CPT 68840
Global 010 ActiveExplore/irrigate tear ducts
CPT 68840 Billing & Documentation Guide
CPT code 68840 (Explore/irrigate tear ducts) 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 1.27, a non-facility practice expense RVU of 2.66, and a malpractice RVU of 0.09, a total non-facility RVU of 4.02 and facility RVU of 3.13. With the current conversion factor of $33.4009, the national average non-facility reimbursement is approximately $138.58, though rates vary from $120.29 to $176.81 based on MAC locality and Geographic Practice Cost Indices (GPCIs).
When billing 68840, 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 68840 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 68840 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 68840
| Component | Non-Facility | Facility |
|---|---|---|
| Work RVU | 1.27 | 1.27 |
| Practice Expense RVU | 2.66 | 1.77 |
| Malpractice RVU | 0.09 | 0.09 |
| Total RVU | 4.02 | 3.13 |
| Conversion Factor | $33.4009 | |
2026 Medicare Reimbursement by State, CPT 68840
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 | $150.7 | $115.53 | $142.13 - $176.81 | 29 |
| Florida | $137.41 | $107.59 | $131.87 - $142.51 | 3 |
| Georgia | $130.83 | $102.48 | $125.25 - $136.42 | 2 |
| Illinois | $134.16 | $105.44 | $128.23 - $139.29 | 4 |
| Michigan | $130.08 | $102.17 | $126.93 - $133.22 | 2 |
| North Carolina | $127.23 | $99.5 | $127.23 - $127.23 | 1 |
| New York | $147.63 | $114.47 | $128.94 - $156.35 | 5 |
| Ohio | $126.57 | $99.43 | $126.57 - $126.57 | 1 |
| Pennsylvania | $133.04 | $103.92 | $126.82 - $139.26 | 2 |
| Texas | $132.91 | $103.65 | $126.06 - $139.17 | 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 68840
Procedure-to-procedure (PTP) edits. If you bill any of these codes with 68840 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 68840
What does CPT code 68840 mean? +
CPT code 68840 represents: Explore/irrigate tear ducts. It's in the Surgery (Endocrine/Nervous/Eye/Ear) category with a global period of 010.
What is the Medicare reimbursement for CPT 68840? +
The 2026 Medicare national average non-facility payment for CPT 68840 is $138.58. Rates range from $120.29 to $176.81 across 53 states depending on MAC locality and GPCIs.
What modifiers can I use with CPT 68840? +
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 68840? +
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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