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See a sample rate comparisonCPT 68811 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.
Probing Of Nasolacrimal Duct W//W/O Irrigation; Requir, Probing Of Nasolacrimal Duct With Or Without Irrigation; Requiring Ge
| 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 |
| Medicare Fee Schedule | View Medicare rates for 68811 |
| Medicaid Fee Schedule | View Medicaid rates for 68811 |
National average reimbursement for CPT 68811 by major payers:
$200.90
$206.43
$209.70
$244.54
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CPT 68811
5 of 25 sample ratesHigher to lower in this preview
Franciscan Surgery Center, LLC
$7,688.00Published rateCoral Ridge Outpatient Center LLC, Coral Ridge Outpatient Center
Coral Ridge Outpatient Center, LLC
$2,206.00Published rateRaleigh Nc Endoscopy Asc LLC, Raleigh Endoscopy Center
Raleigh Nc Endoscopy Asc LLC
$1,267.00Published ratePremier Surgical Center, LLC
Premier Surgical Center LLC
$994.00Published rateFemi-Care Surgery Center, LLC
Femicare Surgery Center LLC
$619.00Published rate
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Payer Contract Negotiation
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See a sample payer proposalCPT 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 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 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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