$88.35
Choose 68440 when the punctum is enlarged by incision; choose 68801 when the punctum is dilated, with or without irrigation.
On this page
CMS RVU26D · Effective 2026-10-01
68440 Punctal incision Medicare reimbursement rates in Idaho
An ophthalmologist enlarges a narrowed lacrimal punctum with a snip incision, typically to improve tear drainage when punctal stenosis is treated surgically. Compare 68440 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 68440 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
$99.26
1 of 1 localities have a supported rate.
Payment area: Idaho
One mapped payment locality.
Facility setting
$85.13
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.
Ophthalmology procedure
About 68440: Lacrimal punctum snip incision
An ophthalmologist enlarges a narrowed lacrimal punctum with a snip incision, typically to improve tear drainage when punctal stenosis is treated surgically.
This procedure enlarges a narrowed opening of the eyelid’s lacrimal drainage system with a snip incision, often as a punctoplasty for punctal stenosis associated with tearing. Ophthalmologists, including oculoplastic surgeons, typically perform it in an office or outpatient surgical setting. The service addresses the punctum itself; it is distinct from probing or treating a blockage farther along the canaliculus or nasolacrimal duct.
Report the code for the punctal incision service performed, with documentation identifying the treated eye and the stenosis or drainage problem addressed. Record laterality and whether one or both puncta were treated. CMS assigns a 10-day global period, so related postoperative visits during that period are included. When multiple procedures are performed in one session, CMS pays the highest-valued procedure in full and the others at 50%. For bilateral reporting with modifier 50, CMS pays 150%. CMS does not pay an assistant at surgery for this code; co-surgeons and team surgery are not permitted.
CMS billing rules for 68440
- Global period
- Minor procedure with a 10-day global period: related postoperative visits for 10 days 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 not permitted.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU0.97 · 31%
- Practice expense (office) RVU2.14 · 67%
- Malpractice RVU0.07 · 2%
7.4K
Medicare services in 2024 · #1625 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.
68440 compared with similar codes
Office rates for Idaho, from the same CMS release.
$242.04
Code 68705 addresses punctal ectropion by thermocauterization. Code 68440 describes snip incision to enlarge the punctal opening.
$150.02
Code 68810 is for probing the nasolacrimal duct. Code 68440 treats narrowing at the punctum itself.
Compare 68440 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
$99.26
Facility
$85.13
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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 68440 in Idaho.
PPRRVU2026_Oct_nonQPP.csv
7,554
- Code
- 68440
- Physician work
- 0.97
- Practice expense
- 2.14
- Malpractice
- 0.07
GPCI2026.csv
47
- Locality
- Idaho
- Physician work
- 1.000
- Practice expense
- 0.920
- Malpractice
- 0.473
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 0.97 | × 1.000 | 0.9700 |
| Practice expense | 2.14 | × 0.920 | 1.9688 |
| Malpractice | 0.07 | × 0.473 | 0.0331 |
| Total RVUs | 2.9719 | ||
| Conversion factor | × 33.4009 | ||
Office / nonfacility rate, Idaho$99.26
Explore RVUs, geographic factors and the full formula
Office / nonfacility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 0.97 | 1 |
| Practice expense | 2.14 | 0.92 |
| Malpractice | 0.07 | 0.473 |
(0.97 × 1 + 2.14 × 0.92 + 0.07 × 0.473) × $33.4009 = $99.26
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 0.97 | 1 |
| Practice expense | 1.68 | 0.92 |
| Malpractice | 0.07 | 0.473 |
(0.97 × 1 + 1.68 × 0.92 + 0.07 × 0.473) × $33.4009 = $85.13
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.
68440 billing questions
When is this code appropriate instead of punctal dilation?
Use 68440 when the punctum is enlarged by snip incision. Punctal dilation, with or without irrigation, is described by 68801.
What should the operative note document?
Document the punctal stenosis or drainage problem, the eye treated, and the snip incision performed. Identify whether treatment was unilateral or bilateral.
Are related postoperative visits separately reported?
Related postoperative visits during the 10-day global period are included in the procedure’s payment.
How is bilateral treatment reported under the CMS facts?
Report bilateral treatment with modifier 50; CMS pays the bilateral procedure at 150%.
How does CMS handle other procedures performed in the same session?
The highest-valued procedure is paid in full, and other procedures are paid at 50%. CMS does not pay an assistant at surgery for 68440 and does not permit co-surgeons or team surgery.
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.
7,55168399,,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
7,55368420,,I&d lacrimal sac,A,,2.29,7.43,,1.75,,0.18,9.90,4.22,0,010,0.10,0.80,0.10,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,55468440,,Snip inc lacrimal punctum,A,,0.97,2.14,,1.68,,0.07,3.18,2.72,0,010,0.10,0.80,0.10,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,55568500,,Removal of tear gland,A,,12.45,14.12,NA,14.12,,1.01,27.58,27.58,0,090,0.10,0.70,0.20,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,55668505,,Partial removal tear gland,A,,12.37,14.10,NA,14.10,,1.00,27.47,27.47,0,090,0.10,0.70,0.20,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,55768510,,Biopsy of tear gland,A,,4.49,8.65,,2.18,,0.36,13.50,7.03,0,000,0.00,0.00,0.00,2,1,0,0,0,9,,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