Billing code 69646: Ear revision surgeryMedicare rate & RVUs in Missouri
Revision surgery involving the middle ear and mastoid is reported when an otolaryngologist reoperates on previously treated ear disease or surgical anatomy.
CMS doesn’t publish an office rate for 69646 in Missouri.
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 69646 covers
billing code 69646 represents revision surgery involving the middle ear and mastoid, typically performed by an otolaryngologist or neurotologist in an operating room. The surgeon re-enters previously operated ear anatomy to address a persistent or recurrent problem, such as disease in a mastoid cavity or a failed prior middle-ear repair. The operative report should establish the prior surgery and describe the structures revised and the work performed; the diagnosis alone does not establish this code.
Report the code for the revision procedure actually performed, distinguishing it from a primary tympanoplasty or a mastoidectomy with a different documented result. This major surgery has a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. When multiple procedures are performed in one session, the highest-valued procedure is paid in full and the others at 50%. For bilateral surgery, modifier 50 is paid at 150%. An assistant is paid only when medical necessity is documented. CMS does not permit co-surgeons or team surgery for this code.
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 69646 pays more and less in Missouri
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
| Payment locality | Office | Facility |
|---|---|---|
| Metropolitan Kansas City | Unavailable | $1,383.88 |
| Metropolitan St. Louis | Unavailable | $1,395.80 |
| Rest Of Missouri | Unavailable | $1,326.48 |
How the 69646 rate is calculated
Each of 69646’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 · 69646
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 17.91Practice expense 22.21Malpractice 2.73
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 69646
69646 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 69646
Ear revision surgery
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 090 | Major surgery: the day before, the day of, and 90 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) | 0 | Not paid without supporting documentation. |
| 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) | 0.07/0.79/0.14 | Share of the payment for pre-op, the procedure itself, and post-op care. |
Global surgery period · 69646
Ear revision surgery
90-day global period ends
Dec 30, 2026
Covers Sep 30, 2026 through Dec 30, 2026 (92 days, including the day before surgery).
Visit on Oct 31, 2026
Day 30 of the 90-day post-op period: related follow-up care is included in the surgical payment.
Pre-op dayGlobal period
What modifiers do to the payment
Modifier 50 · payment effect
With and without the modifier
69646 without 50 · national facility
$1,431.23
Ear revision surgery
69646-50 · Bilateral: 150%
$2,146.85
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).
69646 compared with similar codes
Compare codes
69646 vs 69602 vs 69603 vs 69604 vs 69635: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 69602Mastoid revision
- This code is used for a revision mastoidectomy with the result specified by its descriptor. Compare that result with the middle-ear and mastoid revision documented for 69646.
- 69603Mastoid revision
- Choose 69603 when the operative result matches its radical mastoidectomy descriptor; 69646 is selected for its own documented revision procedure.
- 69604Mastoid revision
- 69604 describes revision mastoidectomy resulting in tympanoplasty. Use 69646 only when the documented operation meets its distinct descriptor.
- 69635Tympanoplasty
- 69635 is a tympanoplasty with mastoidectomy code, rather than a general choice for revision work. Base selection on whether the operation is primary or revision and on the full procedure performed.
69646 billing questions
How is 69646 distinguished from a primary tympanoplasty?
Use 69646 for the documented revision involving previously operated middle-ear and mastoid anatomy. A primary tympanoplasty code describes a different operative circumstance; the operative report should support the revision work.
Can a separate mastoidectomy code also be reported?
Do not infer a separately reportable mastoidectomy from the fact that the revision involves the mastoid. Review the complete operative work and applicable billing code instructions before separately reporting another procedure.
What documentation supports reporting 69646?
Document the relevant prior ear surgery, the indication for reoperation, the middle-ear and mastoid anatomy addressed, and the specific revision performed.
How should bilateral surgery be reported?
For bilateral procedures, CMS pays this code at 150% when reported with modifier 50.
How does the global period affect postoperative visits?
The 90-day global includes the day-before preoperative visit and related postoperative care during the following 90 days.
Can an assistant or co-surgeon be billed?
An assistant at surgery is payable only with documentation of medical necessity. CMS does not permit co-surgeons or team surgery for this code.
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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