How much does Medicare pay for CPT 68720?

Medicare allowed an average of $957.36 per service and paid $757.41 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $3885.19, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 68720?

Creation of drainage tract from tear sac to nasal cavity. It was billed 1,115 times to 1,009 Medicare beneficiaries by 70 providers in 2024.

Does 68720 pay differently in an office than a hospital?

Yes. The allowed amount averaged $563.80 in an office setting and $975.45 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 68720 most?

Ambulatory Surgical Center, with 526 services from 32 clinicians. Next are Ophthalmology, Plastic and Reconstructive Surgery, Physician Assistant.

CPT 68720

Creation of drainage tract from tear sac to nasal cavity

$957.36Medicare-allowed amount per service, averaged across 1,115 services

Providers submitted

$3885.19

Asking price, not received

Medicare allowed

$957.36

The fee schedule figure

Medicare paid

$757.41

Balance is patient coinsurance

Providers submitted an average of $3885.19 for this code and Medicare allowed $957.36 — 4.1× 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 $757.41 (79%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $563.80
Hospital / facility: $975.45

The facility rate is higher for this code, which is unusual and generally means the service depends on equipment or staffing a hospital carries. 49 services were billed in an office setting and 1,066 in a facility.

Services: 1,115
Beneficiaries: 1,009
Providers billing it: 70
Total allowed: $1,067,456

What Medicare pays for CPT 68720

Across 1,115 services billed by 70 providers to 1,009 beneficiaries, Medicare allowed an average of $957.36 per service. 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 68720

Specialty	Services	Beneficiaries	Avg allowed	Providers
Ambulatory Surgical Center	526	462	$1233.64	32
Ophthalmology	520	481	$760.13	33
Plastic and Reconstructive Surgery	39	38	$506.45	3
Physician Assistant	16	14	$125.58	1
Nurse Practitioner	14	14	$109.26	1

68720 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
New York	115	$930.82	$650.52	6
California	102	$937.81	$611.29	6
Texas	88	$809.14	$667.49	5
Florida	76	$988.71	$821.10	5
South Dakota	60	$881.17	$736.80	4
Georgia	57	$1077.25	$860.46	4
Tennessee	53	$855.10	$776.69	3
Colorado	51	$1018.76	$807.99	3
North Carolina	50	$1135.45	$964.73	3
Nevada	46	$1036.39	$911.85	2
Washington	44	$1217.69	$928.08	3
Illinois	42	$751.68	$609.36	3
Mississippi	41	$891.51	$832.23	3
Indiana	33	$1059.84	$887.05	2
Arizona	33	$1048.56	$885.25	2
Pennsylvania	32	$936.36	$680.11	2
Alabama	30	$733.30	$638.22	2
Maryland	29	$976.25	$770.20	2
Virginia	28	$950.03	$795.05	2
Kansas	25	$1050.02	$877.35	2
Arkansas	25	$743.26	$628.44	2
Ohio	19	$1388.32	$1131.31	1
Louisiana	13	$1249.17	$1188.36	1
Oklahoma	12	$1322.13	$1117.37	1
New Jersey	11	$85.66	$59.41	1

Related codes

68761Closure of tear duct opening$136.23
68760Repair tear duct opening by heat$223.33
68700Plastic repair of tear duct$587.27

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.