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See a sample rate comparisonCPT 68420 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.
Ncision Drain Of Lacriml Sac (Dacryocystotomy Or Dacryocystostom, Incision Drainage Of Lacrimal Sac (Dacryocystotomy Or Dacryocystostom
| 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 50 - Bilateral Procedure LT - Left side of body |
| Complexity Level | Moderate |
| Medicare Fee Schedule | View Medicare rates for 68420 |
| Medicaid Fee Schedule | View Medicaid rates for 68420 |
National average reimbursement for CPT 68420 by major payers:
$377.14
$422.54
$452.20
$525.91
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CPT 68420
5 of 25 sample ratesHigher to lower in this preview
Mother Frances Hospital-Winnsboro
$2,257.00Published rateCentral Delaware Endoscopy Unit LLC
$967.00Published rateHsc Surgical Associates, Fairfield Endoscopy Center
Hsc Surgical Associates Of Cincinnati, LLC
$537.00Published rateGeorgia Urology, PA
$429.00Published rateLakeforest Ambulatory Surgery Center, District Heights Ambulatory Surgery Center
Lakeforest Ambulatory Surgery Center
$184.00Published rate
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See a sample payer proposalCPT 68420 vs. Other Surgical Procedures on the Eye and Ocular Adnexa Codes
The CPT 68420 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 68420 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 |
|---|---|---|
| 68400-CPT | Moderate | Incis, Drainage Of Lacrimal Gland |
| 68420-CPT | Moderate | Ncision Drain Of Lacriml Sac (Dacryocystotomy Or Dacryocystostom, Incision Drainage Of Lacrimal Sac (Dacryocystotomy Or Dacryocystostom |
| 68500-CPT | High | Xcision Of Lacriml Gland (Dacryoadnecto) Excpt For Tumor; Total, Excision Of Lacrimal Gland (Dacryoadenectomy) Except For Tumor; Total |
| 68510-CPT | Moderate | Biopsy Lacrimal Gland |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 68420. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 68420 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.
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