No office rate
Choose this code when the lacrimal sac is removed. Use 68720 when the operation establishes a drainage bypass and retains the sac.
On this page
CMS RVU26D · Effective 2026-10-01
68520 in Modesto
Office / nonfacility
Not available in this setting
Base rate per service
Facility setting
$669.56
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.
Ophthalmic surgery
About 68520: Lacrimal sac excision
Reports surgical removal of the lacrimal sac, typically for selected cases of chronic or recurrent sac disease requiring excision rather than drainage bypass.
An ophthalmologist, often an oculoplastic surgeon, removes the lacrimal sac. This operation may be selected for chronic or recurrent dacryocystitis or other sac disease when removing the sac is the planned treatment. It is distinct from creating a new drainage route while preserving the sac. The procedure is generally performed in an operative setting, and the operative report should identify the affected side, the sac condition, and the extent of excision.
Report the code for the sac excision itself, not for a lacrimal gland procedure or a limited diagnostic sample. Documentation should support why the sac was removed and describe the work performed. The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care. For bilateral surgery, modifier 50 is paid at 150%. When other procedures are performed in the same session, the highest-valued procedure is paid in full and additional procedures are subject to the standard 50% multiple-procedure reduction. Assistant-at-surgery payment requires documented medical necessity; co-surgeons and team surgery are not permitted.
CMS billing rules for 68520
- Global period
- Major surgery with a 90-day global period: the day-before preoperative visit and 90 days of related postoperative care 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
- Assistant at surgery is paid only with documentation of medical necessity.
- Co-surgeons
- Co-surgeons not permitted.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU8.56 · 44%
- Practice expense (office) RVU10.00 · 52%
- Malpractice RVU0.71 · 4%
165
Medicare services in 2024 · #4492 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.
68520 compared with similar codes
Office rates for Modesto, from the same CMS release.
No office rate
68525 represents a diagnostic tissue sample from the lacrimal sac; this code is for removal of the sac, not biopsy alone.
No office rate
68500 concerns the lacrimal gland, which produces tears. This code concerns the lacrimal sac in the tear-drainage system.
The same code, a different location
How does Modesto compare?
68520 across payment areas
Same release and payment basis · bars start at $0
Modesto · This locality
Unavailable
Unavailable
No comparable rate is available in this setting.
Unavailable
No comparable rate is available in this setting.
Unavailable
No comparable rate is available in this setting.
Unavailable
No comparable rate is available in this setting.
Unavailable
No comparable rate is available in this setting.
No comparable rate is available in this setting.
Other payment areas listed in California appear first, followed by selected cross-country examples. The chart compares amounts, not distance.
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
Madera
California · 68520
Office
Unavailable
Facility
$669.56
No comparable office rate is available.
Merced
California · 68520
Office
Unavailable
Facility
$669.56
No comparable office rate is available.
Napa
California · 68520
Office
Unavailable
Facility
$756.20
No comparable office rate is available.
Oxnard-Thousand Oaks-Ventura
California · 68520
Office
Unavailable
Facility
$703.49
No comparable office rate is available.
Redding
California · 68520
Office
Unavailable
Facility
$669.56
No comparable office rate is available.
Rest Of California
California · 68520
Office
Unavailable
Facility
$669.56
No comparable office rate is available.
Riverside-San Bernardino-Ontario
California · 68520
Office
Unavailable
Facility
$677.36
No comparable office rate is available.
Sacramento-Roseville-Folsom
California · 68520
Office
Unavailable
Facility
$697.37
No comparable office rate is available.
Salinas
California · 68520
Office
Unavailable
Facility
$694.60
No comparable office rate is available.
San Diego-Chula Vista-Carlsbad
California · 68520
Office
Unavailable
Facility
$706.82
No comparable office rate is available.
San Francisco-Oakland-Berkeley (Marin Cnty)
California · 68520
Office
Unavailable
Facility
$794.91
No comparable office rate is available.
San Francisco-Oakland-Berkeley (San Francisco/San Mateo/Alameda/Contra Costa Cnty)
California · 68520
Office
Unavailable
Facility
$794.10
No comparable office rate is available.
San Jose-Sunnyvale-Santa Clara (San Benito Cnty)
California · 68520
Office
Unavailable
Facility
$811.71
No comparable office rate is available.
San Jose-Sunnyvale-Santa Clara (Santa Clara Cnty)
California · 68520
Office
Unavailable
Facility
$808.42
No comparable office rate is available.
San Luis Obispo-Paso Robles
California · 68520
Office
Unavailable
Facility
$683.92
No comparable office rate is available.
Santa Cruz-Watsonville
California · 68520
Office
Unavailable
Facility
$710.45
No comparable office rate is available.
Santa Maria-Santa Barbara
California · 68520
Office
Unavailable
Facility
$696.08
No comparable office rate is available.
Santa Rosa-Petaluma
California · 68520
Office
Unavailable
Facility
$717.36
No comparable office rate is available.
Stockton
California · 68520
Office
Unavailable
Facility
$669.56
No comparable office rate is available.
Vallejo
California · 68520
Office
Unavailable
Facility
$755.03
No comparable office rate is available.
Visalia
California · 68520
Office
Unavailable
Facility
$669.56
No comparable office rate is available.
Yuba City
California · 68520
Office
Unavailable
Facility
$669.56
No comparable office rate is available.
Dc + Md/Va Suburbs
District of Columbia · 68520
Office
Unavailable
Facility
$721.21
No comparable office rate is available.
Miami
Florida · 68520
Office
Unavailable
Facility
$693.59
No comparable office rate is available.
Chicago
Illinois · 68520
Office
Unavailable
Facility
$678.02
No comparable office rate is available.
Manhattan
New York · 68520
Office
Unavailable
Facility
$729.94
No comparable office rate is available.
Alaska*
Alaska · 68520
Office
Unavailable
Facility
$797.65
No comparable office rate is available.
Alabama
Alabama · 68520
Office
Unavailable
Facility
$591.59
No comparable office rate is available.
Arkansas
Arkansas · 68520
Office
Unavailable
Facility
$585.04
No comparable office rate is available.
Arizona
Arizona · 68520
Office
Unavailable
Facility
$629.87
No comparable office rate is available.
Colorado
Colorado · 68520
Office
Unavailable
Facility
$663.25
No comparable office rate is available.
Connecticut
Connecticut · 68520
Office
Unavailable
Facility
$680.05
No comparable office rate is available.
Delaware
Delaware · 68520
Office
Unavailable
Facility
$638.66
No comparable office rate is available.
Fort Lauderdale
Florida · 68520
Office
Unavailable
Facility
$667.14
No comparable office rate is available.
Rest Of Florida
Florida · 68520
Office
Unavailable
Facility
$640.87
No comparable office rate is available.
Atlanta
Georgia · 68520
Office
Unavailable
Facility
$654.60
No comparable office rate is available.
Rest Of Georgia
Georgia · 68520
Office
Unavailable
Facility
$612.12
No comparable office rate is available.
Hawaii, Guam
Hawaii · 68520
Office
Unavailable
Facility
$679.41
No comparable office rate is available.
Iowa
Iowa · 68520
Office
Unavailable
Facility
$600.94
No comparable office rate is available.
Idaho
Idaho · 68520
Office
Unavailable
Facility
$604.42
No comparable office rate is available.
East St. Louis
Illinois · 68520
Office
Unavailable
Facility
$640.96
No comparable office rate is available.
Rest Of Illinois
Illinois · 68520
Office
Unavailable
Facility
$627.93
No comparable office rate is available.
Suburban Chicago
Illinois · 68520
Office
Unavailable
Facility
$672.96
No comparable office rate is available.
Indiana
Indiana · 68520
Office
Unavailable
Facility
$607.06
No comparable office rate is available.
Kansas
Kansas · 68520
Office
Unavailable
Facility
$599.81
No comparable office rate is available.
Kentucky
Kentucky · 68520
Office
Unavailable
Facility
$604.54
No comparable office rate is available.
New Orleans
Louisiana · 68520
Office
Unavailable
Facility
$627.15
No comparable office rate is available.
Rest Of Louisiana
Louisiana · 68520
Office
Unavailable
Facility
$604.23
No comparable office rate is available.
Metropolitan Boston
Massachusetts · 68520
Office
Unavailable
Facility
$717.55
No comparable office rate is available.
Rest Of Massachusetts
Massachusetts · 68520
Office
Unavailable
Facility
$661.10
No comparable office rate is available.
Baltimore/Surr. Cntys
Maryland · 68520
Office
Unavailable
Facility
$678.21
No comparable office rate is available.
Rest Of Maryland
Maryland · 68520
Office
Unavailable
Facility
$648.56
No comparable office rate is available.
Rest Of Maine
Maine · 68520
Office
Unavailable
Facility
$607.95
No comparable office rate is available.
Southern Maine
Maine · 68520
Office
Unavailable
Facility
$631.88
No comparable office rate is available.
Detroit
Michigan · 68520
Office
Unavailable
Facility
$648.21
No comparable office rate is available.
Rest Of Michigan
Michigan · 68520
Office
Unavailable
Facility
$617.64
No comparable office rate is available.
Minnesota
Minnesota · 68520
Office
Unavailable
Facility
$636.63
No comparable office rate is available.
Metropolitan Kansas City
Missouri · 68520
Office
Unavailable
Facility
$622.72
No comparable office rate is available.
Metropolitan St. Louis
Missouri · 68520
Office
Unavailable
Facility
$627.65
No comparable office rate is available.
Rest Of Missouri
Missouri · 68520
Office
Unavailable
Facility
$596.93
No comparable office rate is available.
Mississippi
Mississippi · 68520
Office
Unavailable
Facility
$591.02
No comparable office rate is available.
Montana**
Montana · 68520
Office
Unavailable
Facility
$643.59
No comparable office rate is available.
North Carolina
North Carolina · 68520
Office
Unavailable
Facility
$612.70
No comparable office rate is available.
North Dakota**
North Dakota · 68520
Office
Unavailable
Facility
$629.55
No comparable office rate is available.
Nebraska
Nebraska · 68520
Office
Unavailable
Facility
$603.17
No comparable office rate is available.
New Hampshire
New Hampshire · 68520
Office
Unavailable
Facility
$654.37
No comparable office rate is available.
Northern Nj
New Jersey · 68520
Office
Unavailable
Facility
$716.70
No comparable office rate is available.
Rest Of New Jersey
New Jersey · 68520
Office
Unavailable
Facility
$688.10
No comparable office rate is available.
New Mexico
New Mexico · 68520
Office
Unavailable
Facility
$620.68
No comparable office rate is available.
Nevada**
Nevada · 68520
Office
Unavailable
Facility
$640.01
No comparable office rate is available.
Nyc Suburbs/Long Island
New York · 68520
Office
Unavailable
Facility
$745.38
No comparable office rate is available.
Poughkpsie/N Nyc Suburbs
New York · 68520
Office
Unavailable
Facility
$693.21
No comparable office rate is available.
Queens
New York · 68520
Office
Unavailable
Facility
$733.21
No comparable office rate is available.
Rest Of New York
New York · 68520
Office
Unavailable
Facility
$619.89
No comparable office rate is available.
Ohio
Ohio · 68520
Office
Unavailable
Facility
$614.77
No comparable office rate is available.
Oklahoma
Oklahoma · 68520
Office
Unavailable
Facility
$602.61
No comparable office rate is available.
Portland
Oregon · 68520
Office
Unavailable
Facility
$679.21
No comparable office rate is available.
Rest Of Oregon
Oregon · 68520
Office
Unavailable
Facility
$635.26
No comparable office rate is available.
Metropolitan Philadelphia
Pennsylvania · 68520
Office
Unavailable
Facility
$667.05
No comparable office rate is available.
Rest Of Pennsylvania
Pennsylvania · 68520
Office
Unavailable
Facility
$614.94
No comparable office rate is available.
Puerto Rico
Puerto Rico · 68520
Office
Unavailable
Facility
$646.95
No comparable office rate is available.
Rhode Island
Rhode Island · 68520
Office
Unavailable
Facility
$657.53
No comparable office rate is available.
South Carolina
South Carolina · 68520
Office
Unavailable
Facility
$614.69
No comparable office rate is available.
South Dakota**
South Dakota · 68520
Office
Unavailable
Facility
$627.89
No comparable office rate is available.
Tennessee
Tennessee · 68520
Office
Unavailable
Facility
$602.26
No comparable office rate is available.
Austin
Texas · 68520
Office
Unavailable
Facility
$660.88
No comparable office rate is available.
Beaumont
Texas · 68520
Office
Unavailable
Facility
$611.89
No comparable office rate is available.
Brazoria
Texas · 68520
Office
Unavailable
Facility
$637.70
No comparable office rate is available.
Dallas
Texas · 68520
Office
Unavailable
Facility
$641.51
No comparable office rate is available.
Fort Worth
Texas · 68520
Office
Unavailable
Facility
$638.47
No comparable office rate is available.
Galveston
Texas · 68520
Office
Unavailable
Facility
$639.51
No comparable office rate is available.
Houston
Texas · 68520
Office
Unavailable
Facility
$652.50
No comparable office rate is available.
Rest Of Texas
Texas · 68520
Office
Unavailable
Facility
$624.30
No comparable office rate is available.
Utah
Utah · 68520
Office
Unavailable
Facility
$621.18
No comparable office rate is available.
Virginia
Virginia · 68520
Office
Unavailable
Facility
$630.99
No comparable office rate is available.
Virgin Islands
United States Virgin Islands · 68520
Office
Unavailable
Facility
$646.95
No comparable office rate is available.
Vermont
Vermont · 68520
Office
Unavailable
Facility
$628.58
No comparable office rate is available.
Rest Of Washington
Washington · 68520
Office
Unavailable
Facility
$659.39
No comparable office rate is available.
Seattle (King Cnty)
Washington · 68520
Office
Unavailable
Facility
$729.41
No comparable office rate is available.
Wisconsin
Wisconsin · 68520
Office
Unavailable
Facility
$613.20
No comparable office rate is available.
West Virginia
West Virginia · 68520
Office
Unavailable
Facility
$610.10
No comparable office rate is available.
Wyoming**
Wyoming · 68520
Office
Unavailable
Facility
$637.47
No comparable office rate is available.
See how rates vary across the country
68520 · Office / nonfacility · Non-QP. Choose a state to explore its payment localities. A range means the amount varies within that state.
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 all state and territory rates as a table
| State / territory | Rate range | Localities |
|---|---|---|
| AK | No published base rate | 1 |
| AL | No published base rate | 1 |
| AR | No published base rate | 1 |
| AZ | No published base rate | 1 |
| CA | No published base rate | 29 |
| CO | No published base rate | 1 |
| CT | No published base rate | 1 |
| DC | No published base rate | 1 |
| DE | No published base rate | 1 |
| FL | No published base rate | 3 |
| GA | No published base rate | 2 |
| GU | No published base rate | 1 |
| HI | No published base rate | 1 |
| IA | No published base rate | 1 |
| ID | No published base rate | 1 |
| IL | No published base rate | 4 |
| IN | No published base rate | 1 |
| KS | No published base rate | 1 |
| KY | No published base rate | 1 |
| LA | No published base rate | 2 |
| MA | No published base rate | 2 |
| MD | No published base rate | 3 |
| ME | No published base rate | 2 |
| MI | No published base rate | 2 |
| MN | No published base rate | 1 |
| MO | No published base rate | 3 |
| MS | No published base rate | 1 |
| MT | No published base rate | 1 |
| NC | No published base rate | 1 |
| ND | No published base rate | 1 |
| NE | No published base rate | 1 |
| NH | No published base rate | 1 |
| NJ | No published base rate | 2 |
| NM | No published base rate | 1 |
| NV | No published base rate | 1 |
| NY | No published base rate | 5 |
| OH | No published base rate | 1 |
| OK | No published base rate | 1 |
| OR | No published base rate | 2 |
| PA | No published base rate | 2 |
| PR | No published base rate | 1 |
| RI | No published base rate | 1 |
| SC | No published base rate | 1 |
| SD | No published base rate | 1 |
| TN | No published base rate | 1 |
| TX | No published base rate | 8 |
| UT | No published base rate | 1 |
| VA | No published base rate | 2 |
| VI | No published base rate | 1 |
| VT | No published base rate | 1 |
| WA | No published base rate | 2 |
| WI | No published base rate | 1 |
| WV | No published base rate | 1 |
| WY | No published base rate | 1 |
Where does this rate apply?
Modesto is a Medicare payment area. Our Census mapping connects it to 33 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.
Use this rate
What is a percentage of Medicare worth?
Turn a percentage into dollars for 68520 in Modesto. This uses the base rate on this page, so the locality and release stay consistent.
Reference amount per service
$736.52
$669.56 × 110% = $736.52
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.
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 68520 in Modesto.
PPRRVU2026_Oct_nonQPP.csv
7,558
- Code
- 68520
- Physician work
- 8.56
- Practice expense
- 10.00
- Malpractice
- 0.71
GPCI2026.csv
16
- Locality
- Modesto
- Physician work
- 1.017
- Practice expense
- 1.096
- Malpractice
- 0.536
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 8.56 | × 1.017 | 8.7055 |
| Practice expense | 10.00 | × 1.096 | 10.9600 |
| Malpractice | 0.71 | × 0.536 | 0.3806 |
| Total RVUs | 20.0461 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Modesto$669.56
Open 68520 in the RVU calculator →
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 8.56 | 1.017 |
| Practice expense | 10 | 1.096 |
| Malpractice | 0.71 | 0.536 |
(8.56 × 1.017 + 10 × 1.096 + 0.71 × 0.536) × $33.4009 = $669.56
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
68520 · Office / nonfacility
Rate unavailable
Effective 2026-10-01
A rate is unavailable in one of these releases, so a change cannot be calculated.
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
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 from | Office / nonfacility | Facility | CMS release |
|---|---|---|---|
| 2026-10-01 | Not available in this setting | $669.56 | RVU26D |
| 2026-07-01 | Not available in this setting | $669.56 | RVU26C |
| 2026-04-01 | Not available in this setting | $669.56 | RVU26B |
| 2026-01-01 | Not available in this setting | $669.56 | RVU26A |
| 2025-10-01 | Not available in this setting | $739.60 | RVU25D |
| 2025-07-01 | Not available in this setting | $739.60 | RVU25C |
| 2025-04-01 | Not available in this setting | $739.60 | RVU25B |
| 2025-01-01 | Not available in this setting | $739.60 | RVU25A |
68520 billing questions
How does sac removal differ from a dacryocystorhinostomy?
This code represents removal of the lacrimal sac. A dacryocystorhinostomy creates a drainage bypass while retaining the sac.
Can a sac biopsy be reported with the excision?
A separate biopsy code is generally for sampling when the sac is not being removed. The operative documentation should support the distinct work if both procedures are reported.
How is bilateral sac removal reported?
Report bilateral surgery with modifier 50; CMS pays the bilateral procedure at 150%.
What postoperative care is included?
The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care.
May an assistant or co-surgeon be reported?
Assistant-at-surgery payment requires documentation of medical necessity. 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.
7,55568500,,Removal of tear gland,A,,12.45,14.12,NA,14.12,,1.01,27.58,27.58,0,090,0.10,0.70,0.20,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,55668505,,Partial removal tear gland,A,,12.37,14.10,NA,14.10,,1.00,27.47,27.47,0,090,0.10,0.70,0.20,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,55768510,,Biopsy of tear gland,A,,4.49,8.65,,2.18,,0.36,13.50,7.03,0,000,0.00,0.00,0.00,2,1,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,55868520,,Removal of tear sac,A,,8.56,10.00,NA,10.00,,0.71,19.27,19.27,0,090,0.10,0.70,0.20,2,1,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,55968525,,Biopsy of tear sac,A,,4.31,1.51,NA,1.51,,0.36,6.18,6.18,0,000,0.00,0.00,0.00,2,1,1,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,56068530,,Clearance of tear duct,A,,3.61,9.09,,2.48,,0.28,12.98,6.37,0,010,0.10,0.80,0.10,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,56168540,,Remove tear gland lesion,A,,11.88,12.54,NA,12.54,,0.95,25.37,25.37,0,090,0.10,0.70,0.20,2,1,1,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1301182,CA,18,LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY),1.041,1.183,0.664
1401112,CA,58,MADERA,1.017,1.096,0.536
1501112,CA,59,MERCED,1.017,1.096,0.536
1601112,CA,60,MODESTO,1.017,1.096,0.536
1701112,CA,51,NAPA,1.063,1.318,0.508
1801182,CA,17,OXNARD-THOUSAND OAKS-VENTURA,1.028,1.182,0.623
1901112,CA,61,REDDING,1.017,1.096,0.536