No office rate
Both involve an eardrum incision without tube placement; 69421 applies when general anesthesia is required.
On this page
CMS RVU26D · Effective 2026-10-01
69420 Eardrum incision Medicare reimbursement rates in Wyoming
Report this service when a clinician makes an opening in the eardrum to drain middle-ear fluid or perform related myringotomy care without placing a tube. Compare 69420 office and facility rates across CMS payment localities in Wyoming.
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 69420 in Wyoming?
Wyoming 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
$189.98
1 of 1 localities have a supported rate.
Payment area: Wyoming**
One mapped payment locality.
Facility setting
$108.82
1 of 1 localities have a supported rate.
Payment area: Wyoming**
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.
Otolaryngology procedure
About 69420: Eardrum incision without tube placement
Report this service when a clinician makes an opening in the eardrum to drain middle-ear fluid or perform related myringotomy care without placing a tube.
An otolaryngologist typically makes a small incision in the tympanic membrane to access or drain middle-ear fluid. The service may include aspiration and/or eustachian tube inflation; no ventilating tube is placed. It is commonly performed in an office or outpatient setting for selected middle-ear conditions, such as fluid behind the eardrum. The incision may be performed on one or both ears.
Select this code for the incision service without tube insertion, rather than a code for tympanostomy with a tube. Document the clinical reason, the ear treated, the procedure performed, and whether fluid was aspirated. Medicare includes related postoperative visits during the 10-day global period. When multiple procedures are performed in the same session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% multiple-procedure reduction. Bilateral reporting with modifier 50 is paid at 150%. Medicare does not pay an assistant at surgery for this service; co-surgeons and team surgery are not permitted.
CMS billing rules for 69420
- 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 RVU1.35 · 24%
- Practice expense (office) RVU4.19 · 73%
- Malpractice RVU0.20 · 3%
13.4K
Medicare services in 2024 · #1317 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.
69420 compared with similar codes
Office rates for Wyoming, from the same CMS release.
$200.59
This code includes placement of a ventilating tube under local or topical anesthesia; 69420 describes incision without tube insertion.
No office rate
This code includes ventilating tube placement when general anesthesia is required; 69420 is for incision without a tube.
Compare 69420 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
Wyoming** →
Office / nonfacility
$189.98
Facility
$108.82
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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 69420 in Wyoming**.
PPRRVU2026_Oct_nonQPP.csv
7,602
- Code
- 69420
- Physician work
- 1.35
- Practice expense
- 4.19
- Malpractice
- 0.20
GPCI2026.csv
112
- Locality
- Wyoming**
- Physician work
- 1.000
- Practice expense
- 1.000
- Malpractice
- 0.740
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 1.35 | × 1.000 | 1.3500 |
| Practice expense | 4.19 | × 1.000 | 4.1900 |
| Malpractice | 0.20 | × 0.740 | 0.1480 |
| Total RVUs | 5.6880 | ||
| Conversion factor | × 33.4009 | ||
Office / nonfacility rate, Wyoming**$189.98
Explore RVUs, geographic factors and the full formula
Office / nonfacility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 1.35 | 1 |
| Practice expense | 4.19 | 1 |
| Malpractice | 0.2 | 0.74 |
(1.35 × 1 + 4.19 × 1 + 0.2 × 0.74) × $33.4009 = $189.98
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 1.35 | 1 |
| Practice expense | 1.76 | 1 |
| Malpractice | 0.2 | 0.74 |
(1.35 × 1 + 1.76 × 1 + 0.2 × 0.74) × $33.4009 = $108.82
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.
69420 billing questions
How is 69420 different from 69421?
Both describe an eardrum incision without tube placement. Code 69421 is for the procedure requiring general anesthesia; 69420 is used when general anesthesia is not required.
Can aspiration be billed separately?
Aspiration associated with the myringotomy is included in 69420. The procedure may also include eustachian tube inflation.
When should a tube-placement code be used instead?
Use a tympanostomy code when a ventilating tube is inserted through the eardrum. Codes 69433 and 69436 distinguish tube placement by anesthesia circumstances.
How is the procedure reported when both ears are treated?
Report bilateral treatment with modifier 50. CMS pays the bilateral procedure at 150%.
What postoperative care is included?
Related postoperative visits during the 10-day global period are included in the procedure payment.
Can an assistant or co-surgeon be billed?
Medicare does not pay an assistant at surgery for 69420. 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 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.
7,59969310,,Rebuild outer ear canal,A,,10.70,18.72,NA,18.72,,1.63,31.05,31.05,0,090,0.07,0.79,0.14,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,60069320,,Rebuild outer ear canal,A,,16.75,23.52,NA,23.52,,2.44,42.71,42.71,0,090,0.07,0.79,0.14,2,1,2,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,60169399,,Unlisted px external ear,C,,0.00,0.00,,0.00,,0.00,0.00,0.00,0,YYY,0.00,0.00,0.00,2,0,0,1,1,9,,33.4009,09,0,99,0.00,0.00,0.00
7,60269420,,Incision of eardrum,A,,1.35,4.19,,1.76,,0.20,5.74,3.31,0,010,0.10,0.80,0.10,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,60369421,,Incision of eardrum,A,,1.74,2.14,NA,2.14,,0.25,4.13,4.13,0,010,0.10,0.80,0.10,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,60469424,,Remove ventilating tube,A,,0.83,2.98,,0.74,,0.09,3.90,1.66,0,000,0.00,0.00,0.00,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,60569433,,Create eardrum opening,A,,1.53,4.32,,1.84,,0.21,6.06,3.58,0,010,0.10,0.80,0.10,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
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,,,,,,
115*Work GPCI reflects a 1.5 floor in Alaska established by the MIPPA.,,,,,,