$596.08
Use 68320 for conjunctival grafting or extensive tissue rearrangement; 68330 describes conjunctivoplasty without a graft.
On this page
CMS RVU26D · Effective 2026-10-01
68320 Conjunctivoplasty Medicare reimbursement rates in Wisconsin
Report this service when an ophthalmic surgeon reconstructs the conjunctival lining using a conjunctival graft or extensive tissue rearrangement. Compare 68320 office and facility rates across CMS payment localities in Wisconsin.
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 68320 in Wisconsin?
Wisconsin 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
$713.80
1 of 1 localities have a supported rate.
Payment area: Wisconsin
One mapped payment locality.
Facility setting
$446.62
1 of 1 localities have a supported rate.
Payment area: Wisconsin
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.
Ophthalmic surgery
About 68320: Conjunctival reconstruction with graft
Report this service when an ophthalmic surgeon reconstructs the conjunctival lining using a conjunctival graft or extensive tissue rearrangement.
An ophthalmic surgeon uses this code to repair or reconstruct the conjunctival lining when a graft of conjunctival tissue or extensive rearrangement is needed. The work may address scarred or contracted tissue that interferes with the lining’s function, including changes associated with adhesions or ocular surface injury. It is performed in an ophthalmic surgical setting by a surgeon managing the affected eye and surrounding tissues.
Choose the code based on the documented reconstruction method and extent, distinguishing graft-based or extensive rearrangement from a procedure without grafting or a different graft type. The operative report should identify the affected area, the tissue used or rearranged, and the reconstructive work performed. This major surgery includes the day-before preoperative visit and 90 days of related postoperative care. For bilateral reporting with modifier 50, CMS pays 150%. When multiple procedures are performed in one session, the highest-valued is paid in full and others at 50%. Assistant-at-surgery payment is restricted; co-surgeons require supporting documentation, and team surgery is not permitted.
CMS billing rules for 68320
- 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 RVU6.47 · 29%
- Practice expense (office) RVU15.39 · 69%
- Malpractice RVU0.51 · 2%
5.6K
Medicare services in 2024 · #1798 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.
68320 compared with similar codes
Office rates for Wisconsin, from the same CMS release.
No office rate
Use 68325 when the reconstruction uses a buccal mucous membrane graft. This code covers a conjunctival graft or extensive rearrangement.
$588.60
Use 68340 for separating eyelid adhesions. Choose 68320 when the documented service reconstructs the conjunctival lining with a graft or extensive rearrangement.
Compare 68320 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
Wisconsin →
Office / nonfacility
$713.80
Facility
$446.62
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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 68320 in Wisconsin.
PPRRVU2026_Oct_nonQPP.csv
7,541
- Code
- 68320
- Physician work
- 6.47
- Practice expense
- 15.39
- Malpractice
- 0.51
GPCI2026.csv
111
- Locality
- Wisconsin
- Physician work
- 1.000
- Practice expense
- 0.958
- Malpractice
- 0.308
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 6.47 | × 1.000 | 6.4700 |
| Practice expense | 15.39 | × 0.958 | 14.7436 |
| Malpractice | 0.51 | × 0.308 | 0.1571 |
| Total RVUs | 21.3707 | ||
| Conversion factor | × 33.4009 | ||
Office / nonfacility rate, Wisconsin$713.80
Explore RVUs, geographic factors and the full formula
Office / nonfacility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 6.47 | 1 |
| Practice expense | 15.39 | 0.958 |
| Malpractice | 0.51 | 0.308 |
(6.47 × 1 + 15.39 × 0.958 + 0.51 × 0.308) × $33.4009 = $713.80
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 6.47 | 1 |
| Practice expense | 7.04 | 0.958 |
| Malpractice | 0.51 | 0.308 |
(6.47 × 1 + 7.04 × 0.958 + 0.51 × 0.308) × $33.4009 = $446.62
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.
68320 billing questions
When should I report this instead of 68330?
Report 68320 when the reconstruction uses a conjunctival graft or extensive tissue rearrangement. Code 68330 is for conjunctivoplasty without a graft.
What operative details support 68320?
Document the affected conjunctival area, the graft or rearrangement performed, and the extent of the reconstruction. The record should make the method distinguishable from a procedure without grafting.
How does CMS treat bilateral reporting?
For a bilateral procedure reported with modifier 50, CMS pays 150%.
How are other procedures in the same session paid?
Under the standard multiple procedure reduction, the highest-valued procedure is paid in full and the others at 50%.
Does the surgical assistant receive payment?
CMS applies a statutory restriction on assistant-at-surgery payment for this code. Co-surgeons are paid only with supporting documentation, and team surgery is not permitted.
What postoperative care is included?
The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care.
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.
7,53868130,,Exc les conjunctiva adj scl,A,,4.97,11.23,,5.34,,0.40,16.60,10.71,0,090,0.10,0.70,0.20,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,53968135,,Destruction les conjunctiva,A,,1.84,2.79,,1.90,,0.15,4.78,3.89,0,010,0.10,0.80,0.10,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,54068200,,Treat eyelid by injection,A,,0.48,0.72,,0.35,,0.04,1.24,0.87,0,000,0.00,0.00,0.00,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,54168320,,Revise/graft eyelid lining,A,,6.47,15.39,,7.04,,0.51,22.37,14.02,0,090,0.10,0.70,0.20,2,1,1,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,54268325,,Revise/graft eyelid lining,A,,8.41,7.71,NA,7.71,,0.66,16.78,16.78,0,090,0.10,0.70,0.20,2,1,1,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,54368326,,Revise/graft eyelid lining,A,,8.21,7.65,NA,7.65,,0.67,16.53,16.53,0,090,0.10,0.70,0.20,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,54468328,,Revise/graft eyelid lining,A,,9.21,7.99,NA,7.99,,0.73,17.93,17.93,0,090,0.10,0.70,0.20,2,1,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
10802402,WA,02,SEATTLE (KING CNTY),1.050,1.227,0.817
10902402,WA,99,REST OF WASHINGTON,1.013,1.053,0.761
11011402,WV,16,WEST VIRGINIA,1.000,0.869,1.431
11106302,WI,00,WISCONSIN,1.000,0.958,0.308
11203602,WY,21,WYOMING**,1.000,1.000,0.740
113"MAC Assignments as of November 22, 2023",,,,,,
114,,,,,,