CPT 68815
Global 010 ActiveProbe nasolacrimal duct
CPT 68815 Billing & Documentation Guide
CPT code 68815 (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 2.63, a non-facility practice expense RVU of 8.33, and a malpractice RVU of 0.21, a total non-facility RVU of 11.17 and facility RVU of 5.78. With the current conversion factor of $33.4009, the national average non-facility reimbursement is approximately $386.01, though rates vary from $330.46 to $502.47 based on MAC locality and Geographic Practice Cost Indices (GPCIs).
When billing 68815, 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 68815 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 68815 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 68815
| Component | Non-Facility | Facility |
|---|---|---|
| Work RVU | 2.63 | 2.63 |
| Practice Expense RVU | 8.33 | 2.94 |
| Malpractice RVU | 0.21 | 0.21 |
| Total RVU | 11.17 | 5.78 |
| Conversion Factor | $33.4009 | |
2026 Medicare Reimbursement by State, CPT 68815
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 | $424.02 | $210.99 | $398.04 - $502.47 | 29 |
| Florida | $380.65 | $200.02 | $364.37 - $395.22 | 3 |
| Georgia | $361.8 | $190.05 | $344.39 - $379.21 | 2 |
| Illinois | $370.4 | $196.44 | $352.83 - $386.63 | 4 |
| Michigan | $358.98 | $189.93 | $349.79 - $368.16 | 2 |
| North Carolina | $351.91 | $183.95 | $351.91 - $351.91 | 1 |
| New York | $411.94 | $211.09 | $357.09 - $437.31 | 5 |
| Ohio | $348.94 | $184.57 | $348.94 - $348.94 | 1 |
| Pennsylvania | $368.66 | $192.32 | $349.89 - $387.43 | 2 |
| Texas | $368.76 | $191.52 | $347.55 - $388.6 | 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 68815
Procedure-to-procedure (PTP) edits. If you bill any of these codes with 68815 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 68815
What does CPT code 68815 mean? +
CPT code 68815 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 68815? +
The 2026 Medicare national average non-facility payment for CPT 68815 is $386.01. Rates range from $330.46 to $502.47 across 53 states depending on MAC locality and GPCIs.
What modifiers can I use with CPT 68815? +
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 68815? +
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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