$193.09
69000 is the simple external-ear drainage service. Choose 69005 when the documented extent and work support complicated drainage.
On this page
CMS RVU26D · Effective 2026-10-01
69005 Ear drainage Medicare reimbursement rates in Puerto Rico
Report this service for involved drainage of an abscess or hematoma of the external ear, such as the pinna, when the work exceeds simple drainage. Compare 69005 office and facility rates across CMS payment localities in Puerto Rico.
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 69005 in Puerto Rico?
Puerto Rico has 1 payment locality in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the payment area shown below, using the same CMS release.
Office / nonfacility
$223.84
1 of 1 localities have a supported rate.
Payment area: Puerto Rico
One mapped payment locality.
Facility setting
$146.84
1 of 1 localities have a supported rate.
Payment area: Puerto Rico
One mapped payment locality.
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.
Surgical procedure
About 69005: Complicated external ear collection drainage
Report this service for involved drainage of an abscess or hematoma of the external ear, such as the pinna, when the work exceeds simple drainage.
This procedure treats a collection in the external ear, typically the auricle or pinna, by opening and evacuating an abscess or hematoma. A common clinical situation is an auricular hematoma after blunt trauma; external-ear abscesses are another indication. Otolaryngologists and other clinicians who perform minor procedures may provide it in an office or outpatient setting. It is distinct from drainage of an abscess within the external auditory canal.
Choose the complicated service when the documented work and extent of treatment support more than simple drainage; the code does not establish a separate numeric threshold for complexity. Record the collection’s location and diagnosis, relevant findings, and the procedural work performed. Related postoperative visits are included in the 10-day global period. When multiple procedures occur in the same session, the highest-valued procedure is paid in full and the others at 50%. For bilateral treatment, modifier 50 is paid at 150%. Assistant-at-surgery payment is restricted; co-surgeons and team surgery are not permitted.
CMS billing rules for 69005
- 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
- Statutory restriction: assistant at surgery is not paid.
- Co-surgeons
- Co-surgeons not permitted.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU2.11 · 32%
- Practice expense (office) RVU4.22 · 63%
- Malpractice RVU0.33 · 5%
439
Medicare services in 2024 · #3661 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.
69005 compared with similar codes
Office rates for Puerto Rico, from the same CMS release.
$234.64
69020 is for an abscess in the external auditory canal. This code concerns a collection of the external ear, such as the auricle or pinna.
$132.46
10160 describes puncture aspiration of an abscess, hematoma, or other collection. This code is for complicated drainage of an external-ear collection.
Compare 69005 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.
1 of 1 payment localities
Puerto Rico →
Office / nonfacility
$223.84
Facility
$146.84
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.
How this local rate is calculated
Each RVU component is multiplied by its own geographic practice cost index (GPCI). The three adjusted components are added, then multiplied by the conversion factor. These are the inputs used for 69005 in Puerto Rico.
PPRRVU2026_Oct_nonQPP.csv
7,581
- Code
- 69005
- Physician work
- 2.11
- Practice expense
- 4.22
- Malpractice
- 0.33
GPCI2026.csv
91
- Locality
- Puerto Rico
- Physician work
- 1.000
- Practice expense
- 1.011
- Malpractice
- 0.985
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 2.11 | × 1.000 | 2.1100 |
| Practice expense | 4.22 | × 1.011 | 4.2664 |
| Malpractice | 0.33 | × 0.985 | 0.3251 |
| Total RVUs | 6.7015 | ||
| Conversion factor | × 33.4009 | ||
Office / nonfacility rate, Puerto Rico$223.84
Explore RVUs, geographic factors and the full formula
Office / nonfacility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 2.11 | 1 |
| Practice expense | 4.22 | 1.011 |
| Malpractice | 0.33 | 0.985 |
(2.11 × 1 + 4.22 × 1.011 + 0.33 × 0.985) × $33.4009 = $223.84
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 2.11 | 1 |
| Practice expense | 1.94 | 1.011 |
| Malpractice | 0.33 | 0.985 |
(2.11 × 1 + 1.94 × 1.011 + 0.33 × 0.985) × $33.4009 = $146.84
The office and facility calculations use their respective practice-expense RVUs. The facility amount here is the physician fee, not a separate hospital or facility bill.
69005 billing questions
How do I choose this code instead of 69000?
Use 69005 when the documented drainage is complicated rather than simple. The record should describe the extent of the collection and the work supporting that level.
Does this code cover an abscess in the ear canal?
No. This service is for a collection of the external ear, such as the auricle or pinna; 69020 is for an abscess in the external auditory canal.
Are related postoperative visits separately reported?
Related postoperative visits during the 10-day global period are included.
How is bilateral treatment reported?
Report modifier 50 for bilateral treatment. CMS pays the bilateral procedure at 150%.
Can an assistant or co-surgeon be reported?
Assistant-at-surgery payment is restricted for this code. 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.
7,57868850,,Injection for tear sac x-ray,A,,0.78,0.84,,0.52,,0.07,1.69,1.37,0,000,0.00,0.00,0.00,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,57968899,,Unlisted px lacrimal system,C,,0.00,0.00,,0.00,,0.00,0.00,0.00,0,YYY,0.00,0.00,0.00,2,1,0,1,1,9,,33.4009,09,0,99,0.00,0.00,0.00
7,58069000,,Drg xtrnl ear absc/hem smpl,A,,1.46,4.05,,1.83,,0.23,5.74,3.52,0,010,0.10,0.80,0.10,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,58169005,,Drg xtrnl ear absc/hem comp,A,,2.11,4.22,,1.94,,0.33,6.66,4.38,0,010,0.10,0.80,0.10,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,58269020,,Drg xtrnl aud canal abscess,A,,1.49,5.27,,2.28,,0.21,6.97,3.98,0,010,0.10,0.80,0.10,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,58369090,,Ear piercing,N,,0.00,0.00,,0.00,,0.00,0.00,0.00,9,XXX,0.00,0.00,0.00,9,9,9,9,9,9,,33.4009,09,0,99,0.00,0.00,0.00
7,58469100,,Biopsy of external ear,A,,0.79,1.91,,0.26,,0.07,2.77,1.12,0,000,0.00,0.00,0.00,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
8802302,OR,99,REST OF OREGON,1.000,0.996,0.703
8912502,PA,01,METROPOLITAN PHILADELPHIA,1.018,1.041,1.193
9012502,PA,99,REST OF PENNSYLVANIA,1.000,0.918,0.945
9109202,PR,20,PUERTO RICO,1.000,1.011,0.985
9214412,RI,01,RHODE ISLAND,1.019,1.033,0.892
9311202,SC,01,SOUTH CAROLINA,1.000,0.924,0.850
9403402,SD,02,SOUTH DAKOTA**,1.000,1.000,0.336