$150.02
Choose 68801 for dilation of a stenotic punctum. Choose 68810 when the documented service probes the nasolacrimal duct.
On this page
CMS RVU26D · Effective 2026-10-01
68801 Punctum dilation Medicare reimbursement rates in Idaho
Reports dilation of a narrowed lacrimal punctum, with or without irrigation, to improve tear drainage through the opening. Compare 68801 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 68801 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
$88.35
1 of 1 localities have a supported rate.
Payment area: Idaho
One mapped payment locality.
Facility setting
$67.46
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 68801: Lacrimal punctum dilation
Reports dilation of a narrowed lacrimal punctum, with or without irrigation, to improve tear drainage through the opening.
An ophthalmologist or other qualified eye-care practitioner dilates a narrowed lacrimal punctum, the small opening at the eyelid margin that drains tears. The service may include irrigation through the opened punctum. It is typically performed in an office or outpatient setting when punctal narrowing interferes with tear drainage; it addresses the punctal opening rather than probing the downstream canaliculus or nasolacrimal duct.
Report 68801 when the documented service is dilation of the punctum, and record the affected side, the narrowing treated, and whether irrigation was performed. Irrigation is included in this code. CMS assigns a 10-day global period, so related postoperative visits during that period are included. For bilateral treatment, modifier 50 is paid at 150%. When multiple procedures are performed in the same session, the highest-valued procedure is paid in full and the others at 50%. Medicare does not pay an assistant at surgery for this service; co-surgeons and team surgery are not permitted.
CMS billing rules for 68801
- 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 RVU0.80 · 28%
- Practice expense (office) RVU1.98 · 70%
- Malpractice RVU0.05 · 2%
16K
Medicare services in 2024 · #1235 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.
68801 compared with similar codes
Office rates for Idaho, from the same CMS release.
$125.58
68840 involves probing the lacrimal canaliculi. 68801 is specific to dilation of the punctal opening.
$768.24
68816 describes balloon catheter dilation of the nasolacrimal duct with probing. 68801 treats narrowing at the punctum.
Compare 68801 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
$88.35
Facility
$67.46
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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 68801 in Idaho.
PPRRVU2026_Oct_nonQPP.csv
7,571
- Code
- 68801
- Physician work
- 0.80
- Practice expense
- 1.98
- Malpractice
- 0.05
GPCI2026.csv
47
- Locality
- Idaho
- Physician work
- 1.000
- Practice expense
- 0.920
- Malpractice
- 0.473
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 0.80 | × 1.000 | 0.8000 |
| Practice expense | 1.98 | × 0.920 | 1.8216 |
| Malpractice | 0.05 | × 0.473 | 0.0237 |
| Total RVUs | 2.6452 | ||
| Conversion factor | × 33.4009 | ||
Office / nonfacility rate, Idaho$88.35
Explore RVUs, geographic factors and the full formula
Office / nonfacility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 0.8 | 1 |
| Practice expense | 1.98 | 0.92 |
| Malpractice | 0.05 | 0.473 |
(0.8 × 1 + 1.98 × 0.92 + 0.05 × 0.473) × $33.4009 = $88.35
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 0.8 | 1 |
| Practice expense | 1.3 | 0.92 |
| Malpractice | 0.05 | 0.473 |
(0.8 × 1 + 1.3 × 0.92 + 0.05 × 0.473) × $33.4009 = $67.46
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.
68801 billing questions
When should 68801 be chosen instead of 68810?
Use 68801 when the treated structure is a narrowed lacrimal punctum. Code 68810 describes probing the nasolacrimal duct, a different part of the tear drainage pathway.
Is irrigation separately reportable with 68801?
No. Irrigation performed with punctal dilation is included in 68801.
How is bilateral punctal dilation reported?
CMS identifies 68801 as a bilateral procedure; modifier 50 is paid at 150% when both sides are treated.
Are related postoperative visits included?
Yes. Related postoperative visits during the 10-day global period are included in the procedure.
Can an assistant or co-surgeon be paid for 68801?
Medicare does not pay an assistant at surgery for this code, and 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 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.
7,56868760,,Close tear duct opening,A,,1.74,4.69,,1.94,,0.14,6.57,3.82,0,010,0.10,0.80,0.10,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,56968761,,Close tear duct opening,A,,1.37,2.85,,1.66,,0.07,4.29,3.10,0,010,0.10,0.80,0.10,2,1,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,57068770,,Close tear system fistula,A,,8.08,7.31,NA,7.31,,0.64,16.03,16.03,0,090,0.10,0.70,0.20,2,1,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,57168801,,Dilate tear duct opening,A,,0.80,1.98,,1.30,,0.05,2.83,2.15,0,010,0.10,0.80,0.10,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,57268810,,Probe nasolacrimal duct,A,,1.50,3.19,,1.74,,0.12,4.81,3.36,0,010,0.10,0.80,0.10,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,57368811,,Probe nasolacrimal duct,A,,1.70,1.67,NA,1.67,,0.15,3.52,3.52,0,010,0.10,0.80,0.10,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,57468815,,Probe nasolacrimal duct,A,,2.63,8.33,,2.94,,0.21,11.17,5.78,0,010,0.10,0.80,0.10,2,1,1,0,0,9,,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