$138.53
Use 67800 for chalazion treatment. This code is for a non-chalazion eyelid lesion treated without incision.
On this page
CMS RVU26D · Effective 2026-10-01
68040 Eyelid lesion treatment Medicare reimbursement rates in Connecticut
Reports nonincisional treatment of an eyelid lesion, such as molluscum contagiosum, when the lesion is treated rather than biopsied or excised. Compare 68040 office and facility rates across CMS payment localities in Connecticut.
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 68040 in Connecticut?
Connecticut 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
$65.15
1 of 1 localities have a supported rate.
Payment area: Connecticut
One mapped payment locality.
Facility setting
$41.41
1 of 1 localities have a supported rate.
Payment area: Connecticut
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.
Ophthalmology
About 68040: Nonincisional eyelid lesion treatment
Reports nonincisional treatment of an eyelid lesion, such as molluscum contagiosum, when the lesion is treated rather than biopsied or excised.
This service covers treatment of a non-chalazion lesion on the eyelid without making an incision. A typical example is treating eyelid molluscum contagiosum. Ophthalmologists and other clinicians who provide eye care may perform it in an office or outpatient setting. The procedure is directed at a clinically identified lesion; it is distinct from taking a biopsy to establish a diagnosis or surgically excising a lesion.
Choose the code when the documented service treats an eyelid lesion without incision, and distinguish it from chalazion treatment and procedures requiring incision or excision. Record the lesion’s eyelid location, clinical nature, and treatment performed. The service has a 0-day global period, so same-day preoperative and postoperative care is included. When multiple procedures occur in one session, the highest-valued procedure is paid in full and the others at 50%. Bilateral reporting with modifier 50 is paid at 150%. Assistant-at-surgery payment is restricted; co-surgeons and team surgery are not permitted.
CMS billing rules for 68040
- 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 not permitted.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU0.83 · 45%
- Practice expense (office) RVU0.98 · 53%
- Malpractice RVU0.04 · 2%
2.9K
Medicare services in 2024 · #2197 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.
68040 compared with similar codes
Office rates for Connecticut, from the same CMS release.
$193.27
67810 represents eyelid biopsy for diagnostic evaluation. This code represents treatment of a lesion, not tissue sampling.
$296.16
Use 67840 when the eyelid lesion is surgically excised. This code applies when treatment is performed without incision.
$128.35
68020 is for incision and drainage of a conjunctival cyst. This code concerns a lesion on the eyelid and involves no incision.
Compare 68040 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
Connecticut →
Office / nonfacility
$65.15
Facility
$41.41
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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 68040 in Connecticut.
PPRRVU2026_Oct_nonQPP.csv
7,534
- Code
- 68040
- Physician work
- 0.83
- Practice expense
- 0.98
- Malpractice
- 0.04
GPCI2026.csv
38
- Locality
- Connecticut
- Physician work
- 1.020
- Practice expense
- 1.077
- Malpractice
- 1.210
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 0.83 | × 1.020 | 0.8466 |
| Practice expense | 0.98 | × 1.077 | 1.0555 |
| Malpractice | 0.04 | × 1.210 | 0.0484 |
| Total RVUs | 1.9505 | ||
| Conversion factor | × 33.4009 | ||
Office / nonfacility rate, Connecticut$65.15
Explore RVUs, geographic factors and the full formula
Office / nonfacility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 0.83 | 1.02 |
| Practice expense | 0.98 | 1.077 |
| Malpractice | 0.04 | 1.21 |
(0.83 × 1.02 + 0.98 × 1.077 + 0.04 × 1.21) × $33.4009 = $65.15
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 0.83 | 1.02 |
| Practice expense | 0.32 | 1.077 |
| Malpractice | 0.04 | 1.21 |
(0.83 × 1.02 + 0.32 × 1.077 + 0.04 × 1.21) × $33.4009 = $41.41
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.
68040 billing questions
When should this code be chosen instead of an eyelid excision code?
Use it for treatment of an eyelid lesion without incision. If the clinician surgically removes the lesion, consider the excision code that matches the service instead.
Can this code be used for a chalazion?
No. Chalazion is excluded from this lesion-treatment service; use the chalazion-specific code when that is the condition treated.
What documentation supports reporting it?
Document the lesion’s location and clinical nature, that it was on the eyelid and was not a chalazion, and the nonincisional treatment performed.
How is bilateral treatment reported?
CMS pricing recognizes bilateral reporting with modifier 50 at 150%. Document treatment on both sides.
How does the 0-day global period affect same-day care?
Same-day preoperative and postoperative care is included in the procedure. CMS applies the multiple-procedure reduction when other procedures are performed in the same session.
Is an assistant or co-surgeon payable for this service?
Assistant-at-surgery payment is restricted. Co-surgeons and team surgery are not permitted under the CMS rules 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 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.
7,53167975,,Reconstruction of eyelid,A,,9.12,7.41,NA,7.41,,0.79,17.32,17.32,0,090,0.10,0.70,0.20,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,53267999,,Unlisted procedure eyelids,C,,0.00,0.00,,0.00,,0.00,0.00,0.00,0,YYY,0.00,0.00,0.00,2,1,0,1,1,9,,33.4009,09,0,99,0.00,0.00,0.00
7,53368020,,Incise/drain eyelid lining,A,,1.38,2.16,,1.37,,0.09,3.63,2.84,0,010,0.10,0.80,0.10,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,53468040,,Treatment of eyelid lesions,A,,0.83,0.98,,0.32,,0.04,1.85,1.19,0,000,0.00,0.00,0.00,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,53568100,,Biopsy conjunctiva,A,,1.32,3.95,,1.00,,0.11,5.38,2.43,0,000,0.00,0.00,0.00,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,53668110,,Exc les conjunctiva <1 cm,A,,1.77,5.20,,1.95,,0.14,7.11,3.86,0,010,0.10,0.80,0.10,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,53768115,,Exc les conjunctiva >1 cm,A,,2.35,7.37,,2.16,,0.19,9.91,4.70,0,010,0.10,0.80,0.10,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
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
4109102,FL,03,FORT LAUDERDALE,1.000,1.013,1.808