Cost analysis for CPT 68761 — Closure of tear duct opening using plug
Average Medicare Payment
$121.78
2023 data
Total Payments (2023)
$42.9M
Services (2023)
400.5K
Price Change (2014–2023)
+6.4%
| Year | Avg Payment | Total Payments | Services | YoY Change |
|---|---|---|---|---|
| 2014 | $114.45 | $30.3M | 284.1K | — |
| 2015 | $110.65 | $30.6M | 296.1K | -3.3% |
| 2016 | $113.99 | $32.4M | 309.3K | +3.0% |
| 2017 | $114.14 | $33.9M | 324.3K | +0.1% |
| 2018 | $117.66 | $37.4M | 349.3K | +3.1% |
| 2019 | $120.11 | $40.1M | 365.3K | +2.1% |
| 2020 | $121.28 | $33.4M | 303.8K | +1.0% |
| 2021 | $126.57 | $40.8M | 362.3K | +4.4% |
| 2022 | $122.32 | $41.2M | 380.3K | -3.4% |
| 2023 | $121.78 | $42.9M | 400.5K | -0.4% |
The most expensive state pays 2.5x more than the cheapest for this procedure. DE averages $161.03 vs WY at $63.49.
| State | Avg Payment | Total Payments | Services | Providers |
|---|---|---|---|---|
| DE | $161.03 | $69.6K | 432 | 9 |
| NJ | $157.06 | $2.4M | 15.5K | 163 |
| MD | $146.74 | $852.5K | 5.8K | 76 |
| CT | $138.21 | $336.5K | 2.4K | 34 |
| TX | $137.38 | $1.6M | 11.3K | 170 |
| PA | $136.59 | $1.7M | 12.5K | 144 |
| LA | $136.04 | $406.6K | 3.0K | 55 |
| NM | $135.72 | $57.0K | 420 | 11 |
| MS | $135.61 | $246.5K | 1.8K | 32 |
| CO | $134.98 | $447.9K | 3.3K | 49 |
| WI | $127.17 | $207.9K | 1.6K | 25 |
| OK | $123.94 | $208.3K | 1.7K | 40 |
| MN | $122.92 | $93.8K | 763 | 17 |
| AR | $122.80 | $169.8K | 1.4K | 30 |
| OR | $121.47 | $123.8K | 1.0K | 24 |
| NY | $121.29 | $6.0M | 49.3K | 368 |
| WA | $118.10 | $270.6K | 2.3K | 52 |
| SD | $117.94 | $118.8K | 1.0K | 20 |
| RI | $117.73 | $195.9K | 1.7K | 21 |
| AK | $115.90 | $14.7K | 127 | 4 |
| PR | $114.88 | $12.9K | 112 | 3 |
| MA | $113.10 | $720.8K | 6.4K | 75 |
| MT | $110.52 | $64.9K | 587 | 15 |
| VA | $107.84 | $897.6K | 8.3K | 103 |
| NH | $104.86 | $103.5K | 987 | 21 |
| CA | $103.64 | $10.2M | 98.9K | 482 |
| NE | $102.27 | $60.4K | 591 | 11 |
| WV | $100.08 | $54.5K | 545 | 14 |
| UT | $99.26 | $242.8K | 2.4K | 22 |
| MI | $98.92 | $626.6K | 6.3K | 77 |
| NV | $98.05 | $740.3K | 7.5K | 41 |
| KY | $98.04 | $102.8K | 1.0K | 23 |
| ID | $97.35 | $48.5K | 498 | 13 |
| OH | $96.04 | $405.7K | 4.2K | 48 |
| FL | $94.51 | $6.9M | 73.5K | 397 |
| GA | $94.31 | $381.6K | 4.0K | 63 |
| SC | $92.09 | $271.7K | 3.0K | 39 |
| NC | $90.75 | $566.2K | 6.2K | 62 |
| AZ | $89.44 | $1.2M | 13.8K | 96 |
| MO | $89.23 | $115.3K | 1.3K | 29 |
| IN | $88.50 | $301.1K | 3.4K | 51 |
| TN | $88.48 | $529.5K | 6.0K | 62 |
| IL | $88.14 | $1.2M | 13.8K | 118 |
| ME | $87.27 | $21.2K | 243 | 5 |
| ND | $85.81 | $40.3K | 470 | 7 |
| KS | $85.77 | $307.7K | 3.6K | 25 |
| HI | $84.79 | $286.7K | 3.4K | 24 |
| IA | $83.63 | $175.7K | 2.1K | 30 |
| AL | $77.57 | $248.2K | 3.2K | 29 |
| WY | $63.49 | $402.0K | 6.3K | 4 |
| Provider | Specialty | State | Payments | Services | Avg/Service |
|---|---|---|---|---|---|
| Bradley Hamar | Optometry | CA | $484.0K | 7.2K | $67.68 |
| Baljit Sohal | Optometry | CA | $440.2K | 6.6K | $66.63 |
| Brent Bellotte | Ophthalmology | FL | $409.0K | 5.4K | $76.38 |
| Dean Brown | Optometry | WY | $386.8K | 6.2K | $62.56 |
| Leonard Bley | Ophthalmology | NY | $357.9K | 1.8K | $199.82 |
| Jeffrey Wine | Optometry | AZ | $304.3K | 4.1K | $74.38 |
| Adam Dao | Ophthalmology | CA | $269.0K | 1.5K | $176.25 |
| Eric Wolf | Ophthalmology | NY | $238.6K | 2.8K | $85.45 |
| Hamlet Minasvand | Optometry | CA | $186.9K | 1.0K | $180.25 |
| Andrew Cho | Ophthalmology | CA | $186.7K | 1.1K | $177.66 |
| Jonathan Mennucci | Optometry | CA | $185.4K | 2.8K | $67.31 |
| Dan Yin | Ophthalmology | MD | $176.8K | 1.2K | $150.44 |
| Ranjeet Bajwa | Optometry | CA | $174.6K | 1.6K | $112.10 |
| Gerald Shepps | Ophthalmology | NY | $167.2K | 872 | $191.71 |
| Satyesh Rana | Ophthalmology | FL | $163.3K | 1.0K | $159.80 |
| Steven Chang | Ophthalmology | CA | $162.8K | 2.2K | $75.62 |
| David Sutton | Ophthalmology | NC | $156.6K | 1.9K | $80.33 |
| Louis Moriano | Optometry | PA | $154.6K | 1.5K | $103.39 |
| Barry Schechter | Ophthalmology | FL | $153.6K | 1.8K | $87.15 |
| Joel Solano | Ophthalmology | CA | $153.3K | 1.0K | $151.06 |
The data suggests significant pricing inconsistencies for CPT 68761. With a 2.5x price gap between the most and least expensive states, geography plays an outsized role in what Medicare pays for this procedure.
Costs have remained relatively stable over time, but the geographic variation suggests Medicare's geographic adjustment factors may not fully capture the true cost differences across states.
This analysis is based on publicly available CMS data and does not account for patient complexity, comorbidities, or facility-specific factors that may justify pricing differences.
Note: All data is from publicly available Medicare records. OpenMedicare is an independent journalism project not affiliated with CMS.