Billing code 68360: ConjunctivoplastyMedicare rate & RVUs in Texas
An ophthalmic surgeon uses this code for surgical reconstruction of the conjunctival cul-de-sac, often when scarring has contracted the eyelid lining.
Medicare pays $512.66–$566.41 for 68360 in the office in Texas, from Beaumont to Austin. Which amount applies depends on the service address.
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
On this page 9 sections
What 68360 covers
billing code 68360 describes surgical reconstruction of the conjunctival cul-de-sac, the pocket formed by the eyelid lining and the eye surface. Ophthalmologists may perform it to restore the fornix when scarring has shortened or distorted the lining, including after injury, inflammation, or prior surgery. These procedures are generally performed in a surgical facility rather than an office.
Select the code from the operative work documented: the record should identify the affected side, the cul-de-sac or fornix addressed, the extent of reconstruction, and the technique used. 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 others at 50%. For bilateral reporting with modifier 50, CMS pays 150%. Assistant-at-surgery services are not paid; co-surgeons and team surgery are not permitted.
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.
Where 68360 pays more and less in Texas
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
8 payment localities
$512.66 to $566.41
8 of 8 payment localities
| Payment locality | Office | Facility |
|---|---|---|
| Austin | $566.41 | $363.92 |
| Beaumont | $512.66 | $338.50 |
| Brazoria | $541.56 | $351.90 |
| Dallas | $544.60 | $353.98 |
| Fort Worth | $541.12 | $352.42 |
| Galveston | $542.93 | $352.89 |
| Houston | $550.26 | $360.21 |
| Rest Of Texas | $526.54 | $344.91 |
How the 68360 rate is calculated
Each of 68360’s three RVUs is multiplied by a geographic index (GPCI) for the payment locality, added up, and multiplied by the conversion factor. Drag the indexes or enter a ZIP to see what moves the rate.
How the rate is built · 68360
RVUs × geographic indexes × conversion factor
Work5.04
5.04 RVUs× 1.000 GPCI
Practice expense10.92
10.92 RVUs× 1.000 GPCI
Malpractice0.40
0.40 RVUs× 1.000 GPCI
Adjusted RVUs
16.3600
Conversion factor
$33.4009
Medicare rate
$546.44
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 68360
68360 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 68360
Conjunctivoplasty
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 090 | Major surgery: the day before, the day of, and 90 days after are included. |
| Multiple procedures | 2 | Standard reduction: highest-valued procedure at 100%, others at 50%. |
| Bilateral (modifier 50) | 1 | Bilateral with modifier 50 pays 150% of the fee schedule amount. |
| Assistant at surgery (80/81/82/AS) | 1 | Not paid (statutory restriction). |
| Co-surgeons (62) | 0 | Not permitted. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 0 | Physician service: no professional/technical split. |
| Split (54/55/56) | 0.10/0.70/0.20 | Share of the payment for pre-op, the procedure itself, and post-op care. |
Global surgery period · 68360
Conjunctivoplasty
90-day global period ends
Dec 30, 2026
Covers Sep 30, 2026 through Dec 30, 2026 (92 days, including the day before surgery).
Visit on Oct 31, 2026
Day 30 of the 90-day post-op period: related follow-up care is included in the surgical payment.
Pre-op dayGlobal period
What modifiers do to the payment
Modifier 50 · payment effect
With and without the modifier
68360 without 50 · national office
$546.44
Conjunctivoplasty
68360-50 · Bilateral: 150%
$819.66
Both sides on one line with modifier 50 are paid at 150% of the fee schedule amount (subject to multiple-procedure rules with other procedures).
68360 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 68340Adhesion release
- 68360 represents reconstruction of the cul-de-sac. Choose 68340 when the documented procedure is severing adhesions rather than reconstructing the fornix.
- 68320Conjunctivoplasty
- 68320 is a related conjunctivoplasty code associated with a graft or extensive rearrangement. Base code selection on the documented procedure and the specific reconstruction performed.
- 68362Fornix reconstruction
- Both codes concern cul-de-sac reconstruction. Review the operative technique and the precise service represented by each code before selecting one.
68360 billing questions
When is 68360 appropriate instead of 68340?
Use 68360 for reconstruction of the conjunctival cul-de-sac. Code 68340 describes severing adhesions; it is the more fitting choice when the documented service is limited to releasing conjunctival adhesions.
What documentation supports 68360?
Document the side and specific cul-de-sac or fornix treated, the scarring or distortion, and the reconstructive work performed. The operative report should make clear how the work restores the eyelid lining.
How does the 90-day global period affect postoperative billing?
The day-before preoperative visit and 90 days of related postoperative care are included in the global period. The routine related follow-up is not separately represented by another service code.
How is 68360 reported when both sides are reconstructed?
For a bilateral procedure, report modifier 50; CMS pays the bilateral procedure at 150%.
Can an assistant surgeon or co-surgeon be reported?
CMS does not pay an assistant at surgery for this code. Co-surgeons and team surgery are not permitted.
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%.
Where these rates come from
FeeBase calculates base physician payments from CMS work, practice-expense and malpractice RVUs, adjusted by each locality’s geographic indexes and the conversion factor. Services without a published rate are labeled, never given a made-up amount. Amounts are Medicare allowed amounts before claim adjustments: not a patient’s bill or a commercial rate.
CMS RVU26D · effective Oct 1, 2026 through the day before Jan 1, 2027
Show the CMS file lines behind this rate
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