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See a sample rate comparisonCPT 68816 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, Probing Of Nasolacrimal Duct With Or Without Irrigation With Transluminal Balloon Catheter Dilation
| 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 68816 |
| Medicaid Fee Schedule | View Medicaid rates for 68816 |
National average reimbursement for CPT 68816 by major payers:
$808.97
$940.28
$1,095.91
$340.77
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CPT 68816
5 of 25 sample ratesHigher to lower in this preview
Memorial Hermann Surgery Center Sugar Land LLP
$5,729.00Published rateSouth Denver Musculoskeletal Surgical Partners, LLC, South Denver Surgery Center
South Denver Musculoskeletal Surgical Partners LLC
$2,859.00Published rateGainesville Endoscopy Center, LLC
Gainesville Endoscopy Center LLC
$2,206.00Published rateBernstein Hilliker Hartzell Eye Center LLP, The Surgery Center Of Central PA
The Eye Center Of Central PA, LLP
$1,482.00Published rateKuresmart Pain Management Surgery Center-Columbia LLC, Clearway Surgery Center Of Columbia
Kuresmart Pain Management Surgery Centercolumbia LLC
$709.00Published rate
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See a sample payer proposalCPT 68816 vs. Other Surgical Procedures on the Eye and Ocular Adnexa Codes
The CPT 68816 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 68816 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 |
|---|---|---|
| 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 |
| 68816-CPT | Moderate | Probing Of Nasolacrimal Duct, Probing Of Nasolacrimal Duct With Or Without Irrigation With Transluminal Balloon Catheter Dilation |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 68816. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 68816 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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