How much does Medicare pay for CPT 68440?

Medicare allowed an average of $61.72 per service and paid $47.80 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $1005.24, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 68440?

Snip incision of tear duct at inner corner of eye. It was billed 2,472 times to 1,949 Medicare beneficiaries by 98 providers in 2024.

Does 68440 pay differently in an office than a hospital?

Yes. The allowed amount averaged $110.52 in an office setting and $47.20 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 68440 most?

Ophthalmology, with 1,340 services from 62 clinicians. Next are Ambulatory Surgical Center, Plastic and Reconstructive Surgery.

CPT 68440

Snip incision of tear duct at inner corner of eye

$61.72Medicare-allowed amount per service, averaged across 2,472 services

Providers submitted

$1005.24

Asking price, not received

Medicare allowed

$61.72

The fee schedule figure

Medicare paid

$47.80

Balance is patient coinsurance

Providers submitted an average of $1005.24 for this code and Medicare allowed $61.72 — 16.3× 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 $47.80 (77%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $110.52
Hospital / facility: $47.20

The office rate is higher because the practice supplies the room, staff and equipment out of that payment. In a hospital the facility bills those separately, so the clinician's share is smaller — the total cost to Medicare is usually higher, not lower. 567 services were billed in an office setting and 1,905 in a facility.

Services: 2,472
Beneficiaries: 1,949
Providers billing it: 98
Total allowed: $152,572

What Medicare pays for CPT 68440

Across 2,472 services billed by 98 providers to 1,949 beneficiaries, Medicare allowed an average of $61.72 per service. That is 1.3 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 68440

Specialty	Services	Beneficiaries	Avg allowed	Providers
Ophthalmology	1,340	1,249	$84.06	62
Ambulatory Surgical Center	1,111	681	$34.72	35
Plastic and Reconstructive Surgery	21	19	$65.21	1

68440 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
California	366	$80.20	$54.33	9
New York	334	$56.04	$38.27	8
Florida	171	$61.94	$46.45	9
North Carolina	140	$61.90	$48.51	5
South Dakota	127	$39.83	$33.52	3
Georgia	112	$49.46	$40.17	5
Indiana	99	$48.92	$40.63	3
Pennsylvania	89	$53.86	$42.29	3
Washington	85	$51.81	$36.44	4
Texas	84	$57.46	$44.84	4
Virginia	74	$86.41	$67.38	3
New Hampshire	68	$60.60	$47.27	3
Arkansas	57	$46.14	$40.33	2
Arizona	54	$66.21	$54.02	3
Colorado	54	$46.15	$35.96	2
Montana	52	$45.12	$36.60	2
Massachusetts	46	$122.70	$83.67	3
Louisiana	42	$97.75	$73.96	2
Tennessee	40	$88.90	$72.92	3
Oregon	40	$130.37	$101.82	2
Oklahoma	40	$46.36	$38.18	2
North Dakota	38	$44.33	$36.50	2
Delaware	37	$49.55	$38.91	2
Maine	32	$49.96	$38.57	2
Ohio	30	$43.59	$36.56	2
Kansas	26	$30.18	$26.91	1
Kentucky	25	$50.69	$43.04	2
Alaska	23	$47.31	$33.06	2
Illinois	20	$62.02	$50.62	1
New Jersey	20	$35.88	$26.86	1
Minnesota	18	$34.78	$26.84	1
Missouri	15	$31.01	$26.83	1
Maryland	14	$88.35	$55.69	1

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.