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Billing code 69646: Ear revision surgeryMedicare rate & RVUs

Revision surgery involving the middle ear and mastoid is reported when an otolaryngologist reoperates on previously treated ear disease or surgical anatomy.

CMS RVU26DEffective Oct 1, 2026109 payment localities280 Medicare services in 2024

Medicare pays $1,431.23 for 69646 nationally in a facility.

Medicare rate · 69646

Ear revision surgery

Swap in your local Medicare rate.

Work RVUs
17.91
Total RVUs
42.85
Global days
090

National rate · 2026

$1,431.23

Facility setting, before claim adjustments.

See every locality for 69646 → · 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 69646 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 69646 covers

billing code 69646 represents revision surgery involving the middle ear and mastoid, typically performed by an otolaryngologist or neurotologist in an operating room. The surgeon re-enters previously operated ear anatomy to address a persistent or recurrent problem, such as disease in a mastoid cavity or a failed prior middle-ear repair. The operative report should establish the prior surgery and describe the structures revised and the work performed; the diagnosis alone does not establish this code.

Report the code for the revision procedure actually performed, distinguishing it from a primary tympanoplasty or a mastoidectomy with a different documented result. This major surgery has a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. When multiple procedures are performed in one session, the highest-valued procedure is paid in full and the others at 50%. For bilateral surgery, modifier 50 is paid at 150%. An assistant is paid only when medical necessity is documented. CMS does not permit co-surgeons or team surgery for this code.

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 69646 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

69646 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$1,298.93
Alaska*Unavailable$1,737.61
ArizonaUnavailable$1,395.10
ArkansasUnavailable$1,282.41
AtlantaUnavailable$1,463.22
AustinUnavailable$1,465.06
BakersfieldUnavailable$1,478.16
Baltimore/Surr. CntysUnavailable$1,516.56
BeaumontUnavailable$1,357.99
BrazoriaUnavailable$1,409.28

69646 rates by state

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

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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
69646 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 69646 rate is calculated

Each of 69646’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 · 69646

RVUs × geographic indexes × conversion factor

Swap in your local Medicare rate.

Work 17.91Practice expense 22.21Malpractice 2.73

42.8500 adjusted RVUs×$33.4009 conversion factor=$1,431.23

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

Payment rules and modifiers for 69646

69646 has a 90-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 69646

Ear revision surgery

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)0Not paid without supporting documentation.
Co-surgeons (62)0Not permitted.
Team surgery (66)0Not permitted.
Professional/technical0Physician service: no professional/technical split.
Split (54/55/56)0.07/0.79/0.14Share of the payment for pre-op, the procedure itself, and post-op care.

Global surgery period · 69646

Ear revision surgery

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

69646 without 50 · national facility

$1,431.23

Ear revision surgery

69646-50 · Bilateral: 150%

$2,146.85

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

69646 compared with similar codes

Compare codes

69646 vs 69602 vs 69603 vs 69604 vs 69635: national Medicare rates

Swap in your local Medicare rate.

  • 69646
    Ear revision surgery · 17.91 wRVU
    —
  • 69602
    Mastoid revision · 13.42 wRVU
    —
  • 69603
    Mastoid revision · 13.85 wRVU
    —
  • 69604
    Mastoid revision · 13.85 wRVU
    —
  • 69635
    Tympanoplasty · 13.17 wRVU
    —

How to choose

69602Mastoid revision
This code is used for a revision mastoidectomy with the result specified by its descriptor. Compare that result with the middle-ear and mastoid revision documented for 69646.
69603Mastoid revision
Choose 69603 when the operative result matches its radical mastoidectomy descriptor; 69646 is selected for its own documented revision procedure.
69604Mastoid revision
69604 describes revision mastoidectomy resulting in tympanoplasty. Use 69646 only when the documented operation meets its distinct descriptor.
69635Tympanoplasty
69635 is a tympanoplasty with mastoidectomy code, rather than a general choice for revision work. Base selection on whether the operation is primary or revision and on the full procedure performed.

Codes related to 69646

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

Codes related to 69646
CodeHow it relatesNational office range
Same family
69641TympanoplastyRelated middle-ear and mastoid surgery; select according to the documented procedure and applicable descriptor.No office rate
69642TympanoplastyRelated middle-ear and mastoid surgery with a distinct descriptor.No office rate
69643TympanoplastyA related code in the middle-ear and mastoid surgical series.No office rate
69644TympanoplastyCompare the complete descriptor and operative details when selecting between these related procedures.No office rate
69645TympanoplastyA neighboring middle-ear and mastoid surgical code with a distinct procedure definition.No office rate
69602Mastoid revisionRevision mastoidectomy code for a different documented mastoidectomy result.No office rate
69603Mastoid revisionRevision mastoidectomy code for a different documented mastoidectomy result.No office rate

69646 billing questions

How is 69646 distinguished from a primary tympanoplasty?

Use 69646 for the documented revision involving previously operated middle-ear and mastoid anatomy. A primary tympanoplasty code describes a different operative circumstance; the operative report should support the revision work.

Can a separate mastoidectomy code also be reported?

Do not infer a separately reportable mastoidectomy from the fact that the revision involves the mastoid. Review the complete operative work and applicable billing code instructions before separately reporting another procedure.

What documentation supports reporting 69646?

Document the relevant prior ear surgery, the indication for reoperation, the middle-ear and mastoid anatomy addressed, and the specific revision performed.

How should bilateral surgery be reported?

For bilateral procedures, CMS pays this code at 150% when reported with modifier 50.

How does the global period affect postoperative visits?

The 90-day global includes the day-before preoperative visit and related postoperative care during the following 90 days.

Can an assistant or co-surgeon be billed?

An assistant at surgery is payable only with documentation of medical necessity. CMS does not permit co-surgeons or team surgery for this code.

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 69646PPRRVU2026_Oct_nonQPP.csv, line 7,636 (RVU26D)

Open CMS sourceHow we calculate rates

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