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See a sample rate comparisonCPT 68525 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.
Biopsy Lacrimal Sac
| 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 68525 |
| Medicaid Fee Schedule | View Medicaid rates for 68525 |
National average reimbursement for CPT 68525 by major payers:
$341.45
$343.56
$355.73
$418.99
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CPT 68525
5 of 25 sample ratesHigher to lower in this preview
Midtown Surgery Center, LLC
$4,304.00Published rateSdm Asc LLC, Daytime Outpatient Surgery Center
Sdm Asc LLC
$1,500.00Published rateSurgicenter Of Baltimore LLC, Surgicenter Of Baltimore
Surgicenter Of Baltimore LLC
$1,288.00Published rateSandhills Endoscopy Center
$1,044.00Published rateNorthwest Kansas Surgery Center, LLC
Northwest Kansas Surgery Center LLC
$598.00Published rate
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See a sample payer proposalCPT 68525 vs. Other Surgical Procedures on the Eye and Ocular Adnexa Codes
The CPT 68525 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 68525 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 |
| 68525-CPT | Moderate | Biopsy Lacrimal Sac |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 68525. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 68525 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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