How much does Medicare pay for CPT 15823?

Medicare allowed an average of $694.81 per service and paid $548.51 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $3356.74, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 15823?

Removal of excessive skin and fat of upper eyelid. It was billed 94,256 times to 66,857 Medicare beneficiaries by 1,698 providers in 2024.

Does 15823 pay differently in an office than a hospital?

Yes. The allowed amount averaged $810.03 in an office setting and $689.18 in a facility. The office rate is generally higher because the practice supplies the room, staff and equipment out of that single payment; in a hospital those are billed separately by the facility.

Which specialty bills 15823 most?

Ambulatory Surgical Center, with 56,400 services from 699 clinicians. Next are Ophthalmology, Plastic and Reconstructive Surgery, Otolaryngology.

CPT 15823

Removal of excessive skin and fat of upper eyelid

$694.81Medicare-allowed amount per service, averaged across 94,256 services

Providers submitted

$3356.74

Asking price, not received

Medicare allowed

$694.81

The fee schedule figure

Medicare paid

$548.51

Balance is patient coinsurance

Providers submitted an average of $3356.74 for this code and Medicare allowed $694.81 — 4.8× less. That gap is normal and means nothing on its own: Medicare pays its fee schedule regardless of what is billed, so the submitted figure describes a hospital chargemaster, not a price anyone paid. Of the allowed amount Medicare paid $548.51 (79%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $810.03
Hospital / facility: $689.18

The office rate is higher because the practice supplies the room, staff and equipment out of that payment. In a hospital the facility bills those separately, so the clinician's share is smaller — the total cost to Medicare is usually higher, not lower. 4,386 services were billed in an office setting and 89,870 in a facility.

Services: 94,256
Beneficiaries: 66,857
Providers billing it: 1,698
Total allowed: $65,490,011

What Medicare pays for CPT 15823

Across 94,256 services billed by 1,698 providers to 66,857 beneficiaries, Medicare allowed an average of $694.81 per service. That is 1.4 services per beneficiary, so this is a code patients typically receive more than once. The allowed amount is the figure that matters: it is what Medicare and the patient together owe, set by the fee schedule and adjusted for local practice costs. What a provider chose to submit has no bearing on it.

Who bills 15823

Specialty	Services	Beneficiaries	Avg allowed	Providers
Ambulatory Surgical Center	56,400	29,109	$639.09	699
Ophthalmology	35,984	35,877	$778.43	930
Plastic and Reconstructive Surgery	1,505	1,504	$763.13	51
Otolaryngology	330	330	$779.76	15
Internal Medicine	14	14	$777.22	1
General Surgery	12	12	$729.45	1
Maxillofacial Surgery	11	11	$805.64	1

15823 reimbursement by state

Two different numbers. Allowed is what Medicare actually allowed in that state, which includes the local practice-cost adjustment. Standardized strips that geographic adjustment out of the payment, so it is the column to use when comparing states — a difference there reflects how the code was billed, not what it costs to run a practice locally.

State	Services	Allowed	Standardized pmt	Providers
Florida	11,241	$695.44	$564.47	169
California	8,608	$824.29	$566.62	177
Texas	6,791	$696.43	$562.02	124
Tennessee	4,381	$637.15	$556.27	63
North Carolina	4,171	$673.01	$563.64	54
Arizona	3,836	$690.15	$555.33	42
Ohio	3,235	$661.51	$551.77	55
Georgia	3,081	$674.98	$553.52	61
South Carolina	2,879	$675.79	$564.43	42
Pennsylvania	2,787	$677.37	$554.94	64
Oklahoma	2,591	$661.61	$563.96	35
Washington	2,323	$755.97	$571.02	40
Mississippi	2,072	$597.30	$545.38	32
Michigan	2,030	$693.62	$570.52	50
Missouri	1,990	$678.75	$580.96	39
Colorado	1,896	$670.85	$543.04	35
Virginia	1,832	$693.12	$564.81	32
Minnesota	1,767	$677.17	$543.77	38
New York	1,714	$729.58	$532.77	43
Maryland	1,620	$679.15	$530.00	37
Arkansas	1,603	$649.87	$566.57	17
Massachusetts	1,449	$764.85	$549.23	34
South Dakota	1,445	$630.95	$535.87	12
Kansas	1,388	$646.75	$549.21	27
Alabama	1,332	$632.59	$574.70	25
Iowa	1,321	$665.89	$622.30	23
Illinois	1,319	$736.91	$581.45	40
Indiana	1,166	$707.66	$585.69	23
Oregon	1,089	$767.68	$578.29	32
Wisconsin	1,032	$671.40	$553.45	22
Utah	973	$617.66	$516.16	23
Nebraska	961	$670.27	$561.61	16
Nevada	898	$702.96	$540.46	13
Louisiana	868	$652.81	$529.33	18
Kentucky	831	$699.30	$589.34	18
Idaho	736	$638.32	$542.13	17
Delaware	704	$720.23	$556.91	6
North Dakota	650	$632.84	$525.35	12
New Jersey	605	$733.40	$539.72	17
New Hampshire	599	$693.69	$551.73	10
Montana	555	$650.96	$536.64	12
Maine	393	$666.94	$528.21	6
Connecticut	381	$756.80	$553.22	11
Vermont	264	$712.56	$573.91	2
New Mexico	142	$690.85	$581.89	5
Hawaii	135	$817.51	$603.06	5
West Virginia	123	$715.82	$611.54	5
Alaska	120	$754.31	$535.40	4
Guam	98	$724.81	$563.45	2
Puerto Rico	92	$503.71	$491.75	3
Rhode Island	64	$770.25	$598.43	2
District of Columbia	39	$883.06	$608.02	2
Wyoming	36	$710.44	$584.32	2

Related codes

15853Removal of sutures or staples$11.48
15852Dressing change under anesthesia$26.22
15860Injection of agent into vein to assess blood flow of skin graft or fla$53.69

Billing this code is not the same as earning it

An allowed amount is revenue to a practice, not income to a clinician. It funds staff, premises, equipment and supplies before anyone is paid. What clinicians actually earn is published separately by the Department of Labor, and what industry pays them is published separately again by CMS — this site carries both.

What doctors are paid →·Look up a clinician →·All procedure codes →

Where this comes from. CMS Medicare Physician & Other Practitioners, by Provider and Service, 2024. It covers fee-for-service Original Medicare Part B only — not Medicare Advantage, not Medicaid, and not commercial insurance, which typically pays more for the same code.

How it is averaged. CMS publishes one average per provider per code. Every figure here is re-weighted by the number of services, so a clinician who billed the code 4,000 times counts 4,000 times more than one who billed it twice. CMS also suppresses any provider-code pair with fewer than 11 beneficiaries, so low-volume practice is missing from these totals by design.