No office rate
Choose this code when the lacrimal sac is removed. Use 68720 when the operation establishes a drainage bypass and retains the sac.
On this page
CMS RVU26D · Effective 2026-10-01
68520 Tear sac surgery Medicare reimbursement rates in Kentucky
Reports surgical removal of the lacrimal sac, typically for selected cases of chronic or recurrent sac disease requiring excision rather than drainage bypass. Compare 68520 office and facility rates across CMS payment localities in Kentucky.
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 68520 in Kentucky?
Kentucky 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
$604.54
1 of 1 localities have a supported rate.
Payment area: Kentucky
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 68520: Lacrimal sac excision
Reports surgical removal of the lacrimal sac, typically for selected cases of chronic or recurrent sac disease requiring excision rather than drainage bypass.
An ophthalmologist, often an oculoplastic surgeon, removes the lacrimal sac. This operation may be selected for chronic or recurrent dacryocystitis or other sac disease when removing the sac is the planned treatment. It is distinct from creating a new drainage route while preserving the sac. The procedure is generally performed in an operative setting, and the operative report should identify the affected side, the sac condition, and the extent of excision.
Report the code for the sac excision itself, not for a lacrimal gland procedure or a limited diagnostic sample. Documentation should support why the sac was removed and describe the work performed. The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care. For bilateral surgery, modifier 50 is paid at 150%. When other procedures are performed in the same session, the highest-valued procedure is paid in full and additional procedures are subject to the standard 50% multiple-procedure reduction. Assistant-at-surgery payment requires documented medical necessity; co-surgeons and team surgery are not permitted.
CMS billing rules for 68520
- 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
- Assistant at surgery is paid only with documentation of medical necessity.
- Co-surgeons
- Co-surgeons not permitted.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU8.56 · 44%
- Practice expense (office) RVU10.00 · 52%
- Malpractice RVU0.71 · 4%
165
Medicare services in 2024 · #4492 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.
68520 compared with similar codes
Office rates for Kentucky, from the same CMS release.
No office rate
68525 represents a diagnostic tissue sample from the lacrimal sac; this code is for removal of the sac, not biopsy alone.
No office rate
68500 concerns the lacrimal gland, which produces tears. This code concerns the lacrimal sac in the tear-drainage system.
Compare 68520 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
Kentucky →
Office / nonfacility
Unavailable
Facility
$604.54
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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 68520 in Kentucky.
PPRRVU2026_Oct_nonQPP.csv
7,558
- Code
- 68520
- Physician work
- 8.56
- Practice expense
- 10.00
- Malpractice
- 0.71
GPCI2026.csv
55
- Locality
- Kentucky
- Physician work
- 1.000
- Practice expense
- 0.889
- Malpractice
- 0.915
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 8.56 | × 1.000 | 8.5600 |
| Practice expense | 10.00 | × 0.889 | 8.8900 |
| Malpractice | 0.71 | × 0.915 | 0.6496 |
| Total RVUs | 18.0997 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Kentucky$604.54
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 8.56 | 1 |
| Practice expense | 10 | 0.889 |
| Malpractice | 0.71 | 0.915 |
(8.56 × 1 + 10 × 0.889 + 0.71 × 0.915) × $33.4009 = $604.54
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.
68520 billing questions
How does sac removal differ from a dacryocystorhinostomy?
This code represents removal of the lacrimal sac. A dacryocystorhinostomy creates a drainage bypass while retaining the sac.
Can a sac biopsy be reported with the excision?
A separate biopsy code is generally for sampling when the sac is not being removed. The operative documentation should support the distinct work if both procedures are reported.
How is bilateral sac removal reported?
Report bilateral surgery with modifier 50; CMS pays the bilateral procedure at 150%.
What postoperative care is included?
The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care.
May an assistant or co-surgeon be reported?
Assistant-at-surgery payment requires documentation of medical necessity. 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.
7,55568500,,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
7,55868520,,Removal of tear sac,A,,8.56,10.00,NA,10.00,,0.71,19.27,19.27,0,090,0.10,0.70,0.20,2,1,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,55968525,,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
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
5814112,ME,03,SOUTHERN MAINE,1.000,0.991,0.631