CPT 68811
Global 010 ActiveProbe nasolacrimal duct
CPT 68811 Billing & Documentation Guide
CPT code 68811 (Probe nasolacrimal duct) 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 1.7, a non-facility practice expense RVU of 1.67, and a malpractice RVU of 0.15, a total non-facility RVU of 3.52 and facility RVU of 3.52. With the current conversion factor of $33.4009, the national average non-facility reimbursement is approximately $120.44, though rates vary from $107.28 to $147.34 based on MAC locality and Geographic Practice Cost Indices (GPCIs).
When billing 68811, 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 68811 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 1 units of 68811 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 68811
| Component | Non-Facility | Facility |
|---|---|---|
| Work RVU | 1.7 | 1.7 |
| Practice Expense RVU | 1.67 | 1.67 |
| Malpractice RVU | 0.15 | 0.15 |
| Total RVU | 3.52 | 3.52 |
| Conversion Factor | $33.4009 | |
2026 Medicare Reimbursement by State, CPT 68811
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 | $127.54 | $127.54 | $121.57 - $146.15 | 29 |
| Florida | $122.5 | $122.5 | $117.64 - $127.52 | 3 |
| Georgia | $116.08 | $116.08 | $112.51 - $119.64 | 2 |
| Illinois | $120.45 | $120.45 | $115.54 - $124.74 | 4 |
| Michigan | $116.21 | $116.21 | $113.36 - $119.06 | 2 |
| North Carolina | $112.03 | $112.03 | $112.03 - $112.03 | 1 |
| New York | $128.51 | $128.51 | $113.29 - $136.04 | 5 |
| Ohio | $112.76 | $112.76 | $112.76 - $112.76 | 1 |
| Pennsylvania | $117.29 | $117.29 | $112.72 - $121.85 | 2 |
| Texas | $116.66 | $116.66 | $112.2 - $120.35 | 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 68811
Procedure-to-procedure (PTP) edits. If you bill any of these codes with 68811 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 68811
What does CPT code 68811 mean? +
CPT code 68811 represents: Probe nasolacrimal duct. It's in the Surgery (Endocrine/Nervous/Eye/Ear) category with a global period of 010.
What is the Medicare reimbursement for CPT 68811? +
The 2026 Medicare national average non-facility payment for CPT 68811 is $120.44. Rates range from $107.28 to $147.34 across 53 states depending on MAC locality and GPCIs.
What modifiers can I use with CPT 68811? +
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 68811? +
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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