CPT 68811 Fee Schedule
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.
| Key Fact | Detail |
|---|---|
| Service Type | • Surgery • Surgical Procedures on the Eye and Ocular Adnexa |
| Common Place of Service | • 22 - On Campus Outpatient Hospital • 24 - Ambulatory Surgical Center |
| Common Modifiers | • None • RT - Right side of body • LT - Left side of body |
| Complexity Level | Moderate |
National average reimbursement for CPT 68811 by major payers:
$200.90
$206.43
$209.70
$249.47
| Payer | Code | Rate | NPI | Tax ID | State | Specialty |
|---|---|---|---|---|---|---|
Select a payer to view fee schedule data Choose a payer from the options above to see rates for CPT 68811 | ||||||
United | 68811 | $1090.00 | 1225123227 - COMPREHENSIVE PAIN MANAGEMENT CENTER, INC. | 770533953 - (CA) COMPREHENSIVE PAIN MANAGEMENT CENTER, INC. | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 68811 | $2206.00 | 1114126596 - CORAL RIDGE OUTPATIENT CENTER LLC, CORAL RIDGE OUTPATIENT CENTER | 205429299 - (FL) CORAL RIDGE OUTPATIENT CENTER, LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 68811 | $800.00 | 1649790171 - ATHENS SPINE PROCEDURAL CENTER LLC | 364870744 - (GA) ATHENS SPINE PROCEDURAL CENTER LLC | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 68811 | $4781.00 | 1730212879 - TEXAS HEALTH HARRIS METHODIST HOSPITAL SOUTHWEST FORT WORTH | 752678857 - (TX) TEXAS HEALTH HARRIS METHODIST HOSPITAL SOUTHWEST FORT WORTH | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 68811 | $1971.00 | 1093079196 - MERCY HOSPITALS EAST COMMUNITIES, MERCY OUTPATIENTSURGERY CENTER WASHINGTON | 431066883 - (MO) MERCY HOSPITALS EAST COMMUNITIES | MO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 68811 | $691.00 | 1225286354 - ASC DEVELOPMENT COMPANY, LLC | 203405773 - (MD) ASC DEVELOPMENT COMPANY LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 68811 | $6651.00 | 1518920040 - COUNTRYSIDE SURGERY CENTER, LTD | 752400186 - (FL) COUNTRYSIDE SURGERY CENTER LTD | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 68811 | $1000.00 | 1043564784 - COMPREHENSIVE SURGICAL CENTER OF GREEN, LLC | 461313857 - (OH) COMPREHENSIVE SURGICAL CENTER OF GREEN LLC | OH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 68811 | $806.00 | 1447366224 - WEST MICHIGAN SURGERY CENTER, LLC | 371509502 - (MI) MICHIGAN PRIMARY CARE PARTNERS PC | MI | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 68811 | $994.00 | 1093214819 - PREMIER SURGICAL CENTER, LLC | 823438730 - (MS) PREMIER SURGICAL CENTER LLC | MS | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 68811 | $619.00 | 1891716767 - FEMI-CARE SURGERY CENTER, LLC | 710895222 - (MD) FEMICARE SURGERY CENTER LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 68811 | $3500.00 | 1013227248 - TUSCAN SURGERY CENTER AT LAS COLINAS, LLC, TUSCAN SURGERY CENTER AT LAS COLINAS | 273578014 | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 68811 | $1167.00 | 1164976478 - FRANCISCAN MEDICAL GROUP, THE DOCTORS CLINIC AMBULATORY SURGICAL CENTER, A PART OF THE FRANCISCA | 911939739 - FRANCISCAN MEDICAL GROUP | WA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 68811 | $1148.00 | 1023071180 - SAHARA OUTPATIENT SURGERY CENTER LTD | 752509486 - (NV) SAHARA OUTPATIENT SURGERY CENTER LTD | NV | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 68811 | $1023.00 | 1700884608 - SPRINGHILL SURGERY CENTER, DAUPHIN WEST SURGERY CENTER | 630982952 - (AL) SPRINGHILL SURGERY CENTER | AL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
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CPT 68811 vs. Other Surgical Procedures on the Eye and Ocular Adnexa Codes
The CPT 68811 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 68811 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, Requiring General Anesthesia |
| 68815-CPT | Moderate | Probing Of Nasolacrimal Duct, With Insertion Of Tube Or Stent |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 68811. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 68811 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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