No office rate
68525 samples sac tissue for diagnosis; 68520 is the code to consider when the tear sac is removed.
On this page
CMS RVU26D · Effective 2026-10-01
68525 Tear sac biopsy Medicare reimbursement rates in Colorado
Reports surgical sampling of lacrimal sac tissue for diagnostic evaluation when a lesion or abnormal tissue requires examination. Compare 68525 office and facility rates across CMS payment localities in Colorado.
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.
What does Medicare pay for 68525 in Colorado?
Colorado has 1 payment locality in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the payment area shown below, using the same CMS release.
Office / nonfacility
No supported rate
Facility setting
$208.74
1 of 1 localities have a supported rate.
Payment area: Colorado
One mapped payment locality.
These are locality ranges, not averages or address-specific quotes. A facility-setting amount covers the physician service; it does not include a hospital’s separate bill. Choose a locality below to inspect its calculation, compare other payment areas, or price a percentage of Medicare.
Ophthalmic surgery
About 68525: Lacrimal sac tissue biopsy
Reports surgical sampling of lacrimal sac tissue for diagnostic evaluation when a lesion or abnormal tissue requires examination.
An ophthalmologist, often an oculoplastic surgeon, samples tissue from the lacrimal sac for diagnostic evaluation. The sac is part of the tear-drainage system near the inner corner of the eye. Biopsy may be considered when abnormal tissue or a suspected lesion requires examination; the specimen is submitted for pathologic evaluation. The operative note should identify the sac as the tissue sampled and explain the clinical reason for biopsy.
Report this service for tissue sampling, rather than removal of the sac. Document the operative findings, biopsy site, and specimen obtained. CMS assigns a 0-day global period, so same-day preoperative and postoperative care is included. When multiple procedures are performed in the same session, the highest-valued procedure is paid in full and the others are subject to the standard multiple procedure reduction. For bilateral procedures, modifier 50 is paid at 150%. Assistant-at-surgery payment is restricted; co-surgeons require supporting documentation, and team surgery is not permitted.
CMS billing rules for 68525
- Global period
- Minor procedure with a 0-day global period: same-day preoperative and postoperative care is 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 paid only with supporting documentation.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU4.31 · 70%
- Practice expense (office) RVU1.51 · 24%
- Malpractice RVU0.36 · 6%
320
Medicare services in 2024 · #3951 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.
68525 compared with similar codes
Office rates for Colorado, from the same CMS release.
$468.57
Both are biopsy procedures, but 68510 targets the lacrimal gland and 68525 targets the lacrimal sac.
$452.37
68530 concerns clearance of the tear duct; 68525 reports sampling tissue from the tear sac for diagnosis.
Compare 68525 by payment locality
Find the payment area for your service address, then open its rate page for calculation inputs, release history and the percentage-of-Medicare tool. A city may cross payment-area boundaries; the ZIP lookup above helps resolve the location.
1 of 1 payment localities
Colorado →
Office / nonfacility
Unavailable
Facility
$208.74
Need rates for a whole code list?
Fee-sheet and API access are in early access. Tell us which codes and locations your team needs.
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 68525 in Colorado.
PPRRVU2026_Oct_nonQPP.csv
7,559
- Code
- 68525
- Physician work
- 4.31
- Practice expense
- 1.51
- Malpractice
- 0.36
GPCI2026.csv
37
- Locality
- Colorado
- Physician work
- 1.012
- Practice expense
- 1.064
- Malpractice
- 0.781
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 4.31 | × 1.012 | 4.3617 |
| Practice expense | 1.51 | × 1.064 | 1.6066 |
| Malpractice | 0.36 | × 0.781 | 0.2812 |
| Total RVUs | 6.2495 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Colorado$208.74
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 4.31 | 1.012 |
| Practice expense | 1.51 | 1.064 |
| Malpractice | 0.36 | 0.781 |
(4.31 × 1.012 + 1.51 × 1.064 + 0.36 × 0.781) × $33.4009 = $208.74
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.
68525 billing questions
How is a sac biopsy different from removal of the tear sac?
Report 68525 when tissue is sampled for diagnosis. When the tear sac itself is removed, consider 68520 instead.
Can tear-sac biopsy be reported with a pathology service?
The biopsy reports the surgical tissue sampling. Any separately reported pathology service represents examination of the specimen, not the act of obtaining it.
What documentation supports 68525?
The operative note should identify the lacrimal sac as the sampled tissue, describe the reason for biopsy and the tissue obtained, and document relevant findings.
How does Medicare treat bilateral reporting?
CMS lists the procedure as bilateral; when both sides are treated, modifier 50 is paid at 150%.
What happens when another procedure is performed in the same session?
Under the standard multiple procedure reduction, the highest-valued procedure is paid in full and the other procedures are paid at 50%.
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.
7,55668505,,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
7,56268550,,Remove tear gland lesion,A,,14.78,15.57,NA,15.57,,1.19,31.54,31.54,0,090,0.10,0.70,0.20,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
3401112,CA,69,VISALIA,1.017,1.096,0.536
3501112,CA,70,YUBA CITY,1.017,1.096,0.536
3601112,CA,75,REST OF CALIFORNIA,1.017,1.096,0.536
3704112,CO,01,COLORADO,1.012,1.064,0.781
3813102,CT,00,CONNECTICUT,1.020,1.077,1.210
3912202,DC,01,DC + MD/VA SUBURBS,1.054,1.178,1.113
4012102,DE,01,DELAWARE,1.005,0.988,0.899