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Q4 2026 takes effect Oct 1, 2026. CMS published it early; dates of service before then are priced under the current release — see the current CPT 68761 rate.

CPT 68761

Lacrimal Punctum Closure

National PFS baseline · Q4 2026

68761 · Upcoming

GPCIs 1.000 · Participating · Before sequestration

Find the locality-adjusted allowed amount

Nationally priced under PFS, using the RVU formula.

CMS published national PFS baselines of $143.29 in the office (non-facility) setting and $103.54 in a facility for CPT 68761 in the Q4 2026 Physician Fee Schedule. These figures take effect for dates of service beginning Oct 1, 2026.

Calculation evidence

Physician relative value file (Q4 2026) · rvu26d-updated-08-26-2026.zip (PPRRVU2026_Oct_nonQPP.csv row 7,569)

Compact facts

Why are the facility and non-facility amounts different?

Only the practice-expense RVU changes with the setting. For 68761 it's 2.85 RVUs in the office versus 1.66 in a facility—the whole $39.75 gap between $143.29 and $103.54. In an office the practice bears the overhead, so Medicare pays more; in a hospital or ASC the facility bills its own fee, so the professional payment is lower. See facility vs non-facility.

Sources: CMS Medicare Physician Fee Schedule Relative Value Files; CMS Practice Expense methodology (cms.gov).

What could change this amount? Copy link

Review the applicable inputs and payment rules. Each link opens the supporting detail on this page.

Service location and setting · Participation and payment shares

Facility/non-facility Applies Bilateral adjustment Applies Multiple-procedure reduction Context required Global surgery Applies NCCI same-day edits Applies
Other payment indicators (5)

Professional/technical component: Does not apply, Assistant/co-surgeon treatment: Does not apply, MUE behavior: Not determined, Other fee-schedule routing: Does not apply, Contractor pricing: Does not apply.

Compare payment localities

The national baseline uses GPCI 1.000. These locality-adjusted allowed amounts use each payment locality's own GPCIs. Select a state to see its localities.

Maine: $134.79–$141.57 across 2 localities ME Wisconsin: $137.67 WI Vermont: $141.18 VT New Hampshire: $146.90 NH Montana: $143.29 MT North Dakota: $141.90 ND Minnesota: $144.40 MN Michigan: $135.31–$141.56 across 2 localities MI New York: $137.84–$166.21 across 5 localities NY Massachusetts: $148.59–$163.38 across 2 localities MA Rhode Island: $147.05 RI Washington: $148.37–$166.76 across 2 localities WA Idaho: $134.44 ID Wyoming: $142.68 WY South Dakota: $141.74 SD Iowa: $133.79 IA Illinois: $136.32–$147.99 across 4 localities IL Indiana: $135.14 IN Ohio: $135.03 OH Pennsylvania: $135.36–$148.47 across 2 localities PA New Jersey: $154.10–$161.56 across 2 localities NJ Connecticut: $152.03 CT Oregon: $142.21–$153.99 across 2 localities OR Nevada: $142.99 NV Utah: $137.34 UT Colorado: $149.42 CO Nebraska: $134.51 NE Missouri: $130.09–$138.73 across 3 localities MO Kentucky: $132.52 KY West Virginia: $131.83 WV Virginia: $140.98 VA Maryland: $144.70–$151.53 across 2 localities MD Delaware: $142.14 DE California: $152.12–$189.31 across 29 localities CA Arizona: $140.00 AZ New Mexico: $135.86 NM Kansas: $132.99 KS Oklahoma: $132.58 OK Arkansas: $128.73 AR Tennessee: $133.54 TN North Carolina: $136.07 NC South Carolina: $135.70 SC District of Columbia: $162.97 DC Texas: $134.56–$148.64 across 8 localities TX Louisiana: $132.24–$137.99 across 2 localities LA Mississippi: $129.45 MS Alabama: $130.38 AL Georgia: $133.46–$145.42 across 2 localities GA Florida: $140.28–$150.77 across 3 localities FL Alaska: $171.31 AK Hawaii: $155.35 HI
$129–$136 $136–$143 $143–$150 $150–$157 $157–$164 $164–$171

Highest-paying locality

$189.31

CA flag San Jose-Sunnyvale-Santa Clara (San Benito County), Ca, CA

Lowest-paying locality

$128.73

AR flag Arkansas, AR

68761 non-facility rate by metro area

Highest-paying metro first. Each figure is that payment locality's own GPCI-adjusted amount.

Anchorage, AK flag Anchorage, AK $171.31 Locality 02102-01 Washington, DC flag Washington, DC $162.97 Locality 12202-01 Northern New Jersey, NJ flag Northern New Jersey, NJ $161.56 Locality 12402-01 Honolulu, HI flag Honolulu, HI $155.35 Locality 01212-01 Hartford, CT flag Hartford, CT $152.03 Locality 13102-00 Denver, CO flag Denver, CO $149.42 Locality 04112-01 Providence, RI flag Providence, RI $147.05 Locality 14412-01
Show 24 more metros
Minneapolis, MN flag Minneapolis, MN $144.40 Locality 06202-00 Las Vegas, NV flag Las Vegas, NV $142.99 Locality 01312-00 Portland, ME flag Portland, ME $141.57 Locality 14112-03 Richmond, VA flag Richmond, VA $140.98 Locality 11302-00 Tampa, FL flag Tampa, FL $140.28 Locality 09102-99 Phoenix, AZ flag Phoenix, AZ $140.00 Locality 03102-00 San Antonio, TX flag San Antonio, TX $138.21 Locality 04412-99 Buffalo, NY flag Buffalo, NY $137.84 Locality 13282-99 Milwaukee, WI flag Milwaukee, WI $137.67 Locality 06302-00 Salt Lake City, UT flag Salt Lake City, UT $137.34 Locality 03502-09 Charlotte, NC flag Charlotte, NC $136.07 Locality 11502-00 Albuquerque, NM flag Albuquerque, NM $135.86 Locality 04212-05 Charleston, SC flag Charleston, SC $135.70 Locality 11202-01 Pittsburgh, PA flag Pittsburgh, PA $135.36 Locality 12502-99 Indianapolis, IN flag Indianapolis, IN $135.14 Locality 08102-00 Columbus, OH flag Columbus, OH $135.03 Locality 15202-00 Omaha, NE flag Omaha, NE $134.51 Locality 05402-00 Boise, ID flag Boise, ID $134.44 Locality 02202-00 Des Moines, IA flag Des Moines, IA $133.79 Locality 05102-00 Nashville, TN flag Nashville, TN $133.54 Locality 10312-35 Wichita, KS flag Wichita, KS $132.99 Locality 05202-00 Oklahoma City, OK flag Oklahoma City, OK $132.58 Locality 04312-00 Louisville, KY flag Louisville, KY $132.52 Locality 15102-00 Birmingham, AL flag Birmingham, AL $130.38 Locality 10112-00
Maine: $98.22–$102.18 across 2 localities ME Wisconsin: $99.60 WI Vermont: $101.83 VT New Hampshire: $105.52 NH Montana: $103.54 MT North Dakota: $102.15 ND Minnesota: $103.50 MN Michigan: $99.02–$103.21 across 2 localities MI New York: $100.08–$118.95 across 5 localities NY Massachusetts: $106.74–$115.92 across 2 localities MA Rhode Island: $105.99 RI Washington: $106.52–$117.99 across 2 localities WA Idaho: $97.87 ID Wyoming: $102.93 WY South Dakota: $101.99 SD Iowa: $97.42 IA Illinois: $100.04–$107.17 across 4 localities IL Indiana: $98.29 IN Ohio: $98.74 OH Pennsylvania: $98.87–$107.09 across 2 localities PA New Jersey: $110.70–$115.46 across 2 localities NJ Connecticut: $109.22 CT Oregon: $102.63–$109.83 across 2 localities OR Nevada: $103.21 NV Utah: $99.98 UT Colorado: $107.13 CO Nebraska: $97.82 NE Missouri: $95.83–$100.89 across 3 localities MO Kentucky: $97.19 KY West Virginia: $97.29 WV Virginia: $101.91 VA Maryland: $104.47–$108.88 across 2 localities MD Delaware: $102.87 DE California: $108.56–$132.00 across 29 localities CA Arizona: $101.49 AZ New Mexico: $99.41 NM Kansas: $97.06 KS Oklahoma: $97.09 OK Arkansas: $94.59 AR Tennessee: $97.41 TN North Carolina: $98.98 NC South Carolina: $98.98 SC District of Columbia: $116.15 DC Texas: $98.39–$106.58 across 8 localities TX Louisiana: $97.07–$100.59 across 2 localities LA Mississippi: $95.23 MS Alabama: $95.60 AL Georgia: $98.00–$105.04 across 2 localities GA Florida: $102.28–$109.39 across 3 localities FL Alaska: $128.98 AK Hawaii: $110.15 HI
$95–$100 $100–$106 $106–$112 $112–$118 $118–$123 $123–$129

Highest-paying locality

$132.00

CA flag San Jose-Sunnyvale-Santa Clara (San Benito County), Ca, CA

Lowest-paying locality

$94.59

AR flag Arkansas, AR

68761 facility rate by metro area

Highest-paying metro first. Each figure is that payment locality's own GPCI-adjusted amount.

Anchorage, AK flag Anchorage, AK $128.98 Locality 02102-01 Washington, DC flag Washington, DC $116.15 Locality 12202-01 Northern New Jersey, NJ flag Northern New Jersey, NJ $115.46 Locality 12402-01 Honolulu, HI flag Honolulu, HI $110.15 Locality 01212-01 Hartford, CT flag Hartford, CT $109.22 Locality 13102-00 Denver, CO flag Denver, CO $107.13 Locality 04112-01 Providence, RI flag Providence, RI $105.99 Locality 14412-01
Show 24 more metros
Minneapolis, MN flag Minneapolis, MN $103.50 Locality 06202-00 Las Vegas, NV flag Las Vegas, NV $103.21 Locality 01312-00 Tampa, FL flag Tampa, FL $102.28 Locality 09102-99 Portland, ME flag Portland, ME $102.18 Locality 14112-03 Richmond, VA flag Richmond, VA $101.91 Locality 11302-00 Phoenix, AZ flag Phoenix, AZ $101.49 Locality 03102-00 San Antonio, TX flag San Antonio, TX $100.49 Locality 04412-99 Buffalo, NY flag Buffalo, NY $100.08 Locality 13282-99 Salt Lake City, UT flag Salt Lake City, UT $99.98 Locality 03502-09 Milwaukee, WI flag Milwaukee, WI $99.60 Locality 06302-00 Albuquerque, NM flag Albuquerque, NM $99.41 Locality 04212-05 Charlotte, NC flag Charlotte, NC $98.98 Locality 11502-00 Charleston, SC flag Charleston, SC $98.98 Locality 11202-01 Pittsburgh, PA flag Pittsburgh, PA $98.87 Locality 12502-99 Columbus, OH flag Columbus, OH $98.74 Locality 15202-00 Indianapolis, IN flag Indianapolis, IN $98.29 Locality 08102-00 Boise, ID flag Boise, ID $97.87 Locality 02202-00 Omaha, NE flag Omaha, NE $97.82 Locality 05402-00 Des Moines, IA flag Des Moines, IA $97.42 Locality 05102-00 Nashville, TN flag Nashville, TN $97.41 Locality 10312-35 Louisville, KY flag Louisville, KY $97.19 Locality 15102-00 Oklahoma City, OK flag Oklahoma City, OK $97.09 Locality 04312-00 Wichita, KS flag Wichita, KS $97.06 Locality 05202-00 Birmingham, AL flag Birmingham, AL $95.60 Locality 10112-00

Look up your exact locality →

Q4 2026 amounts, computed with each locality's own GPCIs, before the ~2% sequestration cut. A state with more than one payment locality shows a range—its tile is colored by the mean across those localities, which is a shading choice, not an amount anyone is paid.

How this amount is computed Copy link

CPT 68761 has a work RVU of 1.37, a non-facility practice expense RVU of 2.85, a facility practice expense RVU of 1.66 and a malpractice RVU of 0.07—for total non-facility RVUs of 4.29 and total facility RVUs of 3.10 in the Q4 2026 release.

amount = (work RVU × work GPCI + PE RVU × PE GPCI + MP RVU × MP GPCI) × conversion factor. National amounts use GPCI = 1.000. To price an RVU figure of your own, use the RVU-to-dollars converter.

Release Q4 2026
Component RVU
Work RVU 1.37
Practice expense RVU (non-facility) 2.85
Practice expense RVU (facility) 1.66
Malpractice RVU 0.07

Every rate combines three parts: work (the clinician’s time, skill and effort), practice expense (office overhead—higher when the service is done in a doctor’s own office), and malpractice (the share of liability-insurance cost). A blank means CMS publishes no national number for that part. Read it as unknown, and never as zero.

Payment review for 68761 Copy link

Four published payment rules can change what 68761 allows on a claim: the office/facility differential, the 10-day global package, the standard multiple-procedure reduction and the 150% bilateral adjustment. Each is a legitimate reason for a paid amount to differ from the fee-schedule amount on this page.

What to reconcile

  • Check the place-of-service code before attributing the gap to the payer: office and facility pricing differ by $39.75 nationally at GPCI 1.000, before any locality adjustment.
  • Check the date span before writing off a denial: related follow-up care in the 10 days after the procedure is already inside this fee, so a post-operative visit denied in that window is the published rule rather than a variance.
  • Rank the claim’s procedure lines before calling this one short-paid: ranked below a higher-valued procedure on the same date it prices at $71.65 rather than $143.29 nationally at GPCI 1.000, which is the rule working rather than a payer error.
  • Look for modifier 50 or a second-side line before comparing: billed for both sides, this procedure should price at 150% of the single-side amount.
  • Reprice the line against the release, locality, setting, modifier and participation status that applied to the date of service before treating any difference as an underpayment.

Nearby payment lines

National Q4 2026 amounts at GPCI 1.000. A blank means this schedule does not publish a payable PFS amount.

Code Why compare Office Facility
68760 Same payment rules, more physician work $219.44 $127.59
68770 90-day follow-up global period rather than 10-day follow-up $535.42 $535.42
68750 90-day follow-up global period rather than 10-day follow-up $748.85 $748.85
Check an actual payment Model this code in a contract

Sources: CMS Medicare Physician Fee Schedule Relative Value Files; CMS Practice Expense methodology (cms.gov); CMS Medicare Claims Processing Manual (Pub. 100-04).

Payment rules

Global period: what 68761's fee already covers Copy link

010 10-day follow-up

The fee covers pre-operative work on the day of the procedure plus related follow-up care for the next 10 days. Related visits inside that window are not billed separately.

Billing a related follow-up visit inside the 10-day window is the most common way this code gets denied—the payment for that care is already inside the 68761 fee.

Modifiers that report work outside 68761's global period
Modifier Reports
-25 A significant, separately identifiable E/M on the same day as the procedure, beyond its usual pre- and post-operative care.
-24 An E/M during the follow-up window that is unrelated to this surgery, so it is paid separately.
-58 A staged or more extensive follow-on procedure during the window. Starts a new follow-up period.
-78 An unplanned return to the operating room for a related procedure during the window. Does not start a new follow-up period.
-79 An unrelated procedure by the same physician during the window. Starts a new follow-up period.

A modifier reports what happened; it does not by itself make a service payable. Documentation has to support it.

Billing policy Copy link

What 68761's billing-policy indicators mean. These show for every code, priced or not: a restriction like "bilateral not allowed" still matters on a carrier-priced code. See modifier amounts below for the dollar figures these support.

Policy Value What it means
Bilateral surgery 1 150% bilateral adjustment applies. Billed bilaterally (modifier 50, or on both sides), Medicare pays 150% of the single-side fee schedule amount.
Assistant at surgery 0 Restricted without documentation. Payment for an assistant at surgery is restricted for this procedure unless supporting documentation establishes medical necessity.
Co-surgeons 0 Not permitted. Medicare does not recognize co-surgeons (modifier 62) for this procedure.
Team surgery 0 Not permitted. Medicare does not recognize a surgical team (modifier 66) for this procedure.
Multiple procedures 2 Standard reduction applies. The same standard ranking-and-reduction rule as indicator 1 applies to this procedure when billed with others on the same date.
Professional/technical split 0 No PC/TC split. This is a physician service code; the professional/technical split does not apply, and the code is billed as a single service.

Modifier amounts: -26/TC, -50, -80/81/82, -AS, -62, -66 Copy link

National non-facility amounts for the modifiers this code's indicators support. Single-line modifiers only. -51 (multiple-procedure reduction) depends on the other codes on the same claim, so it's a claim-level number rather than a per-code one. Use the calculator for a locality-adjusted, sequestration-aware amount.

Modifier What it means Amount
-26/TC Professional/technical split Not payable
-50 Bilateral procedure (150%) $214.94
-80/81/82 Assistant surgeon (physician) (16%) $22.93 If documented
-AS Assistant at surgery (PA, NP, or CNS) (13.6%) $19.49 If documented
-62 Co-surgeons, each Not payable
-66 Team surgery Not payable

These apply standard MPFS percentages—assistant surgeon 16%, co-surgeon 62.5%, bilateral 150%—to the national non-facility amount above, and require both the RVU inputs and the applicable payment rule as evidence. They are derived here rather than read from a CMS column: check them against the current Medicare Claims Processing Manual before relying on them for payment. A row marked If documented carries the ordinary percentage, but this code's CMS indicator pays it only when supporting documentation of medical necessity is submitted—an unpaid claim without that documentation is not an underpayment.

Can you bill it with another code? Copy link

Enter a second CPT or HCPCS code billed on the same date of service. We'll check the current NCCI procedure-to-procedure edit between it and 68761.

See every current NCCI pair for 68761 →

Billing together (NCCI edits) Copy link

NCCI Q4 2026

Based on CMS's National Correct Coding Initiative (NCCI). A few examples appear here; use the complete edit page to check a specific pair.

Not separately payable with 68761 on the same date of service—no modifier bypasses the edit (modifier indicator 0)

0213T 0213T denies
0216T 0216T denies
36591 36591 denies

Showing 3 of 67.

Separately payable with 68761 only when an NCCI-associated modifier is appropriate and documented (modifier indicator 1)

0596T 0596T denies
0597T 0597T denies
0708T 0708T denies

Showing 3 of 174.

Modifier 59 and the X modifiers are not a universal bypass—CMS expects the most specific applicable modifier, and which one that is depends on the pair and the documented circumstances.

Check a paired code or view all 241 NCCI pairs →

Allowed amount, program payment, and patient share Copy link

These figures use the same national baseline, with different participation and payment assumptions.

Computed from the Q4 2026 CMS release

Medicare allowed amount

What Medicare recognizes as the full price for 68761 in the office (non-facility) setting. Every figure below derives from it.

$143.29
Medicare's share

80% of the allowed amount, before the ~2% sequestration cut.

$114.63
Patient coinsurance

The remaining 20%, once the annual Part B deductible is met. Medigap or Medicaid often covers it.

$28.66
Limiting charge

The ceiling a non-participating provider can bill a patient on an unassigned claim—109.25% of the allowed amount.

$156.55

National Q4 2026 figures at GPCI 1.000. Adjust for your locality and sequestration, or expand the explanations below for each figure in full.

Is $143.29 what a practice actually receives?

It's the national allowed amount—the starting point. Medicare pays 80% of it ($114.63) and the patient owes 20% coinsurance ($28.66). Sequestration trims Medicare's share by about 2%, your locality's GPCIs scale the total up or down, and the expected-payment calculator applies all three. What lands is practice revenue: staff, space, equipment and billing, not clinician take-home pay. The practice-expense RVU above is CMS's estimate of that overhead share.

Sources: Budget Control Act sequestration provisions; CMS Medicare Fee-for-Service payment guidance; CMS Geographic Practice Cost Index (GPCI) files; CMS Physician Fee Schedule overview (cms.gov).

What's the non-participating amount for 68761?

$136.13 in the office (non-facility) setting—95% of the $143.29 participating fee schedule amount above. A participating provider takes the fee schedule amount as payment in full on every claim. A non-participating provider is paid this reduced amount, but chooses claim by claim whether to accept assignment. See participating vs non-participating.

Sources: CMS Physician Fee Schedule overview (cms.gov); CMS Medicare Fee-for-Service payment guidance.

What's the limiting charge for 68761?

$156.55 in the office (non-facility) setting—the ceiling on what a non-participating provider can bill the patient on an unassigned claim. That's 109.25% of the $143.29 amount above. The non-participating amount is 95% of the fee schedule rate ($136.13), and the statutory cap is 115% of that. See limiting charge.

Sources: CMS Physician Fee Schedule overview (cms.gov); CMS Medicare Fee-for-Service payment guidance.

Common payment questions Copy link

Why would a Medicare claim for 68761 be denied or paid less?

These come from CMS indicators on this page, not general billing advice.

  • 67 codes form NCCI pairs with 68761 carrying modifier indicator 0—no NCCI-associated modifier bypasses the edit, so billed together on the same date of service, a line of the pair denies. See billing together
  • 174 codes pair with 68761 under modifier indicator 1—separately payable only when an NCCI-associated modifier (59, or a more specific XE, XS, XP, or XU) is clinically appropriate and the documentation supports a distinct service; without one, a line of the pair denies. See billing together
  • 68761 carries a 10-day global period—routine post-operative care within that window is included in the surgical payment rather than paid on its own claim. See how it's computed
  • Assistant at surgery: restricted without documentation. See billing policy
  • Co-surgeons: not permitted. See billing policy
  • Team surgery: not permitted. See billing policy
  • Multiple procedures: standard reduction applies. See billing policy

Payer-specific coverage and documentation rules live outside these files, so a claim that clears every check here can still be denied on other grounds.

History

Rate history by release Copy link

National non-facility amount for 68761 across quarterly releases. +26.0% increase since Q1 2013 · high $152.96 in Q2 2014

$153 $138 $122 $107 $92 Q1 2013 · $113.75 Q2 2014 · $152.96 (+34.5%) Q3 2014 · $152.96 (0.0%) Q4 2014 · $152.96 (0.0%) Q1 2015 · $149.10 (-2.5%) Q2 2015 · $149.10 (0.0%) Q3 2015 · $149.10 (0.0%) Q4 2015 · $149.84 (+0.5%) Q1 2016 · $149.30 (-0.4%) Q2 2016 · $149.30 (0.0%) Q3 2016 · $149.30 (0.0%) Q4 2016 · $149.30 (0.0%) Q1 2017 · $149.66 (+0.2%) Q2 2017 · $149.66 (0.0%) Q3 2017 · $149.66 (0.0%) Q4 2017 · $149.66 (0.0%) Q1 2018 · $152.28 (+1.8%) Q2 2018 · $152.28 (0.0%) Q3 2018 · $152.28 (0.0%) Q4 2018 · $152.28 (0.0%) Q1 2019 · $152.09 (-0.1%) Q2 2019 · $152.09 (0.0%) Q3 2019 · $152.09 (0.0%) Q4 2019 · $152.09 (0.0%) Q1 2020 · $151.58 (-0.3%) Q2 2020 · $151.58 (0.0%) Q3 2020 · $151.58 (0.0%) Q4 2020 · $151.58 (0.0%) Q1 2021 · $152.48 (+0.6%) Q2 2021 · $152.48 (0.0%) Q3 2021 · $152.48 (0.0%) Q4 2021 · $152.48 (0.0%) Q1 2022 · $150.19 (-1.5%) Q2 2022 · $150.19 (0.0%) Q3 2022 · $150.19 (0.0%) Q4 2022 · $150.19 (0.0%) Q1 2023 · $147.41 (-1.9%) Q2 2023 · $147.41 (0.0%) Q3 2023 · $147.41 (0.0%) Q4 2023 · $147.41 (0.0%) Q1 2024 · $142.76 (-3.2%) Q1 2024 · $145.13 (+1.7%) Q2 2024 · $145.13 (0.0%) Q3 2024 · $145.13 (0.0%) Q4 2024 · $145.13 (0.0%) Q1 2025 · $138.77 (-4.4%) Q2 2025 · $138.77 (0.0%) Q3 2025 · $138.77 (0.0%) Q4 2025 · $138.77 (0.0%) Q1 2026 · $143.29 (+3.3%) Q2 2026 · $143.29 (0.0%) Q3 2026 · $143.29 (0.0%) Q4 2026 · $143.29 (0.0%) Q1 2013 Q3 2016 Q2 2019 Q4 2021 Q2 2024 Q4 2026
Non-facility Facility
Release Status Non-facility Facility
Q4 2026 takes effect Oct 1, 2026 A $143.29 (0.0% no change ) $103.54 (0.0% no change )

This price has been unchanged since Q1 2026, when it increased 3.3%.

When does this rate change?

CMS publishes a fee schedule release every quarter (January, April, July, October), and each is versioned here. See what changed each release, or get an email when a new release moves rates.

The 68761 rate last moved in Q1 2026. See its rate history.

Sources: CMS Medicare Physician Fee Schedule Relative Value Files.

Beyond Medicare

Contracted rate: % of Medicare Copy link

Commercial payer contracts usually price off the Medicare amount above ("BCBS pays 115% of Medicare"). Enter your contract's percentage below to see what 68761 pays at that rate—$143.29 is 100%.

We want to build this: store your multipliers once, and every code page shows your rate instead of Medicare's. Tell us if you'd use it →

See how to find your contract's actual percentage.

Usage & related

How often 68761 is billed Copy link

Across Original Medicare in CY2024, 68761 ranked #284 of the 7,879 CPT codes billed to Medicare that year, by patients served or total allowed dollars. It repeats: a patient billed for it in 2024 was billed 2.5 times on average that year.

Beneficiaries
202,609
Office + facility patients combined
Services
508,384
Times it was billed
Allowed
$69.7M
Total Medicare allowed dollars
Compare: ↑ #283 more popular · 77065 ↓ #285 less popular · 88112

2024 Medicare fee-for-service national totals. They exclude Medicare Advantage, Medicaid and commercial volume, so real-world use runs higher. This is a calendar-year snapshot from the CMS Physician & Other Practitioners dataset, on a different cycle from the Q4 2026 fee schedule above.

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Source & method

Show sources

This page uses CMS's Medicare Physician Fee Schedule Q4 2026 release (effective October 2026). National baselines use GPCI 1.000 and exclude sequestration. Status and payment instructions determine whether a national amount is established; blank RVUs stay blank. Releases are immutable: historical evidence remains tied to the specified release. Modifier amounts apply standard MPFS percentages to this code's billing indicators. We derive them here rather than read them from CMS, so confirm them against the current Claims Processing Manual before relying on them for payment. Our methodology covers the depth: sourcing, parsing, versioning, and how we cross-check claims before they ship.

Physician relative value file (Q4 2026) · rvu26d-updated-08-26-2026.zip (PPRRVU2026_Oct_nonQPP.csv row 7,569)

Conversion factor $33.4009 read from the same file, row 11, column 26.

Use the (i) buttons next to each amount above for the exact row, columns, and math.

Cite this rate

This citation identifies the source release, so its evidence remains reproducible after a newer release lands.

CPT 68761 National PFS baseline: Office (non-facility) $143.29; Facility $103.54 (Q4 2026; participating; whole service; GPCI 1.000; sequestration excluded). Localis. https://localishealth.com/cpt/68761/2026/D