CPT 69205
Global 010 ActiveClear outer ear canal
CPT 69205 Billing & Documentation Guide
CPT code 69205 (Clear outer ear canal) 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 1.18, a non-facility practice expense RVU of 1.27, and a malpractice RVU of 0.17, a total non-facility RVU of 2.62 and facility RVU of 2.62. With the current conversion factor of $33.4009, the national average non-facility reimbursement is approximately $89.35, though rates vary from $78.78 to $107.96 based on MAC locality and Geographic Practice Cost Indices (GPCIs).
When billing 69205, 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 69205 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 69205 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 69205
| Component | Non-Facility | Facility |
|---|---|---|
| Work RVU | 1.18 | 1.18 |
| Practice Expense RVU | 1.27 | 1.27 |
| Malpractice RVU | 0.17 | 0.17 |
| Total RVU | 2.62 | 2.62 |
| Conversion Factor | $33.4009 | |
2026 Medicare Reimbursement by State, CPT 69205
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 | $94.1 | $94.1 | $89.62 - $107.96 | 29 |
| Florida | $93.03 | $93.03 | $88.5 - $97.93 | 3 |
| Georgia | $86.74 | $86.74 | $84.02 - $89.45 | 2 |
| Illinois | $91.39 | $91.39 | $87.02 - $95.35 | 4 |
| Michigan | $87.24 | $87.24 | $84.55 - $89.92 | 2 |
| North Carolina | $82.62 | $82.62 | $82.62 - $82.62 | 1 |
| New York | $96.32 | $96.32 | $83.7 - $102.92 | 5 |
| Ohio | $83.87 | $83.87 | $83.87 - $83.87 | 1 |
| Pennsylvania | $87.38 | $87.38 | $83.72 - $91.05 | 2 |
| Texas | $86.66 | $86.66 | $83.29 - $89.66 | 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 69205
Procedure-to-procedure (PTP) edits. If you bill any of these codes with 69205 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 69205
What does CPT code 69205 mean? +
CPT code 69205 represents: Clear outer ear canal. It's in the Surgery (Endocrine/Nervous/Eye/Ear) category with a global period of 010.
What is the Medicare reimbursement for CPT 69205? +
The 2026 Medicare national average non-facility payment for CPT 69205 is $89.35. Rates range from $78.78 to $107.96 across 53 states depending on MAC locality and GPCIs.
What modifiers can I use with CPT 69205? +
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 69205? +
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 July 16, 2026.
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