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CMS RVU26D · Effective 2026-10-01

69005 in Madera

Office / nonfacility

$232.07

Base rate per service

Facility setting

$148.60

Base rate per service

Amounts below use the non-QP conversion factor for participating physicians. These are base physician payments before claim-level adjustments, not patient costs or total hospital charges.

Surgical procedure

About 69005: Complicated external ear collection drainage

Report this service for involved drainage of an abscess or hematoma of the external ear, such as the pinna, when the work exceeds simple drainage.

This procedure treats a collection in the external ear, typically the auricle or pinna, by opening and evacuating an abscess or hematoma. A common clinical situation is an auricular hematoma after blunt trauma; external-ear abscesses are another indication. Otolaryngologists and other clinicians who perform minor procedures may provide it in an office or outpatient setting. It is distinct from drainage of an abscess within the external auditory canal.

Choose the complicated service when the documented work and extent of treatment support more than simple drainage; the code does not establish a separate numeric threshold for complexity. Record the collection’s location and diagnosis, relevant findings, and the procedural work performed. Related postoperative visits are included in the 10-day global period. When multiple procedures occur in the same session, the highest-valued procedure is paid in full and the others at 50%. For bilateral treatment, modifier 50 is paid at 150%. Assistant-at-surgery payment is restricted; co-surgeons and team surgery are not permitted.

CMS billing rules for 69005

Global period
Minor procedure with a 10-day global period: related postoperative visits for 10 days are included.
Multiple procedures
Standard multiple procedure reduction: the highest-valued procedure is paid in full and others at 50% when performed in the same session.
Bilateral procedures
Bilateral procedure with modifier 50 is paid at 150%.
Assistant at surgery
Statutory restriction: assistant at surgery is not paid.
Co-surgeons
Co-surgeons not permitted.
Team surgery
Team surgery not permitted.

Where the value comes from

  • Work RVU2.11 · 32%
  • Practice expense (office) RVU4.22 · 63%
  • Malpractice RVU0.33 · 5%

439

Medicare services in 2024 · #3661 by national volume

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.

69005 compared with similar codes

Office rates for Madera, from the same CMS release.

69000

Ear drainage

Simple drainage

$201.97

69000 is the simple external-ear drainage service. Choose 69005 when the documented extent and work support complicated drainage.

69020

Canal abscess drainage

External auditory canal

$247.29

69020 is for an abscess in the external auditory canal. This code concerns a collection of the external ear, such as the auricle or pinna.

10160

Lesion aspiration

Abscess, hematoma, or bulla

$138.02

10160 describes puncture aspiration of an abscess, hematoma, or other collection. This code is for complicated drainage of an external-ear collection.

The same code, a different location

How does Madera compare?

In Bakersfield, the office rate for 69005 is $233.01—$0.94 higher than the $232.07 rate in Madera. Both use the same code, release and participation basis.

69005 across payment areas

Same release and payment basis · bars start at $0

  1. Madera · This locality

    $232.07

  2. Bakersfield

    $233.01

    $0.94 higher than Madera

  3. Chico

    $232.07

    The same base rate than Madera

  4. El Centro

    $232.12

    $0.05 higher than Madera

  5. Fresno

    $232.07

    The same base rate than Madera

  6. Hanford-Corcoran

    $232.07

    The same base rate than Madera

  7. Los Angeles-Long Beach-Anaheim (Los Angeles/Orange Cnty)

    $247.43

    $15.36 higher than Madera

Other payment areas listed in California appear first, followed by selected cross-country examples. The chart compares amounts, not distance.

Across 109 of 109 CMS payment localities with a supported office rate, 69005 ranges from $197.23 in Arkansas to $287.39 in San Jose-Sunnyvale-Santa Clara (San Benito Cnty). This is a geographic range, not an average.

The code’s RVUs stay the same in these comparisons. Geographic adjustments to work, practice expense and malpractice change the dollar amount. A city name alone may not identify the payment area for a service address.

Compare all 108 other payment areas

  • Merced

    California · 69005

    Office

    $232.07

    Facility

    $148.60

    The same base rate than Madera for the office setting.

  • Modesto

    California · 69005

    Office

    $232.07

    Facility

    $148.60

    The same base rate than Madera for the office setting.

  • Napa

    California · 69005

    Office

    $266.29

    Facility

    $165.92

    $34.22 higher than Madera for the office setting.

  • Oxnard-Thousand Oaks-Ventura

    California · 69005

    Office

    $245.92

    Facility

    $155.91

    $13.85 higher than Madera for the office setting.

  • Redding

    California · 69005

    Office

    $232.07

    Facility

    $148.60

    The same base rate than Madera for the office setting.

  • Rest Of California

    California · 69005

    Office

    $232.07

    Facility

    $148.60

    The same base rate than Madera for the office setting.

  • Riverside-San Bernardino-Ontario

    California · 69005

    Office

    $235.63

    Facility

    $152.16

    $3.56 higher than Madera for the office setting.

  • Sacramento-Roseville-Folsom

    California · 69005

    Office

    $242.85

    Facility

    $154.28

    $10.78 higher than Madera for the office setting.

  • Salinas

    California · 69005

    Office

    $241.93

    Facility

    $153.67

    $9.86 higher than Madera for the office setting.

  • San Diego-Chula Vista-Carlsbad

    California · 69005

    Office

    $247.14

    Facility

    $156.06

    $15.07 higher than Madera for the office setting.

  • San Francisco-Oakland-Berkeley (Marin Cnty)

    California · 69005

    Office

    $280.97

    Facility

    $173.60

    $48.90 higher than Madera for the office setting.

  • San Francisco-Oakland-Berkeley (San Francisco/San Mateo/Alameda/Contra Costa Cnty)

    California · 69005

    Office

    $280.60

    Facility

    $173.22

    $48.53 higher than Madera for the office setting.

  • San Jose-Sunnyvale-Santa Clara (San Benito Cnty)

    California · 69005

    Office

    $287.39

    Facility

    $177.57

    $55.32 higher than Madera for the office setting.

  • San Jose-Sunnyvale-Santa Clara (Santa Clara Cnty)

    California · 69005

    Office

    $285.86

    Facility

    $176.04

    $53.79 higher than Madera for the office setting.

  • San Luis Obispo-Paso Robles

    California · 69005

    Office

    $238.13

    Facility

    $151.39

    $6.06 higher than Madera for the office setting.

  • Santa Cruz-Watsonville

    California · 69005

    Office

    $249.12

    Facility

    $156.59

    $17.05 higher than Madera for the office setting.

  • Santa Maria-Santa Barbara

    California · 69005

    Office

    $242.71

    Facility

    $153.91

    $10.64 higher than Madera for the office setting.

  • Santa Rosa-Petaluma

    California · 69005

    Office

    $251.59

    Facility

    $158.07

    $19.52 higher than Madera for the office setting.

  • Stockton

    California · 69005

    Office

    $232.07

    Facility

    $148.60

    The same base rate than Madera for the office setting.

  • Vallejo

    California · 69005

    Office

    $265.75

    Facility

    $165.38

    $33.68 higher than Madera for the office setting.

  • Visalia

    California · 69005

    Office

    $232.07

    Facility

    $148.60

    The same base rate than Madera for the office setting.

  • Yuba City

    California · 69005

    Office

    $232.07

    Facility

    $148.60

    The same base rate than Madera for the office setting.

  • Dc + Md/Va Suburbs

    District of Columbia · 69005

    Office

    $252.59

    Facility

    $162.88

    $20.52 higher than Madera for the office setting.

  • Miami

    Florida · 69005

    Office

    $245.08

    Facility

    $165.81

    $13.01 higher than Madera for the office setting.

  • Chicago

    Illinois · 69005

    Office

    $237.92

    Facility

    $161.39

    $5.85 higher than Madera for the office setting.

  • Manhattan

    New York · 69005

    Office

    $256.25

    Facility

    $167.76

    $24.18 higher than Madera for the office setting.

  • Alaska*

    Alaska · 69005

    Office

    $261.90

    Facility

    $180.80

    $29.83 higher than Madera for the office setting.

  • Alabama

    Alabama · 69005

    Office

    $200.05

    Facility

    $133.41

    $32.02 lower than Madera for the office setting.

  • Arkansas

    Arkansas · 69005

    Office

    $197.23

    Facility

    $131.81

    $34.84 lower than Madera for the office setting.

  • Arizona

    Arizona · 69005

    Office

    $216.49

    Facility

    $142.70

    $15.58 lower than Madera for the office setting.

  • Colorado

    Colorado · 69005

    Office

    $229.90

    Facility

    $148.87

    $2.17 lower than Madera for the office setting.

  • Connecticut

    Connecticut · 69005

    Office

    $237.03

    Facility

    $155.01

    $4.96 higher than Madera for the office setting.

  • Delaware

    Delaware · 69005

    Office

    $220.00

    Facility

    $144.76

    $12.07 lower than Madera for the office setting.

  • Fort Lauderdale

    Florida · 69005

    Office

    $233.19

    Facility

    $156.04

    $1.12 higher than Madera for the office setting.

  • Rest Of Florida

    Florida · 69005

    Office

    $221.79

    Facility

    $148.99

    $10.28 lower than Madera for the office setting.

  • Atlanta

    Georgia · 69005

    Office

    $227.13

    Facility

    $149.76

    $4.94 lower than Madera for the office setting.

  • Rest Of Georgia

    Georgia · 69005

    Office

    $209.34

    Facility

    $141.41

    $22.73 lower than Madera for the office setting.

  • Hawaii, Guam

    Hawaii · 69005

    Office

    $237.12

    Facility

    $150.53

    $5.05 higher than Madera for the office setting.

  • Iowa

    Iowa · 69005

    Office

    $203.82

    Facility

    $134.14

    $28.25 lower than Madera for the office setting.

  • Idaho

    Idaho · 69005

    Office

    $205.37

    Facility

    $135.30

    $26.70 lower than Madera for the office setting.

  • East St. Louis

    Illinois · 69005

    Office

    $222.35

    Facility

    $152.29

    $9.72 lower than Madera for the office setting.

  • Rest Of Illinois

    Illinois · 69005

    Office

    $216.39

    Facility

    $146.86

    $15.68 lower than Madera for the office setting.

  • Suburban Chicago

    Illinois · 69005

    Office

    $235.26

    Facility

    $157.05

    $3.19 higher than Madera for the office setting.

  • Indiana

    Indiana · 69005

    Office

    $206.50

    Facility

    $135.90

    $25.57 lower than Madera for the office setting.

  • Kansas

    Kansas · 69005

    Office

    $203.45

    Facility

    $134.61

    $28.62 lower than Madera for the office setting.

  • Kentucky

    Kentucky · 69005

    Office

    $205.87

    Facility

    $138.17

    $26.20 lower than Madera for the office setting.

  • New Orleans

    Louisiana · 69005

    Office

    $215.63

    Facility

    $143.97

    $16.44 lower than Madera for the office setting.

  • Rest Of Louisiana

    Louisiana · 69005

    Office

    $205.78

    Facility

    $138.38

    $26.29 lower than Madera for the office setting.

  • Metropolitan Boston

    Massachusetts · 69005

    Office

    $251.47

    Facility

    $160.54

    $19.40 higher than Madera for the office setting.

  • Rest Of Massachusetts

    Massachusetts · 69005

    Office

    $228.81

    Facility

    $148.62

    $3.26 lower than Madera for the office setting.

  • Baltimore/Surr. Cntys

    Maryland · 69005

    Office

    $236.48

    Facility

    $154.77

    $4.41 higher than Madera for the office setting.

  • Rest Of Maryland

    Maryland · 69005

    Office

    $223.94

    Facility

    $146.87

    $8.13 lower than Madera for the office setting.

  • Rest Of Maine

    Maine · 69005

    Office

    $207.01

    Facility

    $136.95

    $25.06 lower than Madera for the office setting.

  • Southern Maine

    Maine · 69005

    Office

    $217.11

    Facility

    $141.65

    $14.96 lower than Madera for the office setting.

  • Detroit

    Michigan · 69005

    Office

    $225.08

    Facility

    $151.59

    $6.99 lower than Madera for the office setting.

  • Rest Of Michigan

    Michigan · 69005

    Office

    $211.61

    Facility

    $142.08

    $20.46 lower than Madera for the office setting.

  • Minnesota

    Minnesota · 69005

    Office

    $218.78

    Facility

    $140.42

    $13.29 lower than Madera for the office setting.

  • Metropolitan Kansas City

    Missouri · 69005

    Office

    $213.60

    Facility

    $142.09

    $18.47 lower than Madera for the office setting.

  • Metropolitan St. Louis

    Missouri · 69005

    Office

    $215.71

    Facility

    $143.21

    $16.36 lower than Madera for the office setting.

  • Rest Of Missouri

    Missouri · 69005

    Office

    $202.71

    Facility

    $137.07

    $29.36 lower than Madera for the office setting.

  • Mississippi

    Mississippi · 69005

    Office

    $199.98

    Facility

    $134.41

    $32.09 lower than Madera for the office setting.

  • Montana**

    Montana · 69005

    Office

    $222.43

    Facility

    $146.27

    $9.64 lower than Madera for the office setting.

  • North Carolina

    North Carolina · 69005

    Office

    $209.03

    Facility

    $137.98

    $23.04 lower than Madera for the office setting.

  • North Dakota**

    North Dakota · 69005

    Office

    $215.90

    Facility

    $139.75

    $16.17 lower than Madera for the office setting.

  • Nebraska

    Nebraska · 69005

    Office

    $204.74

    Facility

    $134.45

    $27.33 lower than Madera for the office setting.

  • New Hampshire

    New Hampshire · 69005

    Office

    $226.85

    Facility

    $147.57

    $5.22 lower than Madera for the office setting.

  • Northern Nj

    New Jersey · 69005

    Office

    $250.19

    Facility

    $161.85

    $18.12 higher than Madera for the office setting.

  • Rest Of New Jersey

    New Jersey · 69005

    Office

    $239.31

    Facility

    $156.15

    $7.24 higher than Madera for the office setting.

  • New Mexico

    New Mexico · 69005

    Office

    $212.97

    Facility

    $143.13

    $19.10 lower than Madera for the office setting.

  • Nevada**

    Nevada · 69005

    Office

    $220.75

    Facility

    $144.52

    $11.32 lower than Madera for the office setting.

  • Nyc Suburbs/Long Island

    New York · 69005

    Office

    $263.05

    Facility

    $172.50

    $30.98 higher than Madera for the office setting.

  • Poughkpsie/N Nyc Suburbs

    New York · 69005

    Office

    $241.33

    Facility

    $157.94

    $9.26 higher than Madera for the office setting.

  • Queens

    New York · 69005

    Office

    $257.49

    Facility

    $167.47

    $25.42 higher than Madera for the office setting.

  • Rest Of New York

    New York · 69005

    Office

    $212.13

    Facility

    $139.78

    $19.94 lower than Madera for the office setting.

  • Ohio

    Ohio · 69005

    Office

    $210.28

    Facility

    $140.75

    $21.79 lower than Madera for the office setting.

  • Oklahoma

    Oklahoma · 69005

    Office

    $204.91

    Facility

    $136.90

    $27.16 lower than Madera for the office setting.

  • Portland

    Oregon · 69005

    Office

    $236.40

    Facility

    $151.79

    $4.33 higher than Madera for the office setting.

  • Rest Of Oregon

    Oregon · 69005

    Office

    $218.61

    Facility

    $142.76

    $13.46 lower than Madera for the office setting.

  • Metropolitan Philadelphia

    Pennsylvania · 69005

    Office

    $231.62

    Facility

    $152.35

    $0.45 lower than Madera for the office setting.

  • Rest Of Pennsylvania

    Pennsylvania · 69005

    Office

    $210.29

    Facility

    $140.38

    $21.78 lower than Madera for the office setting.

  • Puerto Rico

    Puerto Rico · 69005

    Office

    $223.84

    Facility

    $146.84

    $8.23 lower than Madera for the office setting.

  • Rhode Island

    Rhode Island · 69005

    Office

    $227.25

    Facility

    $148.58

    $4.82 lower than Madera for the office setting.

  • South Carolina

    South Carolina · 69005

    Office

    $210.08

    Facility

    $139.72

    $21.99 lower than Madera for the office setting.

  • South Dakota**

    South Dakota · 69005

    Office

    $215.13

    Facility

    $138.98

    $16.94 lower than Madera for the office setting.

  • Tennessee

    Tennessee · 69005

    Office

    $204.52

    Facility

    $135.30

    $27.55 lower than Madera for the office setting.

  • Austin

    Texas · 69005

    Office

    $229.51

    Facility

    $148.94

    $2.56 lower than Madera for the office setting.

  • Beaumont

    Texas · 69005

    Office

    $208.98

    Facility

    $139.68

    $23.09 lower than Madera for the office setting.

  • Brazoria

    Texas · 69005

    Office

    $219.32

    Facility

    $143.85

    $12.75 lower than Madera for the office setting.

  • Dallas

    Texas · 69005

    Office

    $220.96

    Facility

    $145.11

    $11.11 lower than Madera for the office setting.

  • Fort Worth

    Texas · 69005

    Office

    $219.69

    Facility

    $144.60

    $12.38 lower than Madera for the office setting.

  • Galveston

    Texas · 69005

    Office

    $220.13

    Facility

    $144.51

    $11.94 lower than Madera for the office setting.

  • Houston

    Texas · 69005

    Office

    $226.17

    Facility

    $150.55

    $5.90 lower than Madera for the office setting.

  • Rest Of Texas

    Texas · 69005

    Office

    $214.19

    Facility

    $141.92

    $17.88 lower than Madera for the office setting.

  • Utah

    Utah · 69005

    Office

    $212.87

    Facility

    $141.28

    $19.20 lower than Madera for the office setting.

  • Virginia

    Virginia · 69005

    Office

    $216.81

    Facility

    $141.95

    $15.26 lower than Madera for the office setting.

  • Virgin Islands

    United States Virgin Islands · 69005

    Office

    $223.84

    Facility

    $146.84

    $8.23 lower than Madera for the office setting.

  • Vermont

    Vermont · 69005

    Office

    $215.60

    Facility

    $140.20

    $16.47 lower than Madera for the office setting.

  • Rest Of Washington

    Washington · 69005

    Office

    $228.20

    Facility

    $148.01

    $3.87 lower than Madera for the office setting.

  • Seattle (King Cnty)

    Washington · 69005

    Office

    $255.95

    Facility

    $162.51

    $23.88 higher than Madera for the office setting.

  • Wisconsin

    Wisconsin · 69005

    Office

    $208.90

    Facility

    $135.95

    $23.17 lower than Madera for the office setting.

  • West Virginia

    West Virginia · 69005

    Office

    $208.74

    Facility

    $142.56

    $23.33 lower than Madera for the office setting.

  • Wyoming**

    Wyoming · 69005

    Office

    $219.58

    Facility

    $143.43

    $12.49 lower than Madera for the office setting.

See how rates vary across the country

69005 · Office / nonfacility · Non-QP. Choose a state to explore its payment localities. A range means the amount varies within that state.

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.

$197.23

$261.90

Color shows the midpoint of each state’s locality range.

View all state and territory rates as a table
State / territoryRate rangeLocalities
AK$261.901
AL$200.051
AR$197.231
AZ$216.491
CA$232.07–$287.3929
CO$229.901
CT$237.031
DC$252.591
DE$220.001
FL$221.79–$245.083
GA$209.34–$227.132
GU$237.121
HI$237.121
IA$203.821
ID$205.371
IL$216.39–$237.924
IN$206.501
KS$203.451
KY$205.871
LA$205.78–$215.632
MA$228.81–$251.472
MD$223.94–$252.593
ME$207.01–$217.112
MI$211.61–$225.082
MN$218.781
MO$202.71–$215.713
MS$199.981
MT$222.431
NC$209.031
ND$215.901
NE$204.741
NH$226.851
NJ$239.31–$250.192
NM$212.971
NV$220.751
NY$212.13–$263.055
OH$210.281
OK$204.911
OR$218.61–$236.402
PA$210.29–$231.622
PR$223.841
RI$227.251
SC$210.081
SD$215.131
TN$204.521
TX$208.98–$229.518
UT$212.871
VA$216.81–$252.592
VI$223.841
VT$215.601
WA$228.20–$255.952
WI$208.901
WV$208.741
WY$219.581

Explore 69005 on the national rate map →

Where does this rate apply?

Madera is a Medicare payment area. Our Census mapping connects it to 17 cities and communities in California, including the examples shown here.

Some communities span more than one payment area. Follow a city link to compare all of its mapped areas, or check the service-location ZIP above for an address-level starting point.

Browse all communities in California →

Why are the office and facility amounts different?

For 69005 in Madera, the physician’s office rate is $232.07 and the facility-setting rate is $148.60: a difference of $83.47.

The calculation uses a different practice-expense RVU for each setting. Both amounts here are physician fee-schedule amounts. The facility figure does not include a hospital’s separate charges, so this comparison does not tell you the total cost of receiving care in each setting.

See the inputs behind this difference →

Use this rate

What is a percentage of Medicare worth?

Turn a percentage into dollars for 69005 in Madera. This uses the base rate on this page, so the locality and release stay consistent.

Reference amount per service

$255.28

$232.07 × 110% = $255.28

A contract may specify another Medicare year or additional adjustments. This is percentage arithmetic on the displayed base rate, not a claim adjudication.

Working with a whole code list?

Compare an offer across your annual code mix, including an older Medicare schedule or flat per-code rates.

Compare your contract offer →

How this local rate is calculated

Each RVU component is multiplied by its own geographic practice cost index (GPCI). The three adjusted components are added, then multiplied by the conversion factor. These are the inputs used for 69005 in Madera.

PPRRVU2026_Oct_nonQPP.csv

7,581

Code
69005
Physician work
2.11
Practice expense
4.22
Malpractice
0.33

GPCI2026.csv

14

Locality
Madera
Physician work
1.017
Practice expense
1.096
Malpractice
0.536
Office / nonfacility calculation for 69005 in Madera
ComponentRVULocality factorAdjusted
Physician work2.11× 1.0172.1459
Practice expense4.22× 1.0964.6251
Malpractice0.33× 0.5360.1769
Total RVUs6.9479
Conversion factor× 33.4009

Office / nonfacility rate, Madera$232.07

Values as parsed from CMS release RVU26D, effective 2026-10-01. The amount is rounded to the nearest cent only at the end.

Open 69005 in the RVU calculator →

Explore RVUs, geographic factors and the full formula

Office / nonfacility

Office / nonfacility calculation inputs
ComponentRVULocal GPCI
Work2.111.017
Practice expense4.221.096
Malpractice0.330.536

(2.11 × 1.017 + 4.22 × 1.096 + 0.33 × 0.536) × $33.4009 = $232.07

Facility

Facility calculation inputs
ComponentRVULocal GPCI
Work2.111.017
Practice expense1.941.096
Malpractice0.330.536

(2.11 × 1.017 + 1.94 × 1.096 + 0.33 × 0.536) × $33.4009 = $148.60

The office and facility calculations use their respective practice-expense RVUs. The facility amount here is the physician fee, not a separate hospital or facility bill.

How this rate has changed

69005 · Office / nonfacility

$232.07

Effective 2026-10-01

The base rate is $11.00 higher than on 2025-10-01, moving from $221.07 to $232.07 (5.0%).

It is unchanged from the immediately preceding available release, effective 2026-07-01.

Base rate by release · bars start at $0 · select a bar to compare

One bar per available release, ordered by effective date. Missing rates remain gaps. These comparisons hold the code, setting and locality identifiers constant; they do not isolate which policy or input caused a change.

What changed, release by release

  1. January 1, 2026

    RVU26A

    $221.07changed to$232.07

    • Conversion factor 32.3465 changed to 33.4009
    • Work RVU 2.16 changed to 2.11
    • Practice expense RVU 4.08 changed to 4.22
    • Work GPCI 1.014 changed to 1.017
    • Practice expense GPCI 1.093 changed to 1.096
    • Malpractice GPCI 0.560 changed to 0.536

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    Earliest loaded release: $221.07

    Held through RVU25B, RVU25C, RVU25D.

Explore release dates and calculate this code in an earlier period →

Each row uses the accepted CMS release effective on that date and the same contractor and locality identifiers. Missing rates stay visible. Historical boundaries may differ; verify the service address for an older claim.

Inspect every release and its CMS source
Effective fromOffice / nonfacilityFacilityCMS release
2026-10-01$232.07$148.60RVU26D
2026-07-01$232.07$148.60RVU26C
2026-04-01$232.07$148.60RVU26B
2026-01-01$232.07$148.60RVU26A
2025-10-01$221.07$162.03RVU25D
2025-07-01$221.07$162.03RVU25C
2025-04-01$221.07$162.03RVU25B
2025-01-01$221.07$162.03RVU25A

69005 billing questions

How do I choose this code instead of 69000?

Use 69005 when the documented drainage is complicated rather than simple. The record should describe the extent of the collection and the work supporting that level.

Does this code cover an abscess in the ear canal?

No. This service is for a collection of the external ear, such as the auricle or pinna; 69020 is for an abscess in the external auditory canal.

Are related postoperative visits separately reported?

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

How is bilateral treatment reported?

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

Can an assistant or co-surgeon be reported?

Assistant-at-surgery payment is restricted for this code. 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 indices and the applicable conversion factor. Unavailable or separately priced services are labeled rather than assigned a made-up amount.

Source: RVU26D. Effective 2026-10-01 through the day before 2027-01-01.

RVUs for 69005PPRRVU2026_Oct_nonQPP.csv, line 7,581 (RVU26D)
Geographic factors for MaderaGPCI2026.csv, line 14 (RVU26D)
Open CMS sourceHow this rate is calculatedBuild a fee sheet