVUs×$33.4009 conversion factor=$144.63

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

Payment rules and modifiers for 69436

69436 has a 10-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 69436

Tympanostomy

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 · 69436

Tympanostomy

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

69436 without 50 · national facility

$144.63

Tympanostomy

69436-50 · Bilateral: 150%

$216.95

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

69436 compared with similar codes

Compare codes

69436 vs 69433 vs 69421 vs 69424: national Medicare rates

Swap in your local Medicare rate.

  • 69436
    Tympanostomy · 1.96 wRVU
    —
  • 69433
    Ear tube placement · 1.53 wRVU
    $202.41
  • 69421
    Myringotomy · 1.74 wRVU
    —
  • 69424
    Tube removal · 0.83 wRVU
    $130.26

How to choose

69433Ear tube placement
Both services include ventilating-tube placement. Choose 69436 for general anesthesia and 69433 for local or topical anesthesia.
69421Myringotomy
This code includes a ventilating tube and is performed under general anesthesia; 69421 describes an eardrum incision without tube placement.
69424Tube removal
69424 is for removing a ventilating tube, not creating an eardrum opening and inserting one.

Codes related to 69436

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

Codes related to 69436
CodeHow it relatesNational office range
Used instead
69433Ear tube placementTube placement under local or topical anesthesia rather than general anesthesia.$178.66–$268.55
69421MyringotomyEardrum incision without tube placement under general anesthesia.No office rate
69420Eardrum incisionEardrum incision without tube placement under local or topical anesthesia.$168.75–$255.44

69436 billing questions

How does this differ from 69433?

Both include placement of a ventilating tube. This code is for the procedure under general anesthesia; 69433 is used when it is performed under local or topical anesthesia.

Can this code be reported when no tube is placed?

No. This service includes tube placement. A myringotomy without a tube is represented by a different code, selected according to the anesthesia circumstance.

How is bilateral treatment reported?

Use modifier 50 for bilateral treatment. CMS pays the bilateral procedure at 150%.

Are related postoperative visits separately payable during the global period?

Related postoperative visits during the 10-day global period are included in the procedure payment.

Can an assistant or co-surgeon be billed?

An assistant at surgery is not paid for this service. 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 69436PPRRVU2026_Oct_nonQPP.csv, line 7,606 (RVU26D)

Open CMS sourceHow we calculate rates

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