Billing code 68520: Tear sac surgeryMedicare rate & RVUs in Washington
Reports surgical removal of the lacrimal sac, typically for selected cases of chronic or recurrent sac disease requiring excision rather than drainage bypass.
CMS doesn’t publish an office rate for 68520 in Washington.
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 68520 covers
An ophthalmologist, often an oculoplastic surgeon, removes the lacrimal sac. This operation may be selected for chronic or recurrent dacryocystitis or other sac disease when removing the sac is the planned treatment. It is distinct from creating a new drainage route while preserving the sac. The procedure is generally performed in an operative setting, and the operative report should identify the affected side, the sac condition, and the extent of excision.
Report the code for the sac excision itself, not for a lacrimal gland procedure or a limited diagnostic sample. Documentation should support why the sac was removed and describe the work performed. The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care. For bilateral surgery, modifier 50 is paid at 150%. When other procedures are performed in the same session, the highest-valued procedure is paid in full and additional procedures are subject to the standard 50% multiple-procedure reduction. Assistant-at-surgery payment requires documented 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.
Where 68520 pays more and less in Washington
| Payment locality | Office | Facility |
|---|---|---|
| Rest Of Washington | Unavailable | $659.39 |
| Seattle (King Cnty) | Unavailable | $729.41 |
How the 68520 rate is calculated
Each of 68520’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 · 68520
RVUs × geographic indexes × conversion factor
Work8.56
8.56 RVUs× 1.000 GPCI
Practice expense10.00
10.00 RVUs× 1.000 GPCI
Malpractice0.71
0.71 RVUs× 1.000 GPCI
Adjusted RVUs
19.2700
Conversion factor
$33.4009
Medicare rate
$643.64
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 68520
68520 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 68520
Tear sac surgery
| 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 · 68520
Tear sac surgery
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
68520 without 50 · national facility
$643.64
Tear sac surgery
68520-50 · Bilateral: 150%
$965.46
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).
68520 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 68720Tear drainage surgery
- Choose this code when the lacrimal sac is removed. Use 68720 when the operation establishes a drainage bypass and retains the sac.
- 68525Tear sac biopsy
- 68525 represents a diagnostic tissue sample from the lacrimal sac; this code is for removal of the sac, not biopsy alone.
- 68500Lacrimal gland surgery
- 68500 concerns the lacrimal gland, which produces tears. This code concerns the lacrimal sac in the tear-drainage system.
68520 billing questions
How does sac removal differ from a dacryocystorhinostomy?
This code represents removal of the lacrimal sac. A dacryocystorhinostomy creates a drainage bypass while retaining the sac.
Can a sac biopsy be reported with the excision?
A separate biopsy code is generally for sampling when the sac is not being removed. The operative documentation should support the distinct work if both procedures are reported.
How is bilateral sac removal reported?
Report bilateral surgery with modifier 50; CMS pays the bilateral procedure at 150%.
What postoperative care is included?
The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care.
May an assistant or co-surgeon be reported?
Assistant-at-surgery payment requires documentation of medical necessity. 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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