Billing code 68328: Eyelid lining repairMedicare rate & RVUs in Utah
Reconstructs the conjunctival lining of the eyelid or fornix with a graft, typically to address scarring and tissue loss that impair eyelid function.
CMS doesn’t publish an office rate for 68328 in Utah.
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 68328 covers
An ophthalmologist, often an oculoplastic or ocular surface surgeon, uses a graft to rebuild damaged conjunctival lining and restore the eyelid’s inner surface or fornix. Common situations include cicatricial contraction after trauma, burns, prior surgery, or chronic inflammation, when scarring or tissue loss limits eyelid movement or ocular surface protection. These reconstructions are generally performed in an operating-room setting.
Select this code when the operative service includes graft-based reconstruction of the eyelid lining; document the affected anatomy, the reason reconstruction is needed, and the graft used. The day-before preoperative visit and 90 days of related postoperative care are included in the global period. When multiple procedures are performed in the same session, the highest-valued procedure is paid in full and the others are subject to a 50% reduction. Bilateral reporting with modifier 50 is paid at 150%. Assistant-at-surgery payment requires documentation of medical necessity; 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.
68328 in Utah
| Payment locality | Office | Facility |
|---|---|---|
| Utah | Unavailable | $580.38 |
How the 68328 rate is calculated
Each of 68328’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 · 68328
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 9.21Practice expense 7.99Malpractice 0.73
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 68328
68328 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 68328
Eyelid lining repair
| 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) | 0 | Not paid without supporting documentation. |
| 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 · 68328
Eyelid lining repair
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
68328 without 50 · national facility
$598.88
Eyelid lining repair
68328-50 · Bilateral: 150%
$898.32
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).
68328 compared with similar codes
Compare codes
68328 vs 68320 vs 68325 vs 68326 vs 68335: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 68320Conjunctivoplasty
- 68320 is the related reconstruction approach without a graft. Use 68328 when the documented procedure includes graft-based lining reconstruction.
- 68325Conjunctivoplasty
- Both are related cul-de-sac reconstruction codes, but the appropriate code depends on the graft type or technique documented for the procedure.
- 68326Fornix reconstruction
- This is a related graft-reconstruction code with a distinction based on graft type or technique; follow the operative details when choosing between it and 68328.
- 68335Symblepharon repair
- 68335 is directed to graft repair of symblepharon. Choose 68328 when the documented service is graft reconstruction of the eyelid lining rather than that symblepharon repair.
68328 billing questions
How does 68328 differ from 68320?
68328 describes reconstruction using a graft. 68320 is a related reconstruction code without a graft; the operative report should establish which approach was performed.
How do I choose between 68328 and 68325 or 68326?
These are related reconstruction codes with distinctions tied to graft type or technique. Use the code that matches the documented graft and procedure rather than choosing by diagnosis alone.
What documentation supports 68328?
Document the eyelid or fornix anatomy reconstructed, the scarring or tissue loss prompting surgery, the reconstruction performed, and the graft used.
How is bilateral 68328 reported?
When the procedure is performed bilaterally, report modifier 50; CMS pays the bilateral procedure at 150%.
Can an assistant surgeon be reported?
Assistant-at-surgery payment is available only when medical necessity is documented. CMS does not permit co-surgeon or team-surgery payment for this code.
What happens when 68328 is performed with another procedure 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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