Billing code 68770: Lacrimal fistula closureMedicare rate & RVUs in Oregon
Reports surgical closure of an abnormal fistulous tract involving the lacrimal system, such as a persistent channel causing tear drainage onto the skin.
CMS doesn’t publish an office rate for 68770 in Oregon.
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 68770 covers
An ophthalmologist, often an oculoplastic surgeon, uses this service to close an abnormal communication involving the tear drainage system. A typical presentation is persistent tear-like drainage through an opening near the eye or onto the face. The procedure is performed in an operative setting, with the operative report identifying the fistula site and describing its closure. It is distinct from closing a normal lacrimal punctum to reduce tearing.
Report 68770 when the treated problem is a lacrimal-system fistula, not a punctal opening or a damaged canaliculus. Documentation should establish the abnormal tract, its location, and the surgical work performed. CMS assigns a 90-day major-surgery global period, including the day-before preoperative visit and related postoperative care during that period. When multiple procedures occur in the same 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%. Assistant-at-surgery payment requires documented medical necessity; co-surgeon and team-surgery reporting 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.
Where 68770 pays more and less in Oregon
| Payment locality | Office | Facility |
|---|---|---|
| Portland | Unavailable | $561.36 |
| Rest Of Oregon | Unavailable | $528.09 |
How the 68770 rate is calculated
Each of 68770’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 · 68770
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 8.08Practice expense 7.31Malpractice 0.64
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 68770
68770 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 68770
Lacrimal fistula closure
| 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) | 0.10/0.70/0.20 | Share of the payment for pre-op, the procedure itself, and post-op care. |
Global surgery period · 68770
Lacrimal fistula closure
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
68770 without 50 · national facility
$535.42
Lacrimal fistula closure
68770-50 · Bilateral: 150%
$803.13
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).
68770 compared with similar codes
Compare codes
68770 vs 68760 vs 68761 vs 68700 vs 68720: national Medicare rates
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How to choose
- 68760Punctal closure
- This code closes the lacrimal punctum by a destructive or ligating method. Choose 68770 when the operative target is an abnormal fistula of the lacrimal system.
- 68761Punctal occlusion
- This code closes the lacrimal punctum with a plug. It does not describe surgical closure of a fistulous tract.
- 68700Canaliculus repair
- This code repairs the lacrimal canaliculi. Use 68770 when the documented problem is a fistula rather than canalicular damage.
- 68720Tear drainage surgery
- This code creates a drainage route between the lacrimal sac and the nose. Code 68770 closes an abnormal lacrimal fistula.
68770 billing questions
When should 68770 be chosen over lacrimal punctum closure?
Use 68770 for surgical closure of an abnormal fistulous tract involving the lacrimal system. Codes 68760 and 68761 address closure of the lacrimal punctum, not a fistula.
What documentation supports 68770?
The record should identify the abnormal fistula and its location, describe the operative closure, and support that the work treated a fistulous tract rather than a punctum or canaliculus.
How is bilateral treatment reported?
CMS lists this as a bilateral procedure; modifier 50 is paid at 150% when both sides are treated.
What postoperative care is included?
The 90-day global period includes the day-before preoperative visit and related postoperative care for 90 days.
Can an assistant or co-surgeon be reported?
Assistant-at-surgery payment is available only with documentation of medical necessity. CMS does not permit co-surgeon or team-surgery reporting for this code.
How does CMS handle another procedure performed in the same session?
The highest-valued procedure is paid in full, and other procedures in the same session are subject to the standard multiple-procedure reduction.
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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