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CPT 68520: Excision of Lacrimal Sac for Dacryocystitis

CPT code 68520 represents surgical removal of the lacrimal sac to treat dacryocystitis, addressing chronic or recurrent inflammation of the tear drainage system. This procedure is clinically significant because it provides definitive management when conservative measures or less invasive lacrimal procedures fail, impacting surgical workflow, specialty practice patterns, and hospital and ambulatory surgical center utilization nationally. Payers commonly involved in coverage and reimbursement for this service include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare.

This publication explains the clinical context of CPT code 68520, outlines typical sites of service, and summarizes what stakeholders can expect from the analysis: national benchmarks for utilization and setting of care, relevant coding considerations, and policy or coverage themes affecting surgical ophthalmology services. Readers will gain an understanding of where 68520 fits within oculoplastic surgical care, payer coverage landscape, and the operational settings in which the procedure is delivered. Data not available in the input will be noted where applicable.

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Billing Code Overview

CPT code 68520 describes the surgical removal of the lacrimal sac (tear duct) performed to treat dacryocystitis, an inflammation or infection of the tear drainage system. The service type is a surgical excision of lacrimal apparatus tissue.

The typical site of service for this procedure is an operating room or ambulatory surgical center where ophthalmic or oculoplastic surgeries are performed. The procedure is performed by ophthalmologists or oculoplastic surgeons and is intended to resolve chronic or recurrent dacryocystitis when other interventions are ineffective.

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CPT 68520: Excision of Lacrimal Sac for Dacryocystitis

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Billing Code Overview

Clinical & Coding Specifications

Clinical Context

A typical patient is an adult presenting with chronic or recurrent dacryocystitis characterized by persistent tearing (epiphora), recurrent periorbital cellulitis, purulent discharge from the medial canthus, and a history of failed conservative therapy (topical/systemic antibiotics, lacrimal massage) or failed dacryocystorhinostomy. Preoperative evaluation includes ophthalmology or oculoplastic consultation, lacrimal system probing and irrigation to confirm obstruction and infection control, medical clearance, informed consent, and planning for anesthesia (general or monitored anesthesia care). The clinical workflow: initial outpatient evaluation and imaging if indicated (dacryocystography or CT for complex anatomy), preoperative clearance and infection control, scheduling in an ambulatory surgery center or hospital operating room, administration of anesthesia, surgical removal of the lacrimal sac (68520) with hemostasis and possible adjunct procedures, postoperative observation for bleeding, ocular pressure checks, discharge with antibiotics and wound care instructions, and outpatient follow-up for wound healing and lacrimal drainage status.

Coding Specifications

Modifier	Description	When to Use
`22`	Increased procedural services	Use when the operative report documents substantially greater work or complexity than typical for `68520`.
`23`	Unusual anesthesia	Use when a procedure that normally does not require general anesthesia is performed under general due to patient condition.
`26`	Professional component	Use when billing for the surgeon's professional component separate from technical facility services.
`50`	Bilateral procedure	Use if bilateral lacrimal sac removal is performed and payer requires bilateral modifier instead of modifier `59`.
`51`	Multiple procedures	Use when `68520` is billed with additional distinct procedures on the same day to denote multiple procedure reduction per payer rules.
`52`	Reduced services	Use when a surgeon intentionally performs a reduced service, documented in the operative note.
`53`	Discontinued procedure	Use if the operation was started but discontinued for documented patient-related reasons.
`59`	Distinct procedural service	Use to indicate a distinct procedural service when other procedures are performed on adjacent or separate sites if documentation supports distinctness.
`62`	Two surgeons	Use when two surgeons work together as primary surgeons, each submitting documentation per payer policy.
`76`	Repeat procedure by same physician	Use when the same physician repeats the procedure later the same day (note: `76` is not in the provided list; not included).

Taxonomy Code	Specialty	Notes
`207K00000X`	Ophthalmology	Oculoplastic surgeons and ophthalmologists commonly perform lacrimal sac surgery.
`207K00000X`	Oculoplastic Surgery (subset of ophthalmology)	Subspecialty dealing with lacrimal and periocular procedures.
`163W00000X`	Otolaryngology	ENT surgeons perform lacrimal system surgeries when combined with nasal procedures.
`2080P0207X`	Plastic and Reconstructive Surgery	Facial plastic surgeons may perform lacrimal sac procedures in complex reconstructions.
`363LE0200X`	Hospitalist/General Surgery (support)	Perioperative medical management and anesthesia coordination.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`H04.521`	Acute dacryocystitis, right lacrimal sac	Acute infection indicating need for urgent drainage or definitive surgery if recurrent.
`H04.522`	Acute dacryocystitis, left lacrimal sac	Same as above for the left side.
`H04.523`	Acute dacryocystitis, bilateral lacrimal sac	Bilateral disease potentially requiring bilateral procedures.
`H04.531`	Chronic dacryocystitis, right lacrimal sac	Chronic obstruction/infection often leading to lacrimal sac excision when other treatments fail.
`H04.532`	Chronic dacryocystitis, left lacrimal sac	Chronic disease on left side.
`H04.533`	Chronic dacryocystitis, bilateral lacrimal sac	Chronic bilateral disease indicating possible bilateral surgical management.
`H04.59`	Other disorders of lacrimal system	Used for atypical lacrimal sac pathology requiring excision.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`67830`	Dacryocystorhinostomy (DCR) with or without stent; external approach	Alternative surgical procedure to restore lacrimal drainage often performed before considering lacrimal sac excision or when creating a new lacrimal drainage pathway.
`68810`	Excision of lacrimal sac; with canaliculus reconstruction or other complex repair (note: code for canalicular procedures)	Performed when lacrimal sac excision requires concurrent canalicular repair or reconstruction.
`31025`	Excision of nasal lesion or intranasal procedure, adjunct to lacrimal surgery	ENT intranasal procedures may be performed concurrently to address nasal factors affecting lacrimal drainage.
`99140`	Emergency department on-call service (procedural assistance by another physician)	May be used in urgent settings if additional physician services are required for acute infection or complications.
`64450`	Injection, anesthetic agent; trigeminal nerve, for regional anesthesia (note: illustrative)	Regional blocks or local infiltration codes may be billed adjunctively for anesthesia support in outpatient or ambulatory settings.

CPT 68500: Lacrimal Gland Excision for Excessive Tearing

CPT-68505-PARTIAL-LACRIMAL-GLAND-EXCISION-FOR-EPIPHORA

CPT 68505: Partial Lacrimal Gland Excision for Excessive Tearing

CPT-68510-LACRIMAL-GLAND-BIOPSY-PATHOLOGY

CPT 68510: Lacrimal Gland Biopsy with Specimen for Pathology

CPT-68525-LACRIMAL-SAC-BIOPSY-NASOLACRIMAL-DUCT

CPT 68525: Lacrimal Sac Biopsy, Nasolacrimal Duct

CPT-68530-DACRYOLITH-REMOVAL-LACRIMAL-GLAND-SACCULAR-STONE

CPT 68530: Removal of Dacryolith or Foreign Body from Lacrimal Gland or Sac

CPT-68540-LACRIMAL-GLAND-TUMOR-EXCISION

CPT 68540: Excision of Lacrimal Gland Tumor

CPT-68550-LACRIMAL-GLAND-EXCISION-ORBITAL-APPROACH-TUMOR

CPT 68550: Lacrimal Gland Excision via Orbital/Bony Approach

Frequently Asked Questions

References

1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.

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Clinical & Coding Specifications

Clinical Context

Coding Specifications

Modifier	Description	When to Use
`22`	Increased procedural services	Use when the operative report documents substantially greater work or complexity than typical for `68520`.
`23`	Unusual anesthesia	Use when a procedure that normally does not require general anesthesia is performed under general due to patient condition.
`26`	Professional component	Use when billing for the surgeon's professional component separate from technical facility services.
`50`	Bilateral procedure	Use if bilateral lacrimal sac removal is performed and payer requires bilateral modifier instead of modifier `59`.
`51`	Multiple procedures	Use when `68520` is billed with additional distinct procedures on the same day to denote multiple procedure reduction per payer rules.
`52`	Reduced services	Use when a surgeon intentionally performs a reduced service, documented in the operative note.
`53`	Discontinued procedure	Use if the operation was started but discontinued for documented patient-related reasons.
`59`	Distinct procedural service	Use to indicate a distinct procedural service when other procedures are performed on adjacent or separate sites if documentation supports distinctness.
`62`	Two surgeons	Use when two surgeons work together as primary surgeons, each submitting documentation per payer policy.
`76`	Repeat procedure by same physician	Use when the same physician repeats the procedure later the same day (note: `76` is not in the provided list; not included).

Taxonomy Code	Specialty	Notes
`207K00000X`	Ophthalmology	Oculoplastic surgeons and ophthalmologists commonly perform lacrimal sac surgery.
`207K00000X`	Oculoplastic Surgery (subset of ophthalmology)	Subspecialty dealing with lacrimal and periocular procedures.
`163W00000X`	Otolaryngology	ENT surgeons perform lacrimal system surgeries when combined with nasal procedures.
`2080P0207X`	Plastic and Reconstructive Surgery	Facial plastic surgeons may perform lacrimal sac procedures in complex reconstructions.
`363LE0200X`	Hospitalist/General Surgery (support)	Perioperative medical management and anesthesia coordination.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`H04.521`	Acute dacryocystitis, right lacrimal sac	Acute infection indicating need for urgent drainage or definitive surgery if recurrent.
`H04.522`	Acute dacryocystitis, left lacrimal sac	Same as above for the left side.
`H04.523`	Acute dacryocystitis, bilateral lacrimal sac	Bilateral disease potentially requiring bilateral procedures.
`H04.531`	Chronic dacryocystitis, right lacrimal sac	Chronic obstruction/infection often leading to lacrimal sac excision when other treatments fail.
`H04.532`	Chronic dacryocystitis, left lacrimal sac	Chronic disease on left side.
`H04.533`	Chronic dacryocystitis, bilateral lacrimal sac	Chronic bilateral disease indicating possible bilateral surgical management.
`H04.59`	Other disorders of lacrimal system	Used for atypical lacrimal sac pathology requiring excision.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`67830`	Dacryocystorhinostomy (DCR) with or without stent; external approach	Alternative surgical procedure to restore lacrimal drainage often performed before considering lacrimal sac excision or when creating a new lacrimal drainage pathway.
`68810`	Excision of lacrimal sac; with canaliculus reconstruction or other complex repair (note: code for canalicular procedures)	Performed when lacrimal sac excision requires concurrent canalicular repair or reconstruction.
`31025`	Excision of nasal lesion or intranasal procedure, adjunct to lacrimal surgery	ENT intranasal procedures may be performed concurrently to address nasal factors affecting lacrimal drainage.
`99140`	Emergency department on-call service (procedural assistance by another physician)	May be used in urgent settings if additional physician services are required for acute infection or complications.
`64450`	Injection, anesthetic agent; trigeminal nerve, for regional anesthesia (note: illustrative)	Regional blocks or local infiltration codes may be billed adjunctively for anesthesia support in outpatient or ambulatory settings.

CPT 68500: Lacrimal Gland Excision for Excessive Tearing

CPT-68505-PARTIAL-LACRIMAL-GLAND-EXCISION-FOR-EPIPHORA

CPT 68505: Partial Lacrimal Gland Excision for Excessive Tearing

CPT-68510-LACRIMAL-GLAND-BIOPSY-PATHOLOGY

CPT 68510: Lacrimal Gland Biopsy with Specimen for Pathology

CPT-68525-LACRIMAL-SAC-BIOPSY-NASOLACRIMAL-DUCT

CPT 68525: Lacrimal Sac Biopsy, Nasolacrimal Duct

CPT-68530-DACRYOLITH-REMOVAL-LACRIMAL-GLAND-SACCULAR-STONE

CPT 68530: Removal of Dacryolith or Foreign Body from Lacrimal Gland or Sac

CPT-68540-LACRIMAL-GLAND-TUMOR-EXCISION

CPT 68540: Excision of Lacrimal Gland Tumor

CPT-68550-LACRIMAL-GLAND-EXCISION-ORBITAL-APPROACH-TUMOR

CPT 68550: Lacrimal Gland Excision via Orbital/Bony Approach

Frequently Asked Questions

References

1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.

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CPT 68520: Excision of Lacrimal Sac for Dacryocystitis

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Billing Code Overview

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CPT 68520: Excision of Lacrimal Sac for Dacryocystitis

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Billing Code Overview

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Related Diagnoses

Related CPT Codes

Related Codes

References

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Related Diagnoses

Related CPT Codes

Related Codes

References

CPT 68520: Excision of Lacrimal Sac for Dacryocystitis

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Billing Code Overview

CPT 68520: Excision of Lacrimal Sac for Dacryocystitis

Sign up for cpt 68520 policy alerts

Billing Code Overview

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Related Diagnoses

Related CPT Codes

Related Codes

What does CPT 68520 represent and who typically performs it?

What clinical and preoperative steps are typically required before performing 68520?

Which CPT modifiers are commonly applicable to billing 68520?

What other CPT codes are related to or commonly billed with 68520?

What diagnoses and payers are associated with CPT 68520?

References

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Related Diagnoses

Related CPT Codes

Related Codes

What does CPT 68520 represent and who typically performs it?

What clinical and preoperative steps are typically required before performing 68520?

Which CPT modifiers are commonly applicable to billing 68520?

What other CPT codes are related to or commonly billed with 68520?

What diagnoses and payers are associated with CPT 68520?

References