How much does Medicare pay for CPT 68841?

Medicare allowed an average of $16.63 per service and paid $13.28 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $195.80, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 68841?

Insertion of drug delivery implant into tear duct of eye. It was billed 89,197 times to 54,662 Medicare beneficiaries by 600 providers in 2024.

Does 68841 pay differently in an office than a hospital?

Yes. The allowed amount averaged $29.18 in an office setting and $16.04 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 68841 most?

Ophthalmology, with 87,980 services from 591 clinicians. Next are Optometry.

CPT 68841

Insertion of drug delivery implant into tear duct of eye

$16.63Medicare-allowed amount per service, averaged across 89,197 services

Providers submitted

$195.80

Asking price, not received

Medicare allowed

$16.63

The fee schedule figure

Medicare paid

$13.28

Balance is patient coinsurance

Providers submitted an average of $195.80 for this code and Medicare allowed $16.63 — 11.8× 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 $13.28 (80%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $29.18
Hospital / facility: $16.04

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. 3,992 services were billed in an office setting and 85,205 in a facility.

Services: 89,197
Beneficiaries: 54,662
Providers billing it: 600
Total allowed: $1,483,346

What Medicare pays for CPT 68841

Across 89,197 services billed by 600 providers to 54,662 beneficiaries, Medicare allowed an average of $16.63 per service. That is 1.6 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 68841

Specialty	Services	Beneficiaries	Avg allowed	Providers
Ophthalmology	87,980	53,940	$16.32	591
Optometry	1,217	722	$39.04	9

68841 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 Jersey	9,009	$17.38	$12.58	71
Arizona	8,790	$16.24	$12.50	25
Florida	7,536	$18.84	$14.62	50
Virginia	6,722	$15.56	$12.53	36
New York	5,975	$18.84	$12.85	53
Texas	5,353	$16.52	$13.48	33
California	3,504	$17.02	$12.47	33
Mississippi	3,123	$14.89	$12.84	11
Pennsylvania	2,943	$21.79	$18.01	23
Georgia	2,690	$15.62	$12.55	13
Illinois	2,395	$16.33	$12.55	19
Kansas	2,165	$14.97	$12.52	7
Massachusetts	2,119	$17.06	$12.62	15
Indiana	2,115	$14.74	$12.49	15
North Carolina	2,059	$15.23	$12.59	16
Wisconsin	1,977	$14.86	$12.54	15
Michigan	1,744	$16.10	$12.99	22
South Carolina	1,741	$15.10	$12.49	15
Maryland	1,542	$16.73	$12.49	13
Missouri	1,494	$15.43	$12.53	8
New Hampshire	1,437	$15.85	$12.49	8
Delaware	1,253	$15.71	$12.50	3
Ohio	1,221	$15.49	$12.84	17
Kentucky	1,130	$15.33	$12.53	8
Tennessee	1,112	$15.42	$13.11	10
Connecticut	1,080	$16.83	$12.48	8
New Mexico	1,066	$15.52	$12.49	5
Louisiana	785	$14.97	$12.56	9
Oklahoma	720	$15.66	$12.98	8
Alabama	679	$14.49	$12.54	5
Iowa	610	$15.52	$12.54	2
Nebraska	566	$14.82	$12.54	2
Arkansas	533	$14.84	$12.74	5
Nevada	515	$15.97	$12.50	7
Rhode Island	432	$16.20	$12.49	2
Minnesota	400	$16.43	$12.96	3
Wyoming	348	$15.48	$12.56	1
Colorado	235	$16.65	$12.57	2
Utah	79	$15.84	$12.76	2

Related codes

68840Probing of nasal tear duct$166.24
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.