How much does Medicare pay for CPT 68760?

Medicare allowed an average of $223.33 per service and paid $170.69 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $1328.45, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 68760?

Repair tear duct opening by heat, tying, or laser surgery. It was billed 2,913 times to 1,903 Medicare beneficiaries by 52 providers in 2024.

Does 68760 pay differently in an office than a hospital?

Yes. The allowed amount averaged $253.11 in an office setting and $80.98 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 68760 most?

Ophthalmology, with 2,652 services from 46 clinicians. Next are Ambulatory Surgical Center.

CPT 68760

Repair tear duct opening by heat, tying, or laser surgery

$223.33Medicare-allowed amount per service, averaged across 2,913 services

Providers submitted

$1328.45

Asking price, not received

Medicare allowed

$223.33

The fee schedule figure

Medicare paid

$170.69

Balance is patient coinsurance

Providers submitted an average of $1328.45 for this code and Medicare allowed $223.33 — 5.9× 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 $170.69 (76%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $253.11
Hospital / facility: $80.98

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. 2,409 services were billed in an office setting and 504 in a facility.

Services: 2,913
Beneficiaries: 1,903
Providers billing it: 52
Total allowed: $650,560

What Medicare pays for CPT 68760

Across 2,913 services billed by 52 providers to 1,903 beneficiaries, Medicare allowed an average of $223.33 per service. That is 1.5 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 68760

Specialty	Services	Beneficiaries	Avg allowed	Providers
Ophthalmology	2,652	1,723	$238.32	46
Ambulatory Surgical Center	261	180	$70.98	6

68760 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	819	$285.98	$188.94	11
New York	523	$319.43	$227.80	2
Florida	411	$165.18	$128.50	6
Virginia	229	$152.16	$118.74	3
South Dakota	187	$80.16	$67.14	2
Texas	163	$278.79	$216.85	4
Minnesota	93	$73.59	$57.94	3
Idaho	75	$70.18	$57.93	2
Michigan	73	$180.07	$138.59	2
Pennsylvania	69	$227.49	$170.58	3
Montana	68	$113.16	$86.57	3
Kansas	67	$117.57	$97.47	3
Arizona	34	$257.18	$199.25	2
Massachusetts	26	$203.51	$138.84	2
South Carolina	26	$163.20	$124.83	1
New Jersey	22	$206.99	$143.65	1
Illinois	15	$217.27	$158.73	1
Tennessee	13	$268.61	$242.56	1

Related codes

68761Closure of tear duct opening$136.23
68720Creation of drainage tract from tear sac to nasal cavity$957.36
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.