Billing code 68040: Eyelid lesion treatmentMedicare rate & RVUs in Utah
Reports nonincisional treatment of an eyelid lesion, such as molluscum contagiosum, when the lesion is treated rather than biopsied or excised.
Medicare pays $59.69 for 68040 in the office in Utah (Utah). 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 68040 covers
This service covers treatment of a non-chalazion lesion on the eyelid without making an incision. A typical example is treating eyelid molluscum contagiosum. Ophthalmologists and other clinicians who provide eye care may perform it in an office or outpatient setting. The procedure is directed at a clinically identified lesion; it is distinct from taking a biopsy to establish a diagnosis or surgically excising a lesion.
Choose the code when the documented service treats an eyelid lesion without incision, and distinguish it from chalazion treatment and procedures requiring incision or excision. Record the lesion’s eyelid location, clinical nature, and treatment performed. The service has a 0-day global period, so same-day preoperative and postoperative care is included. When multiple procedures occur in one session, the highest-valued procedure is paid in full and the others at 50%. Bilateral reporting with modifier 50 is paid at 150%. 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.
68040 in Utah
| Payment locality | Office | Facility |
|---|---|---|
| Utah | $59.69 | $38.97 |
How the 68040 rate is calculated
Each of 68040’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 · 68040
RVUs × geographic indexes × conversion factor
Work0.83
0.83 RVUs× 1.000 GPCI
Practice expense0.98
0.98 RVUs× 1.000 GPCI
Malpractice0.04
0.04 RVUs× 1.000 GPCI
Adjusted RVUs
1.8500
Conversion factor
$33.4009
Medicare rate
$61.79
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 68040
The CMS indicators that decide how 68040 is paid alongside other services.
CMS payment indicators · 68040
Eyelid lesion treatment
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 000 | Same-day global: pre- and post-op care on the day of the procedure is 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. |
What modifiers do to the payment
Modifier 50 · payment effect
With and without the modifier
68040 without 50 · national office
$61.79
Eyelid lesion treatment
68040-50 · Bilateral: 150%
$92.69
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).
68040 compared with similar codes
Compare codes · National
5 codes, side by side
How to choose
- 67800Chalazion removal
- Use 67800 for chalazion treatment. This code is for a non-chalazion eyelid lesion treated without incision.
- 67810Eyelid biopsy
- 67810 represents eyelid biopsy for diagnostic evaluation. This code represents treatment of a lesion, not tissue sampling.
- 67840Eyelid lesion excision
- Use 67840 when the eyelid lesion is surgically excised. This code applies when treatment is performed without incision.
- 68020Conjunctival cyst drainage
- 68020 is for incision and drainage of a conjunctival cyst. This code concerns a lesion on the eyelid and involves no incision.
68040 billing questions
When should this code be chosen instead of an eyelid excision code?
Use it for treatment of an eyelid lesion without incision. If the clinician surgically removes the lesion, consider the excision code that matches the service instead.
Can this code be used for a chalazion?
No. Chalazion is excluded from this lesion-treatment service; use the chalazion-specific code when that is the condition treated.
What documentation supports reporting it?
Document the lesion’s location and clinical nature, that it was on the eyelid and was not a chalazion, and the nonincisional treatment performed.
How is bilateral treatment reported?
CMS pricing recognizes bilateral reporting with modifier 50 at 150%. Document treatment on both sides.
How does the 0-day global period affect same-day care?
Same-day preoperative and postoperative care is included in the procedure. CMS applies the multiple-procedure reduction when other procedures are performed in the same session.
Is an assistant or co-surgeon payable for this service?
Assistant-at-surgery payment is restricted. Co-surgeons and team surgery are not permitted under the CMS rules for this code.
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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