Billing code 69005: Ear drainageMedicare rate & RVUs in Delaware
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.
Medicare pays $220.00 for 69005 in the office in Delaware (Delaware). Which amount applies depends on the service address.
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 9 sections
What 69005 covers
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.
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 in Delaware
| Payment locality | Office | Facility |
|---|---|---|
| Delaware | $220.00 | $144.76 |
How the 69005 rate is calculated
Each of 69005’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 · 69005
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 2.11Practice expense 4.22Malpractice 0.33
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 69005
69005 has a 10-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 69005
Ear drainage
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 010 | Minor procedure: the day of the procedure plus 10 days after are included. |
| Multiple procedures | 2 | Standard reduction: highest-valued procedure at 100%, others at 50%. |
| Bilateral (modifier 50) | 1 | Bilateral with modifier 50 pays 150% of the fee schedule amount. |
| Assistant at surgery (80/81/82/AS) | 1 | Not paid (statutory restriction). |
| Co-surgeons (62) | 0 | Not permitted. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 0 | Physician service: no professional/technical split. |
| Split (54/55/56) | 0.10/0.80/0.10 | Share of the payment for pre-op, the procedure itself, and post-op care. |
Global surgery period · 69005
Ear drainage
10-day global period ends
Oct 11, 2026
Covers Oct 1, 2026 through Oct 11, 2026 (11 days).
Visit on Oct 31, 2026
After the global period ends: visits and procedures are billed normally.
What modifiers do to the payment
Modifier 50 · payment effect
With and without the modifier
69005 without 50 · national office
$222.45
Ear drainage
69005-50 · Bilateral: 150%
$333.68
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).
69005 compared with similar codes
Compare codes
69005 vs 69000 vs 69020 vs 10160: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 69000Ear drainage
- 69000 is the simple external-ear drainage service. Choose 69005 when the documented extent and work support complicated drainage.
- 69020Canal abscess drainage
- 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.
- 10160Lesion aspiration
- 10160 describes puncture aspiration of an abscess, hematoma, or other collection. This code is for complicated drainage of an external-ear collection.
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 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
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