No office rate
Both codes describe window fistula repair, but 69666 is specific to the oval window and 69667 to the round window. Use the documented repair site.
On this page
CMS RVU26D · Effective 2026-10-01
69666 Fistula repair Medicare reimbursement rates in Pennsylvania
Reports operative closure of a leak at the oval window, typically when a perilymphatic fistula is identified during middle-ear surgery. Compare 69666 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 69666 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
No supported rate
Facility setting
$689.66–$750.39
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.
Otolaryngology surgery
About 69666: Oval window fistula repair
Reports operative closure of a leak at the oval window, typically when a perilymphatic fistula is identified during middle-ear surgery.
An otologist or other otolaryngologist uses this code to repair a fistula at the oval window, the opening between the middle ear and inner ear. The procedure is generally performed in an operating room. A perilymph leak at this site may be associated with hearing symptoms or vertigo, including after trauma or prior ear surgery. The operative report should identify the oval window as the repair site and describe the fistula and its treatment.
Report the code for the oval-window repair itself, not for a leak at the round window or a procedure directed at stapes fixation. The service has a 90-day global period, which includes the day-before preoperative visit and 90 days of related postoperative care. When multiple procedures are performed in the same session, the highest-valued procedure is paid in full and the others at 50%. For bilateral repair, 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 69666
- 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 RVU9.64 · 45%
- Practice expense (office) RVU10.55 · 49%
- Malpractice RVU1.40 · 6%
70
Medicare services in 2024 · #5150 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.
69666 compared with similar codes
Office rates for Pennsylvania, from the same CMS release.
No office rate
69660 describes surgery for stapes fixation. Use 69666 when the operative target is an oval-window fistula or leak.
No office rate
69631 is for tympanoplasty without mastoidectomy and without ossicular chain reconstruction. It is not the code for a specifically documented oval-window fistula repair.
No office rate
69632 describes tympanoplasty with ossicular chain reconstruction. Choose 69666 when the service is repair of an oval-window fistula rather than ossicular reconstruction.
Compare 69666 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
Unavailable
Facility
$750.39
Rest Of Pennsylvania →
Office / nonfacility
Unavailable
Facility
$689.66
Need rates for a whole code list?
Fee-sheet and API access are in early access. Tell us which codes and locations your team needs.
69666 billing questions
How is this code distinguished from 69667?
69666 is for a fistula at the oval window; 69667 is for a fistula at the round window. The operative documentation should identify the repair site.
What should the operative report document?
Document the oval-window location, the fistula or leak found, and the repair performed. A general note of middle-ear exploration without the site and finding does not establish this specific service.
Is this the correct code for stapes fixation?
No. This code describes repair of an oval-window fistula. Stapes procedures such as 69660 address stapes fixation rather than closure of a fistula.
How does the 90-day global period affect postoperative visits?
The day-before preoperative visit and 90 days of related postoperative care are included in the global period.
What happens when another procedure is performed 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%. For bilateral repair, modifier 50 is paid at 150%.
Can an assistant surgeon or co-surgeon be reported?
Assistant-at-surgery payment is allowed only when medical necessity is documented. Co-surgeons and team surgery are not permitted.
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.
7,63869660,,Revise middle ear bone,A,,11.73,11.07,NA,11.07,,1.72,24.52,24.52,0,090,0.07,0.79,0.14,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,63969661,,Revise middle ear bone,A,,15.52,14.09,NA,14.09,,2.26,31.87,31.87,0,090,0.07,0.79,0.14,2,1,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,64069662,,Revise middle ear bone,A,,15.21,13.02,NA,13.02,,2.32,30.55,30.55,0,090,0.07,0.79,0.14,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,64169666,,Repair middle ear structures,A,,9.64,10.55,NA,10.55,,1.40,21.59,21.59,0,090,0.07,0.79,0.14,2,1,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,64269667,,Repair middle ear structures,A,,9.65,10.58,NA,10.58,,1.44,21.67,21.67,0,090,0.07,0.79,0.14,2,1,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,64369670,,Remove mastoid air cells,A,,11.44,12.04,NA,12.04,,1.67,25.15,25.15,0,090,0.07,0.79,0.14,2,1,2,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,64469676,,Remove middle ear nerve,A,,9.45,11.55,NA,11.55,,1.36,22.36,22.36,0,090,0.07,0.79,0.14,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00