2025 CPT code 68801

Dilation of the lacrimal punctum, with or without irrigation.

CPT codes 68801, 68810-68815, and 68840 have a 10-day global period.Use modifier -50 for bilateral procedures; -RT and -LT for unilateral procedures.Only one site modifier may be billed per claim line.Dilation of the nasolacrimal punctum (68801) is paid only once per eye regardless of the number of dilations.

Modifiers -50 (bilateral procedure), -RT (right eye), -LT (left eye), -51 (multiple procedures), -52 (reduced services), -53 (discontinued procedure), -73 (discontinued procedure prior to anesthesia), -74 (discontinued procedure after anesthesia) may be applicable depending on the circumstances.

Medical necessity is established when the patient presents with symptoms of impaired tear drainage, such as epiphora, and diagnostic tests (e.g., irrigation) confirm a blockage or stenosis of the lacrimal punctum. The procedure is medically necessary to alleviate symptoms and improve the patient's quality of life.

The ophthalmologist or other qualified healthcare professional performs the dilation and irrigation of the lacrimal punctum to restore tear drainage. This requires expertise in ophthalmic surgery and anatomy.

IMPORTANT None specified in provided data.

In simple words: The doctor widens a tiny opening in the eye that drains tears.They may also flush the opening with a sterile solution to clear any blockages. This helps if the tear duct is blocked or narrowed, causing watery eyes.

This procedure involves dilating the lacrimal punctum (the opening that drains tears from the eye) using a small instrument.Irrigation (flushing) of the punctum with a sterile solution may also be performed to ensure patency. This procedure addresses issues such as injury, blockage, or stenosis (narrowing) of the punctum, which can cause epiphora (overflow of tears).

Example 1: A patient presents with epiphora (excessive tearing) due to a suspected blockage of the lacrimal punctum.Dilation and irrigation are performed to restore normal tear drainage., A patient has experienced trauma to the eye resulting in punctal stenosis (narrowing). Dilation is performed to widen the opening and improve tear drainage., A patient with chronic dacryocystitis (inflammation of the tear sac) undergoes dilation and irrigation to clear the punctum of debris and improve tear flow.

* Preoperative assessment of the patient's lacrimal system.* Detailed operative report describing the procedure, including dilation technique and whether irrigation was performed.* Postoperative assessment of the patient's tear drainage.* Indication for the procedure (e.g., epiphora, stenosis, trauma).

** Some payers may require separate line items with -RT and -LT modifiers instead of -50 for bilateral procedures. Always consult payer-specific guidelines.

  • Revenue Code: P4E (EYE PROCEDURE - OTHER)
  • RVU: Not provided in source data.Refer to CMS fee schedules for current RVU values.
  • Global Days : 10-day global period.An EM code is not separately payable on the same day unless a separately identifiable service is provided and documented with modifier -25.
  • Payment Status: Active
  • Modifier TC rule: Not applicable.
  • Fee Schedule : Not provided in source data. Consult CMS fee schedules for historical data.
  • Specialties:Ophthalmology
  • Place of Service:Office, Ambulatory Surgical Center, Hospital Outpatient
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