Billing code 68440: Punctal incisionMedicare rate & RVUs in Ohio
An ophthalmologist enlarges a narrowed lacrimal punctum with a snip incision, typically to improve tear drainage when punctal stenosis is treated surgically.
Medicare pays $100.01 for 68440 in the office in Ohio (Ohio). Which amount applies depends on the service address.
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 68440 covers
This procedure enlarges a narrowed opening of the eyelid’s lacrimal drainage system with a snip incision, often as a punctoplasty for punctal stenosis associated with tearing. Ophthalmologists, including oculoplastic surgeons, typically perform it in an office or outpatient surgical setting. The service addresses the punctum itself; it is distinct from probing or treating a blockage farther along the canaliculus or nasolacrimal duct.
Report the code for the punctal incision service performed, with documentation identifying the treated eye and the stenosis or drainage problem addressed. Record laterality and whether one or both puncta were treated. CMS assigns a 10-day global period, so related postoperative visits during that period are included. When multiple procedures are performed in one session, CMS pays the highest-valued procedure in full and the others at 50%. For bilateral reporting with modifier 50, CMS pays 150%. CMS does not pay an assistant at surgery for this code; co-surgeons and team surgery are not permitted.
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.
68440 in Ohio
| Payment locality | Office | Facility |
|---|---|---|
| Ohio | $100.01 | $85.99 |
How the 68440 rate is calculated
Each of 68440’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 · 68440
RVUs × geographic indexes × conversion factor
Work0.97
0.97 RVUs× 1.000 GPCI
Practice expense2.14
2.14 RVUs× 1.000 GPCI
Malpractice0.07
0.07 RVUs× 1.000 GPCI
Adjusted RVUs
3.1800
Conversion factor
$33.4009
Medicare rate
$106.21
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 68440
68440 has a 10-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 68440
Punctal incision
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 010 | Minor procedure: the day of the procedure plus 10 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) | 1 | Not paid (statutory restriction). |
| 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) | 0.10/0.80/0.10 | Share of the payment for pre-op, the procedure itself, and post-op care. |
Global surgery period · 68440
Punctal incision
10-day global period ends
Oct 11, 2026
Covers Oct 1, 2026 through Oct 11, 2026 (11 days).
Visit on Oct 31, 2026
After the global period ends: visits and procedures are billed normally.
What modifiers do to the payment
Modifier 50 · payment effect
With and without the modifier
68440 without 50 · national office
$106.21
Punctal incision
68440-50 · Bilateral: 150%
$159.31
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).
68440 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 68801Punctum dilation
- Choose 68440 when the punctum is enlarged by incision; choose 68801 when the punctum is dilated, with or without irrigation.
- 68705Punctum revision
- Code 68705 addresses punctal ectropion by thermocauterization. Code 68440 describes snip incision to enlarge the punctal opening.
- 68810Tear duct probing
- Code 68810 is for probing the nasolacrimal duct. Code 68440 treats narrowing at the punctum itself.
68440 billing questions
When is this code appropriate instead of punctal dilation?
Use 68440 when the punctum is enlarged by snip incision. Punctal dilation, with or without irrigation, is described by 68801.
What should the operative note document?
Document the punctal stenosis or drainage problem, the eye treated, and the snip incision performed. Identify whether treatment was unilateral or bilateral.
Are related postoperative visits separately reported?
Related postoperative visits during the 10-day global period are included in the procedure’s payment.
How is bilateral treatment reported under the CMS facts?
Report bilateral treatment with modifier 50; CMS pays the bilateral procedure at 150%.
How does CMS handle other procedures performed in the same session?
The highest-valued procedure is paid in full, and other procedures are paid at 50%. CMS does not pay an assistant at surgery for 68440 and does not permit co-surgeons or team surgery.
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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