$465.30–$521.79
68510 represents biopsy of the lacrimal gland. Use 68540 when the surgeon excises the lesion rather than taking tissue for diagnostic sampling.
On this page
CMS RVU26D · Effective 2026-10-01
68540 Lacrimal lesion excision Medicare reimbursement rates in Washington
Reports surgical removal of a localized, non-tumor lesion of the lacrimal gland, rather than biopsy or removal of the gland itself. Compare 68540 office and facility rates across CMS payment localities in Washington.
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 68540 in Washington?
Washington has 2 payment localities in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the 2 payment areas shown below, using the same CMS release.
Office / nonfacility
No supported rate
Facility setting
$867.15–$956.49
2 of 2 localities have a supported rate.
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.
Ophthalmic surgery
About 68540: Excision of lacrimal gland lesion
Reports surgical removal of a localized, non-tumor lesion of the lacrimal gland, rather than biopsy or removal of the gland itself.
An ophthalmic surgeon, often an oculoplastic specialist, removes a discrete lesion arising in the lacrimal gland while distinguishing the procedure from removal of the whole gland. The lacrimal gland sits in the upper outer portion of the orbit and produces tears. The service is generally performed in an operating-room setting; Medicare recorded facility services for this code in 2024.
Choose this code when the operative service removes a gland lesion, not when the provider only takes a diagnostic sample or removes the gland or a portion of it. Documentation should identify the lacrimal gland as the site, describe the lesion, and explain the excision performed. Medicare assigns a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. When multiple procedures occur in the same session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% reduction. Bilateral reporting with modifier 50 is paid at 150%. Medicare does not pay an assistant at surgery; co-surgeons require supporting documentation, and team surgery is not permitted.
CMS billing rules for 68540
- Global period
- Major surgery with a 90-day global period: the day-before preoperative visit and 90 days of related postoperative care 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 paid only with supporting documentation.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU11.88 · 47%
- Practice expense (office) RVU12.54 · 49%
- Malpractice RVU0.95 · 4%
26
Medicare services in 2024 · #5772 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.
68540 compared with similar codes
Office rates for Washington, from the same CMS release.
No office rate
68500 represents removal of the lacrimal gland itself. Use 68540 for excision of a localized gland lesion without reporting whole-gland removal.
No office rate
68505 represents partial removal of lacrimal gland tissue. Choose 68540 when the operative target is a discrete lesion rather than a portion of the gland.
No office rate
68550 applies to lesion excision from the lacrimal sac. Code 68540 is for a lesion arising in the lacrimal gland.
Compare 68540 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.
2 of 2 payment localities
Rest Of Washington →
Office / nonfacility
Unavailable
Facility
$867.15
Seattle (King Cnty) →
Office / nonfacility
Unavailable
Facility
$956.49
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68540 billing questions
How is this different from lacrimal gland biopsy?
Report 68540 when the surgeon removes the lesion. Report 68510 when the service is limited to obtaining tissue for diagnostic examination.
When would 68500 or 68505 be more appropriate?
Those codes describe removal of the lacrimal gland or part of the gland. Use 68540 for excision of a discrete lesion rather than gland removal.
Can modifier 50 be used for lesions on both sides?
Yes. CMS identifies this as a bilateral procedure; bilateral reporting with modifier 50 is paid 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.
Can an assistant or co-surgeon be reported?
Medicare does not pay an assistant at surgery for this code. Co-surgeon payment requires supporting documentation; team surgery is not permitted.
What documentation supports reporting 68540?
Document that the lesion arose from the lacrimal gland, its clinical description, and the excision performed. Clarify whether the service removed a lesion, sampled tissue, or removed gland tissue.
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.
7,55868520,,Removal of tear sac,A,,8.56,10.00,NA,10.00,,0.71,19.27,19.27,0,090,0.10,0.70,0.20,2,1,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,55968525,,Biopsy of tear sac,A,,4.31,1.51,NA,1.51,,0.36,6.18,6.18,0,000,0.00,0.00,0.00,2,1,1,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,56068530,,Clearance of tear duct,A,,3.61,9.09,,2.48,,0.28,12.98,6.37,0,010,0.10,0.80,0.10,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,56168540,,Remove tear gland lesion,A,,11.88,12.54,NA,12.54,,0.95,25.37,25.37,0,090,0.10,0.70,0.20,2,1,1,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,56268550,,Remove tear gland lesion,A,,14.78,15.57,NA,15.57,,1.19,31.54,31.54,0,090,0.10,0.70,0.20,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,56368700,,Repair tear ducts,A,,7.67,7.17,NA,7.17,,0.62,15.46,15.46,0,090,0.10,0.70,0.20,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,56468705,,Revise tear duct opening,A,,2.06,5.55,,2.06,,0.17,7.78,4.29,0,010,0.10,0.80,0.10,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00