No office rate
68520 represents removal of the lacrimal sac itself. Use 68550 when the operation targets a focal lesion involving the sac.
On this page
CMS RVU26D · Effective 2026-10-01
68550 Lacrimal sac lesion Medicare reimbursement rates in Kansas
Reports surgical removal of a focal lesion involving the lacrimal sac, the tear-drainage structure at the inner corner of the eye. Compare 68550 office and facility rates across CMS payment localities in Kansas.
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 68550 in Kansas?
Kansas 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
$983.82
1 of 1 localities have a supported rate.
Payment area: Kansas
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 68550: Excision of a lacrimal sac lesion
Reports surgical removal of a focal lesion involving the lacrimal sac, the tear-drainage structure at the inner corner of the eye.
This service removes a focal abnormal growth involving the lacrimal sac, which collects tears near the inner corner of the eye before they drain into the nose. An ophthalmologist, often an oculoplastic surgeon, performs the operation when the lesion requires excision rather than diagnostic sampling alone. The removed tissue may be sent for pathology. The operative report should identify the affected side, the lesion’s location and extent, and what tissue was removed.
Choose this code for excision of a lesion of the lacrimal sac, not removal of the entire sac or treatment of a lesion in the lacrimal gland. Medicare assigns a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. For multiple procedures in one session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% reduction. Bilateral reporting with modifier 50 is paid at 150%. Medicare does not pay an assistant at surgery; co-surgeons and team surgery are not permitted.
CMS billing rules for 68550
- 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 not permitted.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU14.78 · 47%
- Practice expense (office) RVU15.57 · 49%
- Malpractice RVU1.19 · 4%
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.
68550 compared with similar codes
Office rates for Kansas, from the same CMS release.
No office rate
68525 is for diagnostic tissue sampling from the lacrimal sac. Use 68550 when the operative intent is to excise a focal sac lesion.
No office rate
68540 concerns a lesion of the lacrimal gland, which produces tears. Code 68550 concerns a lesion of the tear-drainage sac.
Compare 68550 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
Kansas →
Office / nonfacility
Unavailable
Facility
$983.82
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 68550 in Kansas.
PPRRVU2026_Oct_nonQPP.csv
7,562
- Code
- 68550
- Physician work
- 14.78
- Practice expense
- 15.57
- Malpractice
- 1.19
GPCI2026.csv
54
- Locality
- Kansas
- Physician work
- 1.000
- Practice expense
- 0.904
- Malpractice
- 0.504
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 14.78 | × 1.000 | 14.7800 |
| Practice expense | 15.57 | × 0.904 | 14.0753 |
| Malpractice | 1.19 | × 0.504 | 0.5998 |
| Total RVUs | 29.4550 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Kansas$983.82
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 14.78 | 1 |
| Practice expense | 15.57 | 0.904 |
| Malpractice | 1.19 | 0.504 |
(14.78 × 1 + 15.57 × 0.904 + 1.19 × 0.504) × $33.4009 = $983.82
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.
68550 billing questions
How is this different from excision of the lacrimal sac?
This code is for removing a focal lesion involving the sac. Choose the whole-sac excision code when the operation removes the lacrimal sac itself.
When would a lacrimal sac biopsy code be more appropriate?
Use the biopsy code when tissue is sampled for diagnosis without an operation intended to excise the lesion. The operative note should make the procedure’s intent and extent clear.
Can modifier 50 be used when lesions are excised on both sides?
CMS identifies this as a bilateral procedure; bilateral reporting with modifier 50 is paid at 150%. Document the work performed on each side.
Is an assistant surgeon payable for this procedure?
No. CMS lists a statutory restriction on assistant-at-surgery payment for this code. Co-surgeons and team surgery are also not permitted.
What postoperative care is included in the global period?
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.
7,55968525,,Biopsy of tear sac,A,,4.31,1.51,NA,1.51,,0.36,6.18,6.18,0,000,0.00,0.00,0.00,2,1,1,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,56068530,,Clearance of tear duct,A,,3.61,9.09,,2.48,,0.28,12.98,6.37,0,010,0.10,0.80,0.10,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,56168540,,Remove tear gland lesion,A,,11.88,12.54,NA,12.54,,0.95,25.37,25.37,0,090,0.10,0.70,0.20,2,1,1,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,56268550,,Remove tear gland lesion,A,,14.78,15.57,NA,15.57,,1.19,31.54,31.54,0,090,0.10,0.70,0.20,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,56368700,,Repair tear ducts,A,,7.67,7.17,NA,7.17,,0.62,15.46,15.46,0,090,0.10,0.70,0.20,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,56468705,,Revise tear duct opening,A,,2.06,5.55,,2.06,,0.17,7.78,4.29,0,010,0.10,0.80,0.10,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,56568720,,Create tear sac drain,A,,9.71,10.51,NA,10.51,,0.82,21.04,21.04,0,090,0.10,0.70,0.20,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
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
5707202,LA,99,REST OF LOUISIANA,1.000,0.885,0.958