How much does Medicare pay for CPT 68840?

Medicare allowed an average of $166.24 per service and paid $126.36 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $464.03, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 68840?

Probing of nasal tear duct. It was billed 22,911 times to 19,300 Medicare beneficiaries by 522 providers in 2024.

Does 68840 pay differently in an office than a hospital?

Yes. The allowed amount averaged $167.39 in an office setting and $122.95 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 68840 most?

Ophthalmology, with 21,419 services from 488 clinicians. Next are Optometry, General Surgery, Plastic and Reconstructive Surgery.

CPT 68840

Probing of nasal tear duct

$166.24Medicare-allowed amount per service, averaged across 22,911 services

Providers submitted

$464.03

Asking price, not received

Medicare allowed

$166.24

The fee schedule figure

Medicare paid

$126.36

Balance is patient coinsurance

Providers submitted an average of $464.03 for this code and Medicare allowed $166.24 — 2.8× 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 $126.36 (76%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $167.39
Hospital / facility: $122.95

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. 22,315 services were billed in an office setting and 596 in a facility.

Services: 22,911
Beneficiaries: 19,300
Providers billing it: 522
Total allowed: $3,808,725

What Medicare pays for CPT 68840

Across 22,911 services billed by 522 providers to 19,300 beneficiaries, Medicare allowed an average of $166.24 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 68840

Specialty	Services	Beneficiaries	Avg allowed	Providers
Ophthalmology	21,419	18,126	$167.77	488
Optometry	530	486	$190.43	15
General Surgery	394	233	$96.52	1
Plastic and Reconstructive Surgery	324	266	$148.98	9
Physician Assistant	148	110	$138.91	4
Ambulatory Surgical Center	68	52	$44.76	3
Otolaryngology	16	15	$172.12	1
Nurse Practitioner	12	12	$131.86	1

68840 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	4,208	$182.77	$124.67	79
Texas	2,246	$172.56	$135.29	36
Florida	1,873	$159.43	$119.94	47
New York	1,727	$197.63	$132.02	35
New Jersey	1,609	$182.98	$126.23	21
Illinois	912	$168.33	$122.06	17
Nevada	764	$102.86	$80.49	4
North Carolina	698	$157.63	$118.17	20
Michigan	632	$157.89	$121.12	22
Georgia	601	$147.57	$114.22	16
Massachusetts	522	$153.97	$106.77	12
Washington	500	$166.31	$116.50	12
Ohio	495	$141.51	$110.88	16
Virginia	430	$156.97	$114.15	14
Pennsylvania	428	$168.40	$124.14	16
Tennessee	427	$139.99	$111.96	12
Louisiana	361	$104.47	$84.34	7
Maryland	348	$177.46	$122.57	7
Arizona	330	$152.73	$118.33	11
South Carolina	307	$145.68	$115.79	8
Colorado	302	$157.87	$112.85	14
Hawaii	280	$205.94	$148.46	3
Oregon	259	$171.64	$125.33	7
Kansas	257	$155.23	$123.62	6
Minnesota	237	$164.15	$125.31	10
Connecticut	234	$165.83	$114.01	6
Indiana	227	$157.80	$121.17	9
Oklahoma	199	$142.11	$113.43	4
Missouri	188	$143.78	$109.85	7
South Dakota	147	$160.30	$119.32	2
District of Columbia	134	$175.14	$114.58	2
Arkansas	121	$144.26	$115.73	4
Kentucky	98	$155.17	$111.53	4
Mississippi	93	$145.36	$123.25	3
Utah	87	$161.98	$126.04	5
New Hampshire	81	$164.97	$127.54	2
Iowa	78	$145.86	$115.46	2
Idaho	71	$150.01	$125.66	4
Rhode Island	66	$147.75	$117.59	2
Wisconsin	65	$132.28	$97.12	4
Alabama	58	$139.04	$109.65	3
Nebraska	58	$125.94	$102.88	2
Vermont	55	$156.20	$110.22	1
Delaware	45	$166.17	$129.54	1
Maine	28	$154.74	$123.56	1
West Virginia	13	$153.44	$119.95	1
Northern Mariana Islands	12	$183.46	$108.47	1

Related codes

68841Insertion of drug delivery implant into tear duct of eye$16.63
68810Insertion of probe into nasal tear duct$210.56
68801Dilation of tear drainage opening$94.82
68815Probing of nasal tear duct$398.65

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.