How much does Medicare pay for CPT 68326?

Medicare allowed an average of $617.91 per service and paid $490.37 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $2308.46, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 68326?

Reconstruction of conjunctiva with graft from outer eye or rearrangement. It was billed 1,551 times to 1,328 Medicare beneficiaries by 44 providers in 2024.

Does 68326 pay differently in an office than a hospital?

Yes. The allowed amount averaged $343.15 in an office setting and $744.43 in a facility. The office rate is generally higher because the practice supplies the room, staff and equipment out of that single payment; in a hospital those are billed separately by the facility.

Which specialty bills 68326 most?

Ophthalmology, with 1,204 services from 30 clinicians. Next are Ambulatory Surgical Center.

CPT 68326

Reconstruction of conjunctiva with graft from outer eye or rearrangement

$617.91Medicare-allowed amount per service, averaged across 1,551 services

Providers submitted

$2308.46

Asking price, not received

Medicare allowed

$617.91

The fee schedule figure

Medicare paid

$490.37

Balance is patient coinsurance

Providers submitted an average of $2308.46 for this code and Medicare allowed $617.91 — 3.7× less. That gap is normal and means nothing on its own: Medicare pays its fee schedule regardless of what is billed, so the submitted figure describes a hospital chargemaster, not a price anyone paid. Of the allowed amount Medicare paid $490.37 (79%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $343.15
Hospital / facility: $744.43

The facility rate is higher for this code, which is unusual and generally means the service depends on equipment or staffing a hospital carries. 489 services were billed in an office setting and 1,062 in a facility.

Services: 1,551
Beneficiaries: 1,328
Providers billing it: 44
Total allowed: $958,378

What Medicare pays for CPT 68326

Across 1,551 services billed by 44 providers to 1,328 beneficiaries, Medicare allowed an average of $617.91 per service. That is 1.2 services per beneficiary, so this is a code patients typically receive more than once. The allowed amount is the figure that matters: it is what Medicare and the patient together owe, set by the fee schedule and adjusted for local practice costs. What a provider chose to submit has no bearing on it.

Who bills 68326

Specialty	Services	Beneficiaries	Avg allowed	Providers
Ophthalmology	1,204	1,054	$434.73	30
Ambulatory Surgical Center	347	274	$1253.51	14

68326 reimbursement by state

Two different numbers. Allowed is what Medicare actually allowed in that state, which includes the local practice-cost adjustment. Standardized strips that geographic adjustment out of the payment, so it is the column to use when comparing states — a difference there reflects how the code was billed, not what it costs to run a practice locally.

State	Services	Allowed	Standardized pmt	Providers
Florida	295	$486.67	$400.09	5
Texas	252	$542.64	$426.92	7
California	244	$454.43	$316.29	5
Maryland	221	$616.50	$460.84	4
Ohio	144	$999.85	$835.19	5
New York	105	$807.91	$640.71	4
Oklahoma	54	$896.52	$752.07	2
Georgia	40	$681.94	$536.51	3
Missouri	34	$1381.42	$1234.52	2
Washington	30	$659.63	$538.61	1
Arizona	28	$602.81	$489.28	1
Indiana	26	$474.51	$401.95	1
Nebraska	25	$340.77	$284.55	1
Delaware	19	$318.78	$253.89	1
Kentucky	18	$603.28	$495.21	1
South Carolina	16	$314.77	$264.60	1

Related codes

68320Repair of eyelid lining$656.76

Billing this code is not the same as earning it

An allowed amount is revenue to a practice, not income to a clinician. It funds staff, premises, equipment and supplies before anyone is paid. What clinicians actually earn is published separately by the Department of Labor, and what industry pays them is published separately again by CMS — this site carries both.

What doctors are paid →·Look up a clinician →·All procedure codes →

Where this comes from. CMS Medicare Physician & Other Practitioners, by Provider and Service, 2024. It covers fee-for-service Original Medicare Part B only — not Medicare Advantage, not Medicaid, and not commercial insurance, which typically pays more for the same code.

How it is averaged. CMS publishes one average per provider per code. Every figure here is re-weighted by the number of services, so a clinician who billed the code 4,000 times counts 4,000 times more than one who billed it twice. CMS also suppresses any provider-code pair with fewer than 11 beneficiaries, so low-volume practice is missing from these totals by design.