$227.25
Both codes address an external-ear abscess or hematoma. Choose 69000 for simple drainage and 69005 when drainage is complicated.
On this page
CMS RVU26D · Effective 2026-10-01
69000 Ear drainage Medicare reimbursement rates in Rhode Island
Drainage of a simple abscess or hematoma of the external ear, such as the auricle, when the collection requires procedural evacuation. Compare 69000 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 69000 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
$196.28
1 of 1 localities have a supported rate.
Payment area: Rhode Island
One mapped payment locality.
Facility setting
$119.69
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.
Ear procedures
About 69000: Simple external-ear abscess or hematoma drainage
Drainage of a simple abscess or hematoma of the external ear, such as the auricle, when the collection requires procedural evacuation.
CPT 69000 covers straightforward drainage of an abscess or hematoma in the external ear, usually the auricle or pinna. The clinician opens the collection and evacuates its contents; this is distinct from treating an abscess within the external auditory canal. Otolaryngologists and other clinicians who manage acute ear lesions may perform the service in an office, clinic, or hospital outpatient setting. A traumatic auricular hematoma and an external-ear abscess are representative presentations.
Choose 69000 for simple drainage; use 69005 when drainage of the external-ear abscess or hematoma is complicated, and 69020 when the abscess is in the auditory canal. Document the site, diagnosis, collection, and work performed to support the selection. CMS assigns a 10-day global period, so related postoperative visits during that period are included. For same-session procedures, the highest-valued procedure is paid in full and other procedures are paid at 50%. When both ears are treated, modifier 50 is paid at 150%. Medicare does not pay an assistant at surgery for this service; co-surgeons and team surgery are not permitted.
CMS billing rules for 69000
- 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 RVU1.46 · 25%
- Practice expense (office) RVU4.05 · 71%
- Malpractice RVU0.23 · 4%
1.2K
Medicare services in 2024 · #2857 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.
69000 compared with similar codes
Office rates for Rhode Island, from the same CMS release.
$238.80
Use 69020 when the abscess is in the external auditory canal; 69000 is for the external ear, such as the auricle.
$131.67
10060 describes simple or single abscess drainage at sites outside the external ear. For an external-ear collection, 69000 is the site-specific code.
Compare 69000 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
$196.28
Facility
$119.69
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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 69000 in Rhode Island.
PPRRVU2026_Oct_nonQPP.csv
7,580
- Code
- 69000
- Physician work
- 1.46
- Practice expense
- 4.05
- Malpractice
- 0.23
GPCI2026.csv
92
- Locality
- Rhode Island
- Physician work
- 1.019
- Practice expense
- 1.033
- Malpractice
- 0.892
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 1.46 | × 1.019 | 1.4877 |
| Practice expense | 4.05 | × 1.033 | 4.1836 |
| Malpractice | 0.23 | × 0.892 | 0.2052 |
| Total RVUs | 5.8765 | ||
| Conversion factor | × 33.4009 | ||
Office / nonfacility rate, Rhode Island$196.28
Explore RVUs, geographic factors and the full formula
Office / nonfacility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 1.46 | 1.019 |
| Practice expense | 4.05 | 1.033 |
| Malpractice | 0.23 | 0.892 |
(1.46 × 1.019 + 4.05 × 1.033 + 0.23 × 0.892) × $33.4009 = $196.28
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 1.46 | 1.019 |
| Practice expense | 1.83 | 1.033 |
| Malpractice | 0.23 | 0.892 |
(1.46 × 1.019 + 1.83 × 1.033 + 0.23 × 0.892) × $33.4009 = $119.69
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.
69000 billing questions
When should 69000 be reported instead of 69005?
Report 69000 for simple drainage of an external-ear abscess or hematoma. Use 69005 when the drainage is complicated, with documentation supporting the complexity.
How does 69000 differ from 69020?
69000 is for a collection in the external ear, such as the auricle. 69020 is for an abscess in the external auditory canal.
Are related postoperative visits separately payable during the global period?
Related postoperative visits during the 10-day global period are included in 69000.
How is 69000 reported when both ears are treated?
Report modifier 50 for bilateral treatment; CMS pays the bilateral procedure at 150%.
Can an assistant surgeon or co-surgeon be reported?
Medicare does not pay an assistant at surgery for 69000. 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.
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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
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8912502,PA,01,METROPOLITAN PHILADELPHIA,1.018,1.041,1.193
9012502,PA,99,REST OF PENNSYLVANIA,1.000,0.918,0.945
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9403402,SD,02,SOUTH DAKOTA**,1.000,1.000,0.336
9510312,TN,35,TENNESSEE,1.000,0.909,0.537