Rate Benchmarking
Compare your rates with similar providers.
Select a published rate, define comparable providers, and see where that rate falls in your market.
See a sample rate comparisonCPT 68040 Fee Schedule
Last Verified: October 2026
Healthcare providers use this code to document and receive reimbursement for visits that address moderate-level medical decision-making, often including multiple diagnoses or prescription management.
Remove A Bump From The Eyelid, Procedure To Remove Grain-Like Bumps Caused By Irritation (Follicles) From The Inside Of The Eyelid.
| Key Fact | Detail |
|---|---|
| Service Type | Surgery Surgical Procedures on the Eye and Ocular Adnexa |
| Common Place of Service | 11 - Office 24 - Ambulatory Surgical Center |
| Common Modifiers | None E2 - Lower left, eyelid E4 - Lower right, eyelid |
| Complexity Level | Low |
| Medicare Fee Schedule | View Medicare rates for 68040 |
| Medicaid Fee Schedule | View Medicaid rates for 68040 |
National average reimbursement for CPT 68040 by major payers:
$84.17
$89.10
$86.52
$113.74
Compare published rates across providers.
Choose a payer to see a sample of rates for CPT 68040.
CPT 68040
5 of 25 sample ratesHigher to lower in this preview
Ocean Surgical Pavilion, PC, Ocean Surgical Pavilion
$1,344.00Published rateBaptist Plaza Surgicare Lp, Saint Thomas Surgery Center - Midtown
$541.00Published rateSeattle Hand Surgery Group PC, Seattle Hand Surgery Unit, Inc
Seattle Hand Surgery Group, P.C.
$231.00Published ratePvscg, LLC
Pvscg LLC
$110.00Published rateDigestive Health Specialists, PA
Digestive Health Specialists, P.A.
$35.00Published rate
Get a free rate benchmark for your specialty.
Choose your state and specialty to build a report from payer-published rates.
Use market rates to prepare your payer proposal.
Payer Contract Negotiation
Draft a fee schedule renegotiation letter.
Use your fee schedule and market benchmarks to set target rates and draft a letter for your payer.
See a sample payer proposalCPT 68040 vs. Other Surgical Procedures on the Eye and Ocular Adnexa Codes
The CPT 68040 code is part of the Surgery services used for Surgical Procedures on the Eye and Ocular Adnexa. It represents a moderate-complexity encounter and is one of several codes that vary based on time spent, level of medical decision-making, and documentation requirements.
The CPT 68040 code involves more provider time and moderate medical decision-making, unlike lower-level codes that require less time and simpler assessments. It typically includes multiple diagnoses, medication management, or test interpretation, leading to higher reimbursement and more detailed documentation requirements.
| Code | Complexity | Description |
|---|---|---|
| 68020-CPT | Low | Surgery To Drain An Eye Cyst, Surgery To Drain A Cyst (Fluid-Filled Sac) On The Conjunctiva The Clear Mucous Membrane That Covers The Eye. |
| 68040-CPT | Low | Remove A Bump From The Eyelid, Procedure To Remove Grain-Like Bumps Caused By Irritation (Follicles) From The Inside Of The Eyelid. |
| 68100-CPT | Moderate | Biopsy Of Eye Membrane, Surgery On The Eye Membrane (Conjunctiva) To Remove A Sample Of Tissue For Testing (Biopsy). The Conjunctiva Is A Clear Membrane That Covers The Eye. |
| 68110-CPT | Moderate | Remove Growth From The Eye, Surgery To Remove A Growth Of Abnormal Tissue From The Clear Covering Of The Eye (Conjunctiva). |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 68040. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 68040 fee schedule helps patients estimate costs and providers optimize billing for accurate reimbursements.
Factors that affect fee schedules
Medicare & Medicaid Rates
Government-set reimbursement amounts
Private Insurance Rates
Negotiated rates between providers and insurance companies
Geographic Location
Costs may be higher in urban areas.
Provider Type
Hospital providers may have different rates than private practice.
FREE SAMPLE MARKET COMPARISON
Let's review your payer contracts side-by-side with the market.
Bring your top codes (like CPT 68040) and we'll show you how you compare in 15 minutes or less.