Billing code 68420: Lacrimal drainageMedicare rate & RVUs in Illinois
Incision and drainage of an infected lacrimal sac, typically for a localized collection associated with acute dacryocystitis.
Medicare pays $312.46–$342.55 for 68420 in the office in Illinois, from Rest Of Illinois to Suburban Chicago. Which amount applies depends on the service address.
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 68420 covers
An ophthalmologist, often an oculoplastic surgeon, makes an incision to drain purulent material from an infected or abscessed lacrimal sac, commonly in acute dacryocystitis. The target is the sac near the nose at the medial canthus, not the lacrimal gland or the punctum. The procedure may be performed in an office or facility setting, depending on the patient and clinical circumstances.
Report this service when the documented work is drainage of the lacrimal sac, rather than treatment of a blocked punctum or duct without a sac collection. The record should identify the affected side, the sac infection or collection, and the incision and drainage performed. Related postoperative visits during the 10-day global period are included. For bilateral treatment, modifier 50 is paid at 150%; when multiple procedures are performed in the same session, the highest-valued is paid in full and others at 50%. Assistant-at-surgery payment is restricted; 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 68420 pays more and less in Illinois
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
4 payment localities
$312.46 to $342.55
| Payment locality | Office | Facility |
|---|---|---|
| Chicago | $340.23 | $149.57 |
| East St. Louis | $316.91 | $142.37 |
| Rest Of Illinois | $312.46 | $139.25 |
| Suburban Chicago | $342.55 | $147.71 |
How the 68420 rate is calculated
Each of 68420’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 · 68420
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 2.29Practice expense 7.43Malpractice 0.18
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 68420
68420 has a 10-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 68420
Lacrimal drainage
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 010 | Minor procedure: the day of the procedure plus 10 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) | 0.10/0.80/0.10 | Share of the payment for pre-op, the procedure itself, and post-op care. |
Global surgery period · 68420
Lacrimal drainage
10-day global period ends
Oct 11, 2026
Covers Oct 1, 2026 through Oct 11, 2026 (11 days).
Visit on Oct 31, 2026
After the global period ends: visits and procedures are billed normally.
What modifiers do to the payment
Modifier 50 · payment effect
With and without the modifier
68420 without 50 · national office
$330.67
Lacrimal drainage
68420-50 · Bilateral: 150%
$496.01
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).
68420 compared with similar codes
Compare codes
68420 vs 68400 vs 68440 vs 68810: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 68400Lacrimal gland drainage
- Choose 68420 for drainage of the lacrimal sac and 68400 when the lacrimal gland is the structure being drained.
- 68440Punctal incision
- 68440 concerns an incision involving the lacrimal punctum; 68420 is for incision and drainage of the lacrimal sac.
- 68810Tear duct probing
- 68810 is probing of the nasolacrimal duct, whereas 68420 drains an infected or abscessed lacrimal sac.
68420 billing questions
When is 68420 appropriate instead of lacrimal punctum treatment?
Use 68420 when the service drains an infected or abscessed lacrimal sac. Treatment directed at a blocked punctum without a sac collection is a different service.
How does 68420 differ from drainage of the lacrimal gland?
The treated structure determines the code: 68420 is for the lacrimal sac, while 68400 is for the lacrimal gland.
Are postoperative visits separately reported during the global period?
Related postoperative visits during the 10-day global period are included in 68420.
How is bilateral drainage handled?
For bilateral performance, report modifier 50; CMS pays the procedure at 150%.
Can an assistant surgeon or co-surgeon be reported?
Assistant-at-surgery payment is subject to a statutory restriction. Co-surgeons and team surgery are not permitted for this code.
What happens when another procedure is performed in the same session?
Under the standard multiple procedure reduction, the highest-valued procedure is paid in full and the other procedure or procedures are paid at 50%.
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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