$206.34–$227.82
Choose 68761 for plug-based closure; choose 68760 when the punctum is closed by a method such as cauterization or ligation.
On this page
CMS RVU26D · Effective 2026-10-01
68761 Punctal occlusion Medicare reimbursement rates in Pennsylvania
Reports plug-based closure of a lacrimal punctum, commonly to retain tears in patients with aqueous-deficient dry eye. Compare 68761 office and facility rates across CMS payment localities in Pennsylvania.
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 68761 in Pennsylvania?
Pennsylvania 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
$135.36–$148.47
2 of 2 localities have a supported rate.
Facility setting
$98.87–$107.09
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.
Ophthalmology procedure
About 68761: Punctal closure with a plug
Reports plug-based closure of a lacrimal punctum, commonly to retain tears in patients with aqueous-deficient dry eye.
An ophthalmologist places a plug in a lacrimal punctum to reduce tear drainage and help retain the eye’s natural tears. This is commonly performed in an office for patients with dry eye related to inadequate tear volume. The code represents treatment of each punctum, rather than a permanent closure technique or surgery to restore tear drainage.
Report the code for each punctum treated and document the indication, site and number of puncta, and plug placement. For bilateral treatment, modifier 50 applies; CMS pays the bilateral procedure at 150%. A 10-day global period includes related postoperative visits during that period. If multiple procedures subject to the standard multiple-procedure rule are performed in the same session, the highest-valued procedure is paid in full and the others at 50%. Assistant-at-surgery payment requires documentation of medical necessity; co-surgeons and team surgery are not permitted.
CMS billing rules for 68761
- Global period
- Minor procedure with a 10-day global period: related postoperative visits for 10 days 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 RVU1.37 · 32%
- Practice expense (office) RVU2.85 · 66%
- Malpractice RVU0.07 · 2%
508.4K
Medicare services in 2024 · #229 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.
68761 compared with similar codes
Office rates for Pennsylvania, from the same CMS release.
$244.35–$269.79
This code occludes a punctum to retain tears. Code 68705 revises the punctum, such as when a narrowed opening needs revision rather than closure.
68770
No office rateLacrimal fistula closure
This code treats a lacrimal punctum with a plug. Code 68770 addresses closure of a fistula involving the lacrimal system.
Compare 68761 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
Metropolitan Philadelphia →
Office / nonfacility
$148.47
Facility
$107.09
Rest Of Pennsylvania →
Office / nonfacility
$135.36
Facility
$98.87
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68761 billing questions
How does this differ from 68760?
This code is for plug-based punctal closure. Code 68760 is used when the punctum is closed by a method such as cauterization or ligation.
How many units should be reported?
The code represents each punctum treated. Document the punctum or puncta where plugs were placed.
How is bilateral treatment reported?
Use modifier 50 for bilateral treatment. CMS pays the bilateral procedure at 150%.
Are related postoperative visits separately payable?
Related postoperative visits during the 10-day global period are included.
What documentation supports reporting this service?
Document the tear-retention indication, the treated punctum or puncta, and that plug placement was performed.
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.
7,56668745,,Create tear duct drain,A,,9.65,10.71,NA,10.71,,0.78,21.14,21.14,0,090,0.10,0.70,0.20,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,56768750,,Create tear duct drain,A,,9.85,11.75,NA,11.75,,0.82,22.42,22.42,0,090,0.10,0.70,0.20,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,56868760,,Close tear duct opening,A,,1.74,4.69,,1.94,,0.14,6.57,3.82,0,010,0.10,0.80,0.10,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,56968761,,Close tear duct opening,A,,1.37,2.85,,1.66,,0.07,4.29,3.10,0,010,0.10,0.80,0.10,2,1,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,57068770,,Close tear system fistula,A,,8.08,7.31,NA,7.31,,0.64,16.03,16.03,0,090,0.10,0.70,0.20,2,1,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,57168801,,Dilate tear duct opening,A,,0.80,1.98,,1.30,,0.05,2.83,2.15,0,010,0.10,0.80,0.10,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,57268810,,Probe nasolacrimal duct,A,,1.50,3.19,,1.74,,0.12,4.81,3.36,0,010,0.10,0.80,0.10,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00