$510.22
This code involves fornix reconstruction with a mucous membrane graft. Code 68360 describes the related reconstruction without a graft.
On this page
CMS RVU26D · Effective 2026-10-01
68362 Fornix reconstruction Medicare reimbursement rates in Idaho
Reconstructs a shortened or scarred conjunctival fornix using a mucous membrane graft, typically when scarring prevents adequate depth between the eyelid and globe. Compare 68362 office and facility rates across CMS payment localities in Idaho.
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 68362 in Idaho?
Idaho 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
$527.27
1 of 1 localities have a supported rate.
Payment area: Idaho
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 68362: Conjunctival fornix reconstruction with graft
Reconstructs a shortened or scarred conjunctival fornix using a mucous membrane graft, typically when scarring prevents adequate depth between the eyelid and globe.
An ophthalmic surgeon, often an oculoplastic specialist, uses this procedure to restore the conjunctival fornix—the pocket between the eyelid and the eye—when scarring has shortened or distorted it. The operation involves releasing or addressing scarred tissue and using a mucous membrane graft to rebuild the lining and help restore fornix depth. It is generally performed in an operating room for cicatricial changes such as severe conjunctival scarring or symblepharon that compromise the fornix.
Report the code when the service includes fornix reconstruction with a mucous membrane graft, rather than a reconstruction without graft or a more limited adhesion-release procedure. The operative report should identify the affected eye, the scarring and loss of fornix depth, the reconstruction performed, and the graft used. Medicare applies a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. For same-session procedures, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% multiple-procedure reduction. Bilateral reporting with modifier 50 is paid at 150%. Assistant-at-surgery payment is restricted; co-surgeon payment requires supporting documentation, and team surgery is not permitted.
CMS billing rules for 68362
- Global period
- Major surgery with a 90-day global period: the day-before preoperative visit and 90 days of related postoperative care are 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 RVU8.39 · 50%
- Practice expense (office) RVU7.70 · 46%
- Malpractice RVU0.66 · 4%
182
Medicare services in 2024 · #4413 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.
68362 compared with similar codes
Office rates for Idaho, from the same CMS release.
No office rate
Code 68335 is for symblepharon repair with graft. Choose 68362 when the documented operation reconstructs the conjunctival fornix with a mucous membrane graft.
$575.58
Code 68340 describes severing adhesions between the conjunctiva and eyelid. It does not describe graft-based reconstruction of the fornix.
Compare 68362 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
Idaho →
Office / nonfacility
Unavailable
Facility
$527.27
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 68362 in Idaho.
PPRRVU2026_Oct_nonQPP.csv
7,549
- Code
- 68362
- Physician work
- 8.39
- Practice expense
- 7.70
- Malpractice
- 0.66
GPCI2026.csv
47
- Locality
- Idaho
- Physician work
- 1.000
- Practice expense
- 0.920
- Malpractice
- 0.473
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 8.39 | × 1.000 | 8.3900 |
| Practice expense | 7.70 | × 0.920 | 7.0840 |
| Malpractice | 0.66 | × 0.473 | 0.3122 |
| Total RVUs | 15.7862 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Idaho$527.27
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 8.39 | 1 |
| Practice expense | 7.7 | 0.92 |
| Malpractice | 0.66 | 0.473 |
(8.39 × 1 + 7.7 × 0.92 + 0.66 × 0.473) × $33.4009 = $527.27
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.
68362 billing questions
How does this differ from 68360?
68362 is for fornix reconstruction using a mucous membrane graft. Use 68360 for the related fornix reconstruction without a graft.
When is a symblepharon repair code a better fit?
Codes 68330 and 68335 describe repair of symblepharon, without and with graft, respectively. Choose based on the operation performed; use 68362 when the service is reconstruction of the conjunctival fornix with a mucous membrane graft.
What should the operative report document?
Document the eye treated, the scarring and fornix shortening, the reconstructive work, and the mucous membrane graft. These details distinguish graft-based fornix reconstruction from adhesion release or reconstruction without graft.
How are bilateral procedures reported?
For bilateral performance, modifier 50 applies, and CMS pays the procedure at 150% under the supplied fee schedule rule.
Can an assistant or co-surgeon be paid?
Assistant-at-surgery payment is restricted for this code. Co-surgeon payment is available only with supporting documentation; team surgery is not permitted.
What postoperative care is included?
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 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.
7,54668335,,Revise/graft eyelid lining,A,,8.25,7.65,NA,7.65,,0.67,16.57,16.57,0,090,0.10,0.70,0.20,2,1,1,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,54768340,,Separate eyelid adhesions,A,,4.85,13.12,,5.16,,0.66,18.63,10.67,0,090,0.10,0.70,0.20,2,1,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,54868360,,Revise eyelid lining,A,,5.04,10.92,,5.19,,0.40,16.36,10.63,0,090,0.10,0.70,0.20,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,54968362,,Revise eyelid lining,A,,8.39,7.70,NA,7.70,,0.66,16.75,16.75,0,090,0.10,0.70,0.20,2,1,1,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,55068371,,Harvest eye tissue alograft,A,,4.96,5.38,NA,5.38,,0.40,10.74,10.74,0,010,0.10,0.80,0.10,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,55168399,,Unlisted px conjunctiva,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
7,55268400,,I&d lacrimal gland,A,,1.70,7.02,,1.54,,0.14,8.86,3.38,0,010,0.10,0.80,0.10,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4410212,GA,01,ATLANTA,1.003,1.016,1.201
4510212,GA,99,REST OF GEORGIA,1.000,0.892,1.192
4601212,HI,01,"HAWAII, GUAM",1.000,1.137,0.579
4702202,ID,00,IDAHO,1.000,0.920,0.473
4806102,IL,16,CHICAGO,1.007,1.005,2.295
4906102,IL,12,EAST ST. LOUIS,1.000,0.920,2.014
5006102,IL,15,SUBURBAN CHICAGO,1.007,1.027,1.772