$164.69
Choose 68816 when probing includes balloon catheter dilation. For probing without balloon dilation, use the applicable probing code.
On this page
CMS RVU26D · Effective 2026-10-01
68816 Tear duct dilation Medicare reimbursement rates in Rhode Island
An ophthalmologist probes an obstructed nasolacrimal duct and dilates it with a balloon catheter to improve tear drainage. Compare 68816 office and facility rates across CMS payment localities in Rhode Island.
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 68816 in Rhode Island?
Rhode Island 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
$857.42
1 of 1 localities have a supported rate.
Payment area: Rhode Island
One mapped payment locality.
Facility setting
$136.65
1 of 1 localities have a supported rate.
Payment area: Rhode Island
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.
Ophthalmology
About 68816: Nasolacrimal duct balloon dilation
An ophthalmologist probes an obstructed nasolacrimal duct and dilates it with a balloon catheter to improve tear drainage.
This procedure treats obstruction or narrowing in the nasolacrimal duct, the passage that carries tears from the eye into the nose. The ophthalmologist passes a probe through the drainage pathway and uses a balloon catheter to expand the narrowed segment; irrigation may also be performed. It is commonly used for persistent tear-duct obstruction, including congenital obstruction in children, and may be performed in an operating room or another appropriate procedural setting.
Report this code when balloon catheter dilation is performed with probing, rather than probing alone or placement of a tube or stent. The operative note should identify the treated side, the obstruction or narrowing, and the probing and balloon-dilation work performed. The procedure has a 10-day global period, which includes related postoperative visits during that period. For bilateral treatment, modifier 50 is paid at 150%. When multiple procedures are performed in the same session, the highest-valued procedure is paid in full and others at 50%. Assistant-at-surgery payment is restricted; co-surgeons and team surgery are not permitted.
CMS billing rules for 68816
- 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 RVU2.05 · 8%
- Practice expense (office) RVU22.69 · 91%
- Malpractice RVU0.16 · 1%
220
Medicare services in 2024 · #4241 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.
68816 compared with similar codes
Office rates for Rhode Island, from the same CMS release.
No office rate
This is a probing alternative without balloon catheter dilation; 68816 specifically includes balloon dilation.
$383.18
Choose 68815 when a tube or stent is placed with probing. Choose 68816 when balloon catheter dilation is performed instead.
$97.03
68801 addresses dilation at the lacrimal punctum. Code 68816 is for probing and balloon dilation of the nasolacrimal duct.
Compare 68816 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
Rhode Island →
Office / nonfacility
$857.42
Facility
$136.65
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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 68816 in Rhode Island.
PPRRVU2026_Oct_nonQPP.csv
7,575
- Code
- 68816
- Physician work
- 2.05
- Practice expense
- 22.69
- Malpractice
- 0.16
GPCI2026.csv
92
- Locality
- Rhode Island
- Physician work
- 1.019
- Practice expense
- 1.033
- Malpractice
- 0.892
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 2.05 | × 1.019 | 2.0889 |
| Practice expense | 22.69 | × 1.033 | 23.4388 |
| Malpractice | 0.16 | × 0.892 | 0.1427 |
| Total RVUs | 25.6704 | ||
| Conversion factor | × 33.4009 | ||
Office / nonfacility rate, Rhode Island$857.42
Explore RVUs, geographic factors and the full formula
Office / nonfacility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 2.05 | 1.019 |
| Practice expense | 22.69 | 1.033 |
| Malpractice | 0.16 | 0.892 |
(2.05 × 1.019 + 22.69 × 1.033 + 0.16 × 0.892) × $33.4009 = $857.42
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 2.05 | 1.019 |
| Practice expense | 1.8 | 1.033 |
| Malpractice | 0.16 | 0.892 |
(2.05 × 1.019 + 1.8 × 1.033 + 0.16 × 0.892) × $33.4009 = $136.65
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.
68816 billing questions
When should I report this instead of 68810?
Use 68816 when the surgeon performs balloon catheter dilation along with probing. Probing without balloon dilation is reported with the applicable probing code.
How does 68816 differ from 68815?
68816 describes balloon catheter dilation with probing; 68815 is used when probing includes placement of a tube or stent. Select the code for the technique actually performed.
Can I report irrigation separately?
Irrigation may be performed as part of the probing service. Do not separately report a service solely for irrigation performed as part of this procedure.
How should bilateral treatment be reported?
For treatment of both nasolacrimal ducts, report modifier 50. CMS pays bilateral procedures at 150%.
What postoperative care is included?
Related postoperative visits during the 10-day global period are included in the procedure payment.
Can an assistant or co-surgeon be paid for this procedure?
CMS does not pay an assistant at surgery 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.
7,57268810,,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
7,57368811,,Probe nasolacrimal duct,A,,1.70,1.67,NA,1.67,,0.15,3.52,3.52,0,010,0.10,0.80,0.10,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,57468815,,Probe nasolacrimal duct,A,,2.63,8.33,,2.94,,0.21,11.17,5.78,0,010,0.10,0.80,0.10,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,57568816,,Probe nl duct w/balloon,A,,2.05,22.69,,1.80,,0.16,24.90,4.01,0,010,0.10,0.80,0.10,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,57668840,,Explore/irrigate tear ducts,A,,1.27,2.66,,1.77,,0.09,4.02,3.13,0,010,0.10,0.80,0.10,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,57768841,,Insj rx elut implt lac canal,A,,0.48,0.64,,0.30,,0.04,1.16,0.82,0,000,0.00,0.00,0.00,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,57868850,,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
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
9510312,TN,35,TENNESSEE,1.000,0.909,0.537