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See a sample rate comparisonCPT 68520 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.
Excis Of Lacrimal Sac-Dacryocystec
| Key Fact | Detail |
|---|---|
| Service Type | Surgery Surgical Procedures on the Eye and Ocular Adnexa |
| Common Place of Service | 24 - Ambulatory Surgical Center 22 - On Campus Outpatient Hospital |
| Common Modifiers | None LT - Left side of body RT - Right side of body |
| Complexity Level | Moderate |
| Medicare Fee Schedule | View Medicare rates for 68520 |
| Medicaid Fee Schedule | View Medicaid rates for 68520 |
National average reimbursement for CPT 68520 by major payers:
$937.35
$893.23
$979.36
$1,152.42
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CPT 68520
5 of 25 sample ratesHigher to lower in this preview
Texas Health Harris Methodist Hospital Hurst-Euless-Bedford
$9,098.00Published rateGastro-Surgi Center Of New Jersey
Gastro-Surgi Center Of Nj
$3,698.00Published rateMethodist Endoscopy Center LLC
Methodist Endoscopy Center, LLC
$1,823.00Published rateNational Surgical Centers Of America LLC, Nscoa
National Surgical Centers Of America LLC
$1,180.00Published rateAdvanced Laser & Surgicenter Of Arizona, PC
$626.00Published rate
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Payer Contract Negotiation
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See a sample payer proposalCPT 68520 vs. Other Surgical Procedures on the Eye and Ocular Adnexa Codes
The CPT 68520 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 68520 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 |
|---|---|---|
| 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 |
| 68505-CPT | High | Xcision Of Lacriml Gland (Dacryoadnecto) Excpt For Tumor; Parti, Excision Of Lacrimal Gland (Dacryoadenectomy) Except For Tumor; Parti |
| 68520-CPT | Moderate | Excis Of Lacrimal Sac-Dacryocystec |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 68520. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 68520 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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