Billing code 68550: Lacrimal sac lesionMedicare rate & RVUs in Florida
Reports surgical removal of a focal lesion involving the lacrimal sac, the tear-drainage structure at the inner corner of the eye.
CMS doesn’t publish an office rate for 68550 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 68550 covers
This service removes a focal abnormal growth involving the lacrimal sac, which collects tears near the inner corner of the eye before they drain into the nose. An ophthalmologist, often an oculoplastic surgeon, performs the operation when the lesion requires excision rather than diagnostic sampling alone. The removed tissue may be sent for pathology. The operative report should identify the affected side, the lesion’s location and extent, and what tissue was removed.
Choose this code for excision of a lesion of the lacrimal sac, not removal of the entire sac or treatment of a lesion in the lacrimal gland. Medicare assigns a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. For multiple procedures in one 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 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.
Where 68550 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 | $1,092.34 |
| Miami | Unavailable | $1,135.56 |
| Rest Of Florida | Unavailable | $1,050.57 |
How the 68550 rate is calculated
Each of 68550’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 · 68550
RVUs × geographic indexes × conversion factor
Work14.78
14.78 RVUs× 1.000 GPCI
Practice expense15.57
15.57 RVUs× 1.000 GPCI
Malpractice1.19
1.19 RVUs× 1.000 GPCI
Adjusted RVUs
31.5400
Conversion factor
$33.4009
Medicare rate
$1,053.46
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 68550
68550 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 68550
Lacrimal sac lesion
| 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) | 0 | Not permitted. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 0 | Physician service: no professional/technical split. |
| Split (54/55/56) | 0.10/0.70/0.20 | Share of the payment for pre-op, the procedure itself, and post-op care. |
Global surgery period · 68550
Lacrimal sac lesion
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
68550 without 50 · national facility
$1,053.46
Lacrimal sac lesion
68550-50 · Bilateral: 150%
$1,580.19
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).
68550 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 68520Tear sac surgery
- 68520 represents removal of the lacrimal sac itself. Use 68550 when the operation targets a focal lesion involving the sac.
- 68525Tear sac biopsy
- 68525 is for diagnostic tissue sampling from the lacrimal sac. Use 68550 when the operative intent is to excise a focal sac lesion.
- 68540Lacrimal lesion excision
- 68540 concerns a lesion of the lacrimal gland, which produces tears. Code 68550 concerns a lesion of the tear-drainage sac.
68550 billing questions
How is this different from excision of the lacrimal sac?
This code is for removing a focal lesion involving the sac. Choose the whole-sac excision code when the operation removes the lacrimal sac itself.
When would a lacrimal sac biopsy code be more appropriate?
Use the biopsy code when tissue is sampled for diagnosis without an operation intended to excise the lesion. The operative note should make the procedure’s intent and extent clear.
Can modifier 50 be used when lesions are excised on both sides?
CMS identifies this as a bilateral procedure; bilateral reporting with modifier 50 is paid at 150%. Document the work performed on each side.
Is an assistant surgeon payable for this procedure?
No. CMS lists a statutory restriction on assistant-at-surgery payment for this code. Co-surgeons and team surgery are also not permitted.
What postoperative care is included in the global period?
The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care.
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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