$291.28
Choose 68420 for drainage of the lacrimal sac and 68400 when the lacrimal gland is the structure being drained.
On this page
CMS RVU26D · Effective 2026-10-01
68420 Lacrimal drainage Medicare reimbursement rates in Vermont
Incision and drainage of an infected lacrimal sac, typically for a localized collection associated with acute dacryocystitis. Compare 68420 office and facility rates across CMS payment localities in Vermont.
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 68420 in Vermont?
Vermont 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
$325.22
1 of 1 localities have a supported rate.
Payment area: Vermont
One mapped payment locality.
Facility setting
$137.40
1 of 1 localities have a supported rate.
Payment area: Vermont
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.
Ophthalmology procedure
About 68420: Lacrimal sac incision and drainage
Incision and drainage of an infected lacrimal sac, typically for a localized collection associated with acute dacryocystitis.
An ophthalmologist, often an oculoplastic surgeon, makes an incision to drain purulent material from an infected or abscessed lacrimal sac, commonly in acute dacryocystitis. The target is the sac near the nose at the medial canthus, not the lacrimal gland or the punctum. The procedure may be performed in an office or facility setting, depending on the patient and clinical circumstances.
Report this service when the documented work is drainage of the lacrimal sac, rather than treatment of a blocked punctum or duct without a sac collection. The record should identify the affected side, the sac infection or collection, and the incision and drainage performed. Related postoperative visits during the 10-day global period are included. For bilateral treatment, modifier 50 is paid at 150%; when multiple procedures are performed in the same session, the highest-valued is paid in full and others at 50%. Assistant-at-surgery payment is restricted; co-surgeons and team surgery are not permitted.
CMS billing rules for 68420
- 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 RVU2.29 · 23%
- Practice expense (office) RVU7.43 · 75%
- Malpractice RVU0.18 · 2%
783
Medicare services in 2024 · #3172 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.
68420 compared with similar codes
Office rates for Vermont, from the same CMS release.
$104.35
68440 concerns an incision involving the lacrimal punctum; 68420 is for incision and drainage of the lacrimal sac.
$157.61
68810 is probing of the nasolacrimal duct, whereas 68420 drains an infected or abscessed lacrimal sac.
Compare 68420 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
Vermont →
Office / nonfacility
$325.22
Facility
$137.40
Need rates for a whole code list?
Fee-sheet and API access are in early access. Tell us which codes and locations your team needs.
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 68420 in Vermont.
PPRRVU2026_Oct_nonQPP.csv
7,553
- Code
- 68420
- Physician work
- 2.29
- Practice expense
- 7.43
- Malpractice
- 0.18
GPCI2026.csv
105
- Locality
- Vermont
- Physician work
- 1.000
- Practice expense
- 0.990
- Malpractice
- 0.506
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 2.29 | × 1.000 | 2.2900 |
| Practice expense | 7.43 | × 0.990 | 7.3557 |
| Malpractice | 0.18 | × 0.506 | 0.0911 |
| Total RVUs | 9.7368 | ||
| Conversion factor | × 33.4009 | ||
Office / nonfacility rate, Vermont$325.22
Explore RVUs, geographic factors and the full formula
Office / nonfacility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 2.29 | 1 |
| Practice expense | 7.43 | 0.99 |
| Malpractice | 0.18 | 0.506 |
(2.29 × 1 + 7.43 × 0.99 + 0.18 × 0.506) × $33.4009 = $325.22
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 2.29 | 1 |
| Practice expense | 1.75 | 0.99 |
| Malpractice | 0.18 | 0.506 |
(2.29 × 1 + 1.75 × 0.99 + 0.18 × 0.506) × $33.4009 = $137.40
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.
68420 billing questions
When is 68420 appropriate instead of lacrimal punctum treatment?
Use 68420 when the service drains an infected or abscessed lacrimal sac. Treatment directed at a blocked punctum without a sac collection is a different service.
How does 68420 differ from drainage of the lacrimal gland?
The treated structure determines the code: 68420 is for the lacrimal sac, while 68400 is for the lacrimal gland.
Are postoperative visits separately reported during the global period?
Related postoperative visits during the 10-day global period are included in 68420.
How is bilateral drainage handled?
For bilateral performance, report modifier 50; CMS pays the procedure at 150%.
Can an assistant surgeon or co-surgeon be reported?
Assistant-at-surgery payment is subject to a statutory restriction. Co-surgeons and team surgery are not permitted for this code.
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 procedure or 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 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.
7,55068371,,Harvest eye tissue alograft,A,,4.96,5.38,NA,5.38,,0.40,10.74,10.74,0,010,0.10,0.80,0.10,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,55168399,,Unlisted px conjunctiva,C,,0.00,0.00,,0.00,,0.00,0.00,0.00,0,YYY,0.00,0.00,0.00,2,1,0,1,1,9,,33.4009,09,0,99,0.00,0.00,0.00
7,55268400,,I&d lacrimal gland,A,,1.70,7.02,,1.54,,0.14,8.86,3.38,0,010,0.10,0.80,0.10,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,55368420,,I&d lacrimal sac,A,,2.29,7.43,,1.75,,0.18,9.90,4.22,0,010,0.10,0.80,0.10,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,55468440,,Snip inc lacrimal punctum,A,,0.97,2.14,,1.68,,0.07,3.18,2.72,0,010,0.10,0.80,0.10,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,55568500,,Removal of tear gland,A,,12.45,14.12,NA,14.12,,1.01,27.58,27.58,0,090,0.10,0.70,0.20,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,55668505,,Partial removal tear gland,A,,12.37,14.10,NA,14.10,,1.00,27.47,27.47,0,090,0.10,0.70,0.20,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
10204412,TX,18,HOUSTON,1.008,0.993,1.376
10304412,TX,99,REST OF TEXAS,1.000,0.949,0.903
10403502,UT,09,UTAH,1.000,0.940,0.898
10514512,VT,50,VERMONT,1.000,0.990,0.506
10611302,VA,00,VIRGINIA,1.000,0.983,0.706
10709202,VI,50,VIRGIN ISLANDS,1.000,1.011,0.985
10802402,WA,02,SEATTLE (KING CNTY),1.050,1.227,0.817