$305.95
Choose 68400 for a collection in the lacrimal gland and 68420 for a collection in the lacrimal sac. The documented anatomic site determines the code.
On this page
CMS RVU26D · Effective 2026-10-01
68400 Lacrimal gland drainage Medicare reimbursement rates in Iowa
Reports surgical drainage of an infected collection in the lacrimal gland, typically performed by an ophthalmologist for a gland abscess. Compare 68400 office and facility rates across CMS payment localities in Iowa.
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 68400 in Iowa?
Iowa 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
$273.18
1 of 1 localities have a supported rate.
Payment area: Iowa
One mapped payment locality.
Facility setting
$105.70
1 of 1 localities have a supported rate.
Payment area: Iowa
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 68400: Lacrimal gland abscess drainage
Reports surgical drainage of an infected collection in the lacrimal gland, typically performed by an ophthalmologist for a gland abscess.
An ophthalmologist, often an oculoplastic surgeon, uses this service to open and drain a collection within the lacrimal gland, such as an abscess associated with acute dacryoadenitis. The procedure addresses the gland itself, which sits in the upper outer part of the orbit; it is not drainage of the lacrimal sac or treatment of a narrowed punctum. It may be performed in an office or a facility, depending on the clinical circumstances and surgical setting.
Report the code when the operative documentation supports incision and drainage of the lacrimal gland, rather than treatment of another lacrimal structure. The 10-day global period includes related postoperative visits during that period. When other procedures are performed in the same session, Medicare pays the highest-valued procedure in full and reduces the others to 50%. For bilateral gland drainage, modifier 50 is paid at 150%. Medicare does not pay an assistant at surgery for this service; co-surgeons and team surgery are not permitted.
CMS billing rules for 68400
- 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 RVU1.70 · 19%
- Practice expense (office) RVU7.02 · 79%
- Malpractice RVU0.14 · 2%
44
Medicare services in 2024 · #5441 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.
68400 compared with similar codes
Office rates for Iowa, from the same CMS release.
Compare 68400 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
Iowa →
Office / nonfacility
$273.18
Facility
$105.70
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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 68400 in Iowa.
PPRRVU2026_Oct_nonQPP.csv
7,552
- Code
- 68400
- Physician work
- 1.70
- Practice expense
- 7.02
- Malpractice
- 0.14
GPCI2026.csv
53
- Locality
- Iowa
- Physician work
- 1.000
- Practice expense
- 0.915
- Malpractice
- 0.397
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 1.70 | × 1.000 | 1.7000 |
| Practice expense | 7.02 | × 0.915 | 6.4233 |
| Malpractice | 0.14 | × 0.397 | 0.0556 |
| Total RVUs | 8.1789 | ||
| Conversion factor | × 33.4009 | ||
Office / nonfacility rate, Iowa$273.18
Explore RVUs, geographic factors and the full formula
Office / nonfacility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 1.7 | 1 |
| Practice expense | 7.02 | 0.915 |
| Malpractice | 0.14 | 0.397 |
(1.7 × 1 + 7.02 × 0.915 + 0.14 × 0.397) × $33.4009 = $273.18
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 1.7 | 1 |
| Practice expense | 1.54 | 0.915 |
| Malpractice | 0.14 | 0.397 |
(1.7 × 1 + 1.54 × 0.915 + 0.14 × 0.397) × $33.4009 = $105.70
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.
68400 billing questions
How is this different from 68420?
68400 is for drainage of the lacrimal gland. Use 68420 when the incision and drainage is of the lacrimal sac instead.
Does the 10-day global period include postoperative visits?
Yes. Related postoperative visits during the 10 days after the procedure are included.
How is bilateral lacrimal gland drainage reported?
Use modifier 50 when both glands are treated. CMS pays the bilateral procedure at 150%.
Can an assistant surgeon or co-surgeon be reported?
Medicare does not pay an assistant at surgery for this code. Co-surgeons and team surgery are not permitted.
What documentation supports reporting this code?
Document the lacrimal gland as the treated site and describe the incision and drainage performed. The record should distinguish gland drainage from treatment of the lacrimal sac or punctum.
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.
7,54968362,,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
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
5006102,IL,15,SUBURBAN CHICAGO,1.007,1.027,1.772
5106102,IL,99,REST OF ILLINOIS,1.000,0.913,1.563
5208102,IN,00,INDIANA,1.000,0.927,0.486
5305102,IA,00,IOWA,1.000,0.915,0.397
5405202,KS,00,KANSAS,1.000,0.904,0.504
5515102,KY,00,KENTUCKY,1.000,0.889,0.915
5607202,LA,01,NEW ORLEANS,1.000,0.941,1.136