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 68801 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.
Dilation Of Lacrimal Punctum, With Or Without Irrigation
| 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 59 - Distinct Procedural Service |
| Complexity Level | Low |
| Medicare Fee Schedule | View Medicare rates for 68801 |
| Medicaid Fee Schedule | View Medicaid rates for 68801 |
National average reimbursement for CPT 68801 by major payers:
$128.33
$130.77
$140.91
$161.42
Compare published rates across providers.
Choose a payer to see a sample of rates for CPT 68801.
CPT 68801
5 of 25 sample ratesHigher to lower in this preview
Portsmouth Surgicenter, LLC
Portsmouth Surgicenter LLC
$2,287.00Published rateBjosc, LLC, Bjosc At Plover
Bjosc LLC
$788.00Published rateAndrews Institute Asc LLC
Andrews Institute Asc, LLC
$286.00Published rateIdaho Otologic Surgery Center, LLC, Syringa Outpatient Surgery Center
Idaho Otologic Surgery Center LLC
$175.00Published rateCollege Heights Endoscopy Center LLC
$54.00Published 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 68801 vs. Other Surgical Procedures on the Eye and Ocular Adnexa Codes
The CPT 68801 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 68801 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 |
|---|---|---|
| 68801-CPT | Low | Dilation Of Lacrimal Punctum, With Or Without Irrigation |
| 68810-CPT | Moderate | Probing Of Nasolacrimal Duct, With Or Without Irrigation |
| 68811-CPT | Moderate | Probing Of Nasolacrimal Duct W//W/O Irrigation; Requir, Probing Of Nasolacrimal Duct With Or Without Irrigation; Requiring Ge |
| 68815-CPT | Moderate | Probing Of Nasolacrimal Duct W//W/O Irrigation; W/ Inserti, Probing Of Nasolacrimal Duct With Or Without Irrigation; With Inserti |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 68801. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 68801 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 68801) and we'll show you how you compare in 15 minutes or less.