Billing code 68816: Tear duct dilationMedicare rate & RVUs in Texas
An ophthalmologist probes an obstructed nasolacrimal duct and dilates it with a balloon catheter to improve tear drainage.
Medicare pays $763.09–$875.17 for 68816 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 68816 covers
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.
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 68816 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
$763.09 to $875.17
8 of 8 payment localities
| Payment locality | Office | Facility |
|---|---|---|
| Austin | $875.17 | $136.95 |
| Beaumont | $763.09 | $128.15 |
| Brazoria | $824.23 | $132.77 |
| Dallas | $828.51 | $133.55 |
| Fort Worth | $821.00 | $133.02 |
| Galveston | $826.01 | $133.15 |
| Houston | $828.93 | $136.07 |
| Rest Of Texas | $792.51 | $130.35 |
How the 68816 rate is calculated
Each of 68816’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 · 68816
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 2.05Practice expense 22.69Malpractice 0.16
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 68816
68816 has a 10-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 68816
Tear duct dilation
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 010 | Minor procedure: the day of the procedure plus 10 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) | 0.10/0.80/0.10 | Share of the payment for pre-op, the procedure itself, and post-op care. |
Global surgery period · 68816
Tear duct dilation
10-day global period ends
Oct 11, 2026
Covers Oct 1, 2026 through Oct 11, 2026 (11 days).
Visit on Oct 31, 2026
After the global period ends: visits and procedures are billed normally.
What modifiers do to the payment
Modifier 50 · payment effect
With and without the modifier
68816 without 50 · national office
$831.68
Tear duct dilation
68816-50 · Bilateral: 150%
$1,247.52
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).
68816 compared with similar codes
Compare codes
68816 vs 68810 vs 68811 vs 68815 vs 68801: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 68810Tear duct probing
- Choose 68816 when probing includes balloon catheter dilation. For probing without balloon dilation, use the applicable probing code.
- 68811Tear duct probing
- This is a probing alternative without balloon catheter dilation; 68816 specifically includes balloon dilation.
- 68815Duct probing
- Choose 68815 when a tube or stent is placed with probing. Choose 68816 when balloon catheter dilation is performed instead.
- 68801Punctum dilation
- 68801 addresses dilation at the lacrimal punctum. Code 68816 is for probing and balloon dilation of the nasolacrimal duct.
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 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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