How much does Medicare pay for CPT 65205?

Medicare allowed an average of $26.38 per service and paid $19.60 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $125.54, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 65205?

Removal of foreign body from external eye (conjunctiva). It was billed 5,915 times to 4,533 Medicare beneficiaries by 115 providers in 2024.

Which specialty bills 65205 most?

Ophthalmology, with 3,134 services from 72 clinicians. Next are Optometry, Family Practice.

CPT 65205

Removal of foreign body from external eye (conjunctiva)

$26.38Medicare-allowed amount per service, averaged across 5,915 services

Providers submitted

$125.54

Asking price, not received

Medicare allowed

$26.38

The fee schedule figure

Medicare paid

$19.60

Balance is patient coinsurance

Providers submitted an average of $125.54 for this code and Medicare allowed $26.38 — 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 $19.60 (74%); the rest is the patient’s coinsurance and deductible.

Services: 5,915
Beneficiaries: 4,533
Providers billing it: 115
Total allowed: $156,038

What Medicare pays for CPT 65205

Across 5,915 services billed by 115 providers to 4,533 beneficiaries, Medicare allowed an average of $26.38 per service. That is 1.3 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 65205

Specialty	Services	Beneficiaries	Avg allowed	Providers
Ophthalmology	3,134	2,711	$27.29	72
Optometry	2,594	1,660	$24.72	41
Family Practice	187	162	$34.35	2

65205 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
California	1,805	$24.04	$17.65	20
New York	1,230	$28.75	$19.61	14
Arizona	855	$27.15	$21.09	7
Florida	707	$27.48	$19.66	20
New Jersey	260	$21.97	$15.19	7
Texas	140	$28.90	$20.86	6
Georgia	124	$26.86	$18.20	4
Pennsylvania	115	$29.86	$22.44	6
Connecticut	108	$28.66	$20.60	3
Illinois	71	$26.80	$17.91	2
Arkansas	70	$25.97	$20.56	3
Indiana	53	$15.96	$12.97	1
Maryland	45	$29.21	$18.45	2
Alaska	34	$27.59	$18.93	1
Nebraska	34	$34.69	$27.77	2
Virginia	33	$27.05	$17.24	2
Hawaii	32	$21.76	$14.02	1
Montana	28	$28.49	$20.17	2
Ohio	26	$26.66	$20.83	2
New Hampshire	22	$27.45	$14.96	1
Mississippi	16	$25.97	$22.14	1
Wyoming	15	$27.36	$19.21	1
Iowa	15	$30.89	$18.68	1
Vermont	14	$26.94	$21.38	1
Michigan	14	$22.27	$15.10	1
Oklahoma	13	$26.52	$17.37	1
Kansas	13	$28.00	$22.10	1
Tennessee	12	$26.25	$20.43	1
Massachusetts	11	$33.16	$18.03	1

Related codes

65222Removal of foreign body in cornea$68.74
65210Removal of foreign body from external eye (conjunctiva or sclera)$35.92

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.