$699.62–$736.27
68320 is the related reconstruction approach without a graft. Use 68328 when the documented procedure includes graft-based lining reconstruction.
On this page
CMS RVU26D · Effective 2026-10-01
68328 Eyelid lining repair Medicare reimbursement rates in Maine
Reconstructs the conjunctival lining of the eyelid or fornix with a graft, typically to address scarring and tissue loss that impair eyelid function. Compare 68328 office and facility rates across CMS payment localities in Maine.
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 68328 in Maine?
Maine has 2 payment localities in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the 2 payment areas shown below, using the same CMS release.
Office / nonfacility
No supported rate
Facility setting
$568.31–$587.48
2 of 2 localities have a supported rate.
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 68328: Conjunctival lining reconstruction with graft
Reconstructs the conjunctival lining of the eyelid or fornix with a graft, typically to address scarring and tissue loss that impair eyelid function.
An ophthalmologist, often an oculoplastic or ocular surface surgeon, uses a graft to rebuild damaged conjunctival lining and restore the eyelid’s inner surface or fornix. Common situations include cicatricial contraction after trauma, burns, prior surgery, or chronic inflammation, when scarring or tissue loss limits eyelid movement or ocular surface protection. These reconstructions are generally performed in an operating-room setting.
Select this code when the operative service includes graft-based reconstruction of the eyelid lining; document the affected anatomy, the reason reconstruction is needed, and the graft used. The day-before preoperative visit and 90 days of related postoperative care are included in the global period. When multiple procedures are performed in the same session, the highest-valued procedure is paid in full and the others are subject to a 50% reduction. Bilateral reporting with modifier 50 is paid at 150%. Assistant-at-surgery payment requires documentation of medical necessity; co-surgeons and team surgery are not permitted.
CMS billing rules for 68328
- 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 RVU9.21 · 51%
- Practice expense (office) RVU7.99 · 45%
- Malpractice RVU0.73 · 4%
65
Medicare services in 2024 · #5191 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.
68328 compared with similar codes
Office rates for Maine, from the same CMS release.
No office rate
Both are related cul-de-sac reconstruction codes, but the appropriate code depends on the graft type or technique documented for the procedure.
No office rate
This is a related graft-reconstruction code with a distinction based on graft type or technique; follow the operative details when choosing between it and 68328.
No office rate
68335 is directed to graft repair of symblepharon. Choose 68328 when the documented service is graft reconstruction of the eyelid lining rather than that symblepharon repair.
Compare 68328 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.
2 of 2 payment localities
Rest Of Maine →
Office / nonfacility
Unavailable
Facility
$568.31
Southern Maine →
Office / nonfacility
Unavailable
Facility
$587.48
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68328 billing questions
How does 68328 differ from 68320?
68328 describes reconstruction using a graft. 68320 is a related reconstruction code without a graft; the operative report should establish which approach was performed.
How do I choose between 68328 and 68325 or 68326?
These are related reconstruction codes with distinctions tied to graft type or technique. Use the code that matches the documented graft and procedure rather than choosing by diagnosis alone.
What documentation supports 68328?
Document the eyelid or fornix anatomy reconstructed, the scarring or tissue loss prompting surgery, the reconstruction performed, and the graft used.
How is bilateral 68328 reported?
When the procedure is performed bilaterally, report modifier 50; CMS pays the bilateral procedure at 150%.
Can an assistant surgeon be reported?
Assistant-at-surgery payment is available only when medical necessity is documented. CMS does not permit co-surgeon or team-surgery payment for this code.
What happens when 68328 is performed with another procedure in the same session?
Under the standard multiple procedure reduction, the highest-valued procedure is paid in full and the other 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 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.
7,54168320,,Revise/graft eyelid lining,A,,6.47,15.39,,7.04,,0.51,22.37,14.02,0,090,0.10,0.70,0.20,2,1,1,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,54268325,,Revise/graft eyelid lining,A,,8.41,7.71,NA,7.71,,0.66,16.78,16.78,0,090,0.10,0.70,0.20,2,1,1,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,54368326,,Revise/graft eyelid lining,A,,8.21,7.65,NA,7.65,,0.67,16.53,16.53,0,090,0.10,0.70,0.20,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,54468328,,Revise/graft eyelid lining,A,,9.21,7.99,NA,7.99,,0.73,17.93,17.93,0,090,0.10,0.70,0.20,2,1,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,54568330,,Revise eyelid lining,A,,5.64,12.60,,5.82,,0.44,18.68,11.90,0,090,0.10,0.70,0.20,2,1,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,54668335,,Revise/graft eyelid lining,A,,8.25,7.65,NA,7.65,,0.67,16.57,16.57,0,090,0.10,0.70,0.20,2,1,1,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,54768340,,Separate eyelid adhesions,A,,4.85,13.12,,5.16,,0.66,18.63,10.67,0,090,0.10,0.70,0.20,2,1,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00