CPT code 68540: Lacrimal lesion excision2026 Medicare rate & RVUs in Florida
Reports surgical removal of a localized, non-tumor lesion of the lacrimal gland, rather than biopsy or removal of the gland itself.
CMS doesn’t publish an office rate for 68540 in Florida.
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 68540 covers
An ophthalmic surgeon, often an oculoplastic specialist, removes a discrete lesion arising in the lacrimal gland while distinguishing the procedure from removal of the whole gland. The lacrimal gland sits in the upper outer portion of the orbit and produces tears. The service is generally performed in an operating-room setting; Medicare recorded facility services for this code in 2024.
Choose this code when the operative service removes a gland lesion, not when the provider only takes a diagnostic sample or removes the gland or a portion of it. Documentation should identify the lacrimal gland as the site, describe the lesion, and explain the excision performed. Medicare assigns a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. When multiple procedures occur in the same session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% reduction. Bilateral reporting with modifier 50 is paid at 150%. Medicare does not pay an assistant at surgery; co-surgeons require supporting documentation, and team surgery is 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.
Where 68540 pays more and less in Florida
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
| Payment locality | Office | Facility |
|---|---|---|
| Fort Lauderdale | Unavailable | $878.46 |
| Miami | Unavailable | $913.07 |
| Rest Of Florida | Unavailable | $844.91 |
How the 68540 rate is calculated
Each of 68540’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 · 68540
RVUs × geographic indexes × conversion factor
Work11.88
11.88 RVUs× 1.000 GPCI
Practice expense12.54
12.54 RVUs× 1.000 GPCI
Malpractice0.95
0.95 RVUs× 1.000 GPCI
Adjusted RVUs
25.3700
Conversion factor
$33.4009
Medicare rate
$847.38
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 68540
68540 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 68540
Lacrimal lesion excision
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 090 | Major surgery: the day before, the day of, and 90 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) | 1 | Permitted with supporting documentation. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 0 | Physician service: no professional/technical split. |
| Split (54/55/56) | 0.10/0.70/0.20 | Share of the payment for pre-op, the procedure itself, and post-op care. |
Global surgery period · 68540
Lacrimal lesion excision
90-day global period ends
Dec 30, 2026
Covers Sep 30, 2026 through Dec 30, 2026 (92 days, including the day before surgery).
Visit on Oct 31, 2026
Day 30 of the 90-day post-op period: related follow-up care is included in the surgical payment.
Pre-op dayGlobal period
What modifiers do to the payment
Modifier 50 · payment effect
With and without the modifier
68540 without 50 · national facility
$847.38
Lacrimal lesion excision
68540-50 · Bilateral: 150%
$1,271.07
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).
68540 compared with similar codes
Compare codes · National
5 codes, side by side
How to choose
- 68510Lacrimal biopsy
- 68510 represents biopsy of the lacrimal gland. Use 68540 when the surgeon excises the lesion rather than taking tissue for diagnostic sampling.
- 68500Lacrimal gland surgery
- 68500 represents removal of the lacrimal gland itself. Use 68540 for excision of a localized gland lesion without reporting whole-gland removal.
- 68505Lacrimal gland surgery
- 68505 represents partial removal of lacrimal gland tissue. Choose 68540 when the operative target is a discrete lesion rather than a portion of the gland.
- 68550Lacrimal sac lesion
- 68550 applies to lesion excision from the lacrimal sac. Code 68540 is for a lesion arising in the lacrimal gland.
68540 billing questions
How is this different from lacrimal gland biopsy?
Report 68540 when the surgeon removes the lesion. Report 68510 when the service is limited to obtaining tissue for diagnostic examination.
When would 68500 or 68505 be more appropriate?
Those codes describe removal of the lacrimal gland or part of the gland. Use 68540 for excision of a discrete lesion rather than gland removal.
Can modifier 50 be used for lesions on both sides?
Yes. CMS identifies this as a bilateral procedure; bilateral reporting with modifier 50 is paid 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.
Can an assistant or co-surgeon be reported?
Medicare does not pay an assistant at surgery for this code. Co-surgeon payment requires supporting documentation; team surgery is not permitted.
What documentation supports reporting 68540?
Document that the lesion arose from the lacrimal gland, its clinical description, and the excision performed. Clarify whether the service removed a lesion, sampled tissue, or removed gland tissue.
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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