CPT code 68815 – Probing nasolacrimal duct with tube or stent

Key takeaways

CPT code 68815 covers nasolacrimal duct probing with insertion of a tube or stent, and the stent placement is included in the code.

Irrigation does not separate 68815 from 68810 or 68811, because all three descriptors read “with or without irrigation.”

Report 68815 whenever a tube or stent is left in place, under local or general anesthesia, while balloon catheter dilation moves the claim to 68816.

The operative note must record the tube or stent type, the side treated and the anesthesia used, or the claim can’t support 68815.

Pabau, the practice software we build, submits lacrimal probing claims electronically with their modifiers and tracks each one to payment.

CPT code 68815: Official descriptor and procedure overview

The American Medical Association (AMA) defines CPT code 68815 as: Probing of nasolacrimal duct, with or without irrigation; with insertion of tube or stent. The code applies when the surgeon probes the duct and leaves a tube or stent in place at the end of the procedure.

The nasolacrimal duct (NLD) is the channel that drains tears from the inner corner of the eye into the nasal cavity. Obstruction (NLDO) is common in infants, whose membranous valve at the duct’s lower end fails to open spontaneously. It can also occur in adults from infection, trauma or scarring.

Probing opens the obstruction with a fine metal probe, and a silicone tube or stent then holds the passage open while it heals.

The stent placement is part of 68815, so it isn’t billed under a separate code. Surgeons typically choose a stent after a failed first probing, or when they expect a higher risk of recurrence. The decision is often made during the procedure, so the operative note has to record both the probing and the device left in place.

The procedure is performed in an office, ambulatory surgical center (ASC) or hospital outpatient department. Adults and cooperative older children may tolerate office-based probing. Infants usually need general anesthesia in an ASC or hospital, which adds a separate anesthesia claim but doesn’t change the procedure code (covered below).

What the procedure covers: Included and excluded services

CPT 68815 bundles the probing, any irrigation and the insertion of the tube or stent into a single billable unit. Billing these components separately for the same duct on the same date is unbundling.

Included in 68815:

• Insertion and passage of the lacrimal probe through the punctum and canaliculus into the nasolacrimal duct
• Irrigation (lavage) of the duct when performed, since the descriptor reads “with or without irrigation”
• Insertion of the tube or stent, such as a bicanalicular or monocanalicular silicone tube, left in place at the end of the procedure
• Punctal dilation performed in the same session to pass the probe
• Local or topical anesthetic application at the punctum

Not included:

• Transluminal balloon catheter dilation of the duct, which is reported with 68816 instead
• Dacryocystorhinostomy (DCR), which is reported with 68720 (see the bundling section below)
• Anesthesia professional services, which the anesthesia provider bills separately
• Evaluation and management (E/M) services on the same date, unless a separately identifiable E/M is documented with modifier 25

CPT 68815 vs 68810, 68811 and 68816: Choosing the right probing code

The four nasolacrimal duct probing codes share one parent descriptor: Probing of nasolacrimal duct, with or without irrigation. Irrigation is optional in every one of them, so it never moves a claim from one code to another. The codes split on three other questions instead.

Ask the questions in order. A tube or stent left in place makes the claim 68815, whatever anesthesia was used. A child probed and intubated under general anesthesia is therefore 68815, not 68811. A balloon catheter dilation makes the claim 68816. The flow below runs the three questions in that order.

Only when neither a stent nor a balloon was used does anesthesia decide between 68810 and 68811. Check the CPT manual’s parenthetical notes before reporting a session that combined balloon dilation with a stent.

NCCI bundling rules: When 68815 cannot be billed separately

CPT 68815 already includes the probing and any irrigation. So 68810 or 68811 is never billed alongside it for the same duct on the same date. Billing both is an unbundling error, and billing 68810 when a stent was placed is a downcoding error.

Dacryocystorhinostomy (DCR) is a different case. It is reported with 68720. The current National Correct Coding Initiative (NCCI) procedure-to-procedure (PTP) edit for that pair decides whether a same-session 68815 is payable. Codes 68760 and 68761 are sometimes grouped with DCR, but they describe closure of the lacrimal punctum.

Check the quarterly PTP table before appending modifier 59 or XS to any same-day lacrimal pair. A pair with a modifier indicator of 0 can’t be unbundled with any modifier. An indicator of 1 allows a modifier only when the services were distinct and the record shows it.

Good medical billing compliance means running this edit check before submission rather than on appeal.

ICD-10 diagnosis codes that support CPT 68815

Accurate ICD-10 pairing establishes medical necessity and prevents laterality-based denials. The diagnosis code laterality must match the side documented in the operative note and on the claim form.

Verify all ICD-10-CM codes against the current year’s code set using the CDC/NCHS ICD-10-CM web tool before billing. Code descriptions and validity change with each October 1 update.

Modifiers for CPT code 68815: RT, LT, 50, 52 and 59

Modifier selection for CPT code 68815 depends on the side treated, whether both ducts were done, and whether the procedure was completed as planned. Incorrect modifier use is a common denial driver alongside missing stent documentation.

For bilateral billing, Medicare contractors generally expect one line with modifier 50. Some commercial payers want two lines instead, 68815-RT and 68815-LT. Confirm the payer’s bilateral billing policy before submitting.

Reimbursement and RVU values for CPT 68815

Medicare reimbursement for CPT code 68815 varies by year, locality and place of service. Non-facility rates (office, POS 11) are typically higher than facility rates (ASC or hospital outpatient), because the practice carries the overhead in an office setting.

Use the CMS Physician Fee Schedule lookup tool to retrieve the current-year facility and non-facility amounts for your locality. FastRVU’s 2026 RVU lookup shows the work, practice expense and malpractice RVUs from the same CMS data. Rates change with each January update, so check them before quoting patients or forecasting revenue.

Commercial rates vary by contract and are often benchmarked to the Medicare fee schedule.

Documentation requirements for a clean 68815 claim

The tube or stent is the only element that separates 68815 from 68810 and 68811. A note that never records it leaves the code unsupported. The operative note must contain all of the following to support a clean claim and survive a payer audit.

• Confirmation of obstruction pre-procedure: Record the finding that established NLDO, such as epiphora, discharge or a positive dye disappearance test.
• Tube or stent type: Name the device, such as a bicanalicular or monocanalicular silicone tube, and state that it was left in place. A note that says only “probe passed and duct irrigated” supports 68810 or 68811, not 68815.
• Reason for intubation: Record why a tube or stent was chosen over probing alone, such as a failed earlier probing or a high recurrence risk.
• Laterality: State “right,” “left” or “bilateral” explicitly, and say which duct received the stent. A note without laterality does not support the RT, LT or 50 modifier.
• Anesthesia type: State whether local, topical or general anesthesia was used. It doesn’t change 68815, but it supports the separate anesthesia claim and any authorization for general anesthesia.
• Failed conservative management (when prior auth is required): Some commercial and Medicaid plans require prior authorization. For those plans, document how long conservative treatment (lacrimal massage, topical antibiotics) ran before probing.
• Provider credentials and place of service: Confirm the performing provider is credentialed with the payer. The place-of-service code on the claim (11 for office, 24 for ASC) must match the operative location.

Pair the operative note with a superbill workflow that carries the stent line through to the claim. That way no coder has to search the operative note to tell 68815 from 68810.

Prior authorization and medical necessity criteria

Prior authorization requirements for CPT code 68815 vary by payer class. Medicare does not typically require prior authorization for NLD probing but does require documented medical necessity in the record. Commercial and Medicaid pediatric plans commonly require pre-authorization before the procedure.

Clinical criteria that commonly satisfy medical necessity for pediatric NLD probing include:

• Persistent epiphora or mucopurulent discharge lasting three months or longer
• Documentation of failed conservative management, such as Crigler massage and topical antibiotics for at least 4-6 weeks, which many commercial plans require
• Failed watchful waiting, particularly for neonatal NLDO, which resolves spontaneously in a large proportion of infants within the first year of life
• Recurrent dacryocystitis or preseptal cellulitis attributable to the obstruction

For adult acquired NLDO, the medical necessity bar is generally lower. Symptom duration, failed conservative treatment, and the clinical finding of obstruction on irrigation testing are typically sufficient. Confirm prior authorization requirements with each individual payer before scheduling, as requirements vary by state and plan type.

Insurance eligibility verification at the time of scheduling helps identify plans that require pre-authorization and prevents unexpected denials.

Common claim denial reasons for CPT 68815 and how to avoid them

Six denial patterns are common on 68815 claims. Each has a specific documentation or workflow fix. The denial codes on the payer’s remittance usually point to the pattern.

1. Recoded or denied for missing stent documentation: The claim reports 68815, but the operative note describes probing alone and records no tube or stent. Fix: Use an operative note template with a mandatory tube or stent field covering device type and side. If a stent was placed, appeal with the complete operative record.
2. 68815 billed with 68810 or 68811 for the same duct: The claim reports both codes for the same side on the same date. Fix: Bill only 68815 when a tube or stent was left in place, then remove the probing-only line and resubmit.
3. Bilateral claim denied for formatting: The claim used one bilateral format, and the payer requires the other. Fix: Check the payer’s bilateral billing policy before submission, and resubmit in the required format as a corrected claim.
4. Missing prior authorization for pediatric commercial plans: The procedure was performed without pre-authorization from a plan that requires it. Fix: Verify authorization requirements at scheduling. On denial, check whether the plan allows retrospective authorization and file that request with the supporting clinical documentation.
5. Laterality mismatch: The ICD-10 code on the claim specifies the right side (H04.531), but the operative note or modifier indicates the left. Fix: Cross-reference the diagnosis code, modifier and operative note before submission. Automated coding software can flag mismatches before claims leave the practice.
6. Incorrect place-of-service code: The claim shows POS 11 (office), but the procedure was performed in an ASC (POS 24). This triggers a facility and non-facility payment error. Fix: Confirm the POS code against the procedure location, not the ordering provider’s office address.

Structured denial management that sorts 68815 denials by root cause reduces rework. They also show which of these six patterns is most frequent for a practice’s payer mix.

Billing CPT 68815 under general anesthesia for pediatric patients

When an infant or young child needs general anesthesia for NLD probing and a tube or stent is placed, the surgeon bills CPT 68815. CPT 68811 applies only when the child is probed under general anesthesia without a stent or balloon. General anesthesia doesn’t change 68815. It changes how anesthesia services are billed and what payers require for authorization.

Anesthesia billing (separate claim): The anesthesia provider bills independently using anesthesia CPT codes from the 00100-01999 range. For eye procedures, the relevant base unit code is typically 00140 (anesthesia for procedures on the eye). The anesthesia charge is base units plus time units, multiplied by the anesthesia conversion factor, and goes on a separate claim from the surgeon’s 68815.

Prior authorization for GA in pediatric lacrimal probing: Plans that require prior authorization for pediatric lacrimal probing often add criteria when general anesthesia is requested. Common requirements include:

• Documentation of the patient’s age and why office-based probing is not feasible (inability to cooperate, airway concerns)
• An anesthesia risk assessment or anesthesia provider consultation note for patients with comorbidities
• Confirmation that the procedure will take place in an accredited ASC or hospital outpatient department

Some payers apply age thresholds when assessing whether GA is medically necessary for NLD probing, but these thresholds vary by plan. Document the clinical rationale for general anesthesia in every pediatric case rather than relying on age alone. Confirm the age criteria a given payer applies directly with that payer before scheduling.

How Pabau supports clean claims for CPT 68815

Claims for 68815 tend to fail on details fixed before submission: The side, the stent documentation and the authorization number. Without a connected system, staff re-key each claim into a payer portal and chase its status by phone.

Pabau’s claims management software submits claims electronically from the patient’s billing record and tracks each one after it leaves. Its Claim.MD integration adds eligibility checks and ERA remittances. Coverage is confirmed before the procedure, and payments reconcile against expected rates.

The result is fewer re-keyed claims and a clear view of which 68815 claims are paid, pending or denied.

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Conclusion

Once the operative note names the tube or stent left in place, the choice between 68815 and its sibling codes is settled. Irrigation never enters that decision, and neither does the patient’s age.

The harder work sits upstream: Confirming the payer’s criteria and authorization before booking. Any same-day lacrimal code pair also needs checking against the current NCCI edits. Book a demo to see how Pabau submits and tracks lacrimal probing claims electronically, from eligibility check to payment.

Continue your research

Need to understand claim denial patterns across procedure codes? Denial management in healthcare covers root-cause analysis methods and appeal workflows for common payer denials.

Submitting claims electronically and tracking ERA responses? Electronic remittance advice (ERA) explains how 835 remittance files work and how to reconcile payments against expected allowables.

Looking for guidance on medical billing fundamentals? Revenue cycle management outlines the end-to-end process from eligibility verification through final payment posting.

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