CPT 68801
Global 010 ActiveDilate tear duct opening
CPT 68801 Billing & Documentation Guide
CPT code 68801 (Dilate tear duct opening) is classified under Surgery (Endocrine/Nervous/Eye/Ear) with a global period indicator of 010. The 2026 Medicare Physician Fee Schedule assigns a work RVU of 0.8, a non-facility practice expense RVU of 1.98, and a malpractice RVU of 0.05, a total non-facility RVU of 2.83 and facility RVU of 2.15. With the current conversion factor of $33.4009, the national average non-facility reimbursement is approximately $97.72, though rates vary from $84.39 to $125.92 based on MAC locality and Geographic Practice Cost Indices (GPCIs).
When billing 68801, ensure documentation supports medical necessity and the specific components required for the code's level of service. For E/M codes, document MDM (medical decision-making) elements: problems addressed, data reviewed, and risk. For procedural codes, document the indication, technique, and any complications. Always verify NCCI edits before bundling 68801 with related codes; this code has 10 PTP bundling relationships on file (see table below).
Payment Status & Global Period
Active code (paid under MPFS)
10-day global period (minor procedure: pre-op day + procedure + 10 days post-op)
MUE Limit (Medically Unlikely Edits)
Submitting more than 4 units of 68801 for the same patient on the same date triggers automatic line denial unless an appropriate modifier and supporting documentation justify the higher quantity.
RVU Breakdown, CPT 68801
| Component | Non-Facility | Facility |
|---|---|---|
| Work RVU | 0.8 | 0.8 |
| Practice Expense RVU | 1.98 | 1.3 |
| Malpractice RVU | 0.05 | 0.05 |
| Total RVU | 2.83 | 2.15 |
| Conversion Factor | $33.4009 | |
2026 Medicare Reimbursement by State, CPT 68801
State-level averages across all MAC localities. Non-facility rates typically apply to office-based services; facility rates apply to hospital outpatient / inpatient.
| State | Non-Facility | Facility | Range (Non-Fac) | Localities |
|---|---|---|---|---|
| California | $106.84 | $79.96 | $100.55 - $125.92 | 29 |
| Florida | $96.32 | $73.54 | $92.45 - $99.79 | 3 |
| Georgia | $91.85 | $70.18 | $87.7 - $96 | 2 |
| Illinois | $93.91 | $71.96 | $89.71 - $97.79 | 4 |
| Michigan | $91.18 | $69.85 | $88.99 - $93.36 | 2 |
| North Carolina | $89.49 | $68.3 | $89.49 - $89.49 | 1 |
| New York | $104.04 | $78.7 | $90.72 - $110.17 | 5 |
| Ohio | $88.78 | $68.05 | $88.78 - $88.78 | 1 |
| Pennsylvania | $93.53 | $71.28 | $89.01 - $98.04 | 2 |
| Texas | $93.53 | $71.17 | $88.45 - $98.22 | 8 |
Source: CMS PFSRVU 2026 · Updated 2026-04-01. Full locality-level detail available for all 53 states, contact us for custom reports.
NCCI Bundling Edits, CPT 68801
Procedure-to-procedure (PTP) edits. If you bill any of these codes with 68801 on the same date of service, review the modifier indicator and payer policy before submission.
| Partner Code | Relationship | Modifier Allowed | Rationale |
|---|---|---|---|
| 0213T | Column 1 (primary), can be billed with modifier | No | Misuse of Column Two code with Column One code |
| 0216T | Column 1 (primary), can be billed with modifier | No | Misuse of Column Two code with Column One code |
| 0228T | Column 1 (primary), can be billed with modifier | No | Standards of medical/surgical practice |
| 0230T | Column 1 (primary), can be billed with modifier | No | Standards of medical/surgical practice |
| 0596T | Column 1 (primary), can be billed with modifier | Yes | Standards of medical/surgical practice |
| 0597T | Column 1 (primary), can be billed with modifier | Yes | Standards of medical/surgical practice |
| 0708T | Column 1 (primary), can be billed with modifier | Yes | Standards of medical/surgical practice |
| 0709T | Column 1 (primary), can be billed with modifier | Yes | Standards of medical/surgical practice |
| 0903T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 0904T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
Frequently Asked Questions, CPT 68801
What does CPT code 68801 mean? +
CPT code 68801 represents: Dilate tear duct opening. It's in the Surgery (Endocrine/Nervous/Eye/Ear) category with a global period of 010.
What is the Medicare reimbursement for CPT 68801? +
The 2026 Medicare national average non-facility payment for CPT 68801 is $97.72. Rates range from $84.39 to $125.92 across 53 states depending on MAC locality and GPCIs.
What modifiers can I use with CPT 68801? +
Surgery codes commonly use modifier 22 (increased procedural services), 50 (bilateral), 51 (multiple procedures), 52 (reduced services), 58/78/79 (staged, unplanned return, unrelated within global), 62 (co-surgeons), 80/82 (assistant surgeon), and 59 or the X{EPSU} subset for distinct procedural service.
What bundling edits apply to CPT 68801? +
This code has 10 NCCI PTP bundling relationships. See the NCCI Bundling section below for full list.
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Reviewed by the PayerReady Medical Coding Team
Verified against the CMS 2026 code set on May 31, 2026.
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