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See a sample rate comparisonCPT 68540 Fee Schedule
Last Verified: October 2026
Healthcare providers use this code to document and receive reimbursement for visits that address high-level medical decision-making, often including multiple diagnoses or prescription management.
Exc Tumor Lacrimal Gland Frontal
| 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 | High |
| Medicare Fee Schedule | View Medicare rates for 68540 |
| Medicaid Fee Schedule | View Medicaid rates for 68540 |
National average reimbursement for CPT 68540 by major payers:
$1,280.35
$1,200.95
$1,324.43
$1,538.02
Compare published rates across providers.
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CPT 68540
5 of 25 sample ratesHigher to lower in this preview
Trident Ambulatory Surgery Center, L.P.
Trident Ambulatory Surgery Center Lp
$6,455.00Published rateSkyway Surgery Center. LLC
Skyway Surgery Center LLC
$2,323.00Published rateBoulder Medical Center, PC, Boulder Medical Center Asc
Boulder Medical Center, P.C.
$1,282.00Published rateThe Arcadia Ca Endoscopy Asc Lp, Valley Digestive Health Center
$927.00Published rateOld Moultrie Surgical Center Inc
$467.00Published rate
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See a sample payer proposalCPT 68540 vs. Other Surgical Procedures on the Eye and Ocular Adnexa Codes
The CPT 68540 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 68540 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 |
|---|---|---|
| 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 |
| 68520-CPT | Moderate | Excis Of Lacrimal Sac-Dacryocystec |
| 68540-CPT | High | Exc Tumor Lacrimal Gland Frontal |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 68540. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 68540 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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