How much does Medicare pay for CPT 65400?

Medicare allowed an average of $617.96 per service and paid $484.04 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $1842.33, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 65400?

Removal of growth of cornea. It was billed 4,245 times to 3,367 Medicare beneficiaries by 176 providers in 2024.

Does 65400 pay differently in an office than a hospital?

Yes. The allowed amount averaged $702.17 in an office setting and $514.52 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 65400 most?

Ophthalmology, with 2,964 services from 132 clinicians. Next are Ambulatory Surgical Center, General Surgery.

CPT 65400

Removal of growth of cornea

$617.96Medicare-allowed amount per service, averaged across 4,245 services

Providers submitted

$1842.33

Asking price, not received

Medicare allowed

$617.96

The fee schedule figure

Medicare paid

$484.04

Balance is patient coinsurance

Providers submitted an average of $1842.33 for this code and Medicare allowed $617.96 — 3.0× 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 $484.04 (78%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $702.17
Hospital / facility: $514.52

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. 2,340 services were billed in an office setting and 1,905 in a facility.

Services: 4,245
Beneficiaries: 3,367
Providers billing it: 176
Total allowed: $2,623,240

What Medicare pays for CPT 65400

Across 4,245 services billed by 176 providers to 3,367 beneficiaries, Medicare allowed an average of $617.96 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 65400

Specialty	Services	Beneficiaries	Avg allowed	Providers
Ophthalmology	2,964	2,329	$639.79	132
Ambulatory Surgical Center	1,011	819	$465.79	43
General Surgery	270	219	$948.01	1

65400 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	652	$576.57	$462.54	21
Nevada	468	$909.85	$728.36	4
Texas	233	$561.15	$461.14	9
Arizona	215	$572.25	$450.19	11
California	207	$695.54	$490.12	11
Virginia	203	$516.07	$416.00	10
South Dakota	178	$608.64	$486.37	5
Pennsylvania	176	$581.38	$447.13	11
Ohio	163	$479.31	$398.94	9
Indiana	147	$569.07	$453.75	6
Georgia	140	$501.38	$402.59	6
North Carolina	140	$645.46	$529.70	7
Tennessee	124	$525.16	$456.46	6
Kansas	108	$543.28	$460.44	3
Maryland	104	$661.28	$502.82	5
Iowa	97	$615.06	$523.75	4
Illinois	94	$634.58	$483.60	6
Nebraska	92	$531.36	$445.75	4
Michigan	70	$526.87	$428.05	4
Missouri	68	$602.77	$493.08	4
New Jersey	63	$727.29	$531.85	4
Wisconsin	61	$556.24	$453.50	3
Washington	45	$552.86	$416.40	2
Montana	43	$576.28	$442.99	3
Kentucky	42	$618.21	$506.49	2
Colorado	40	$635.71	$480.96	2
North Dakota	38	$569.17	$426.86	1
Oklahoma	34	$444.36	$396.34	2
Delaware	34	$668.67	$526.46	1
South Carolina	28	$650.74	$545.66	1
Connecticut	20	$687.21	$527.97	1
West Virginia	18	$567.80	$545.43	1
New York	17	$793.33	$538.14	1
Maine	16	$559.82	$454.04	1
Massachusetts	15	$704.04	$525.91	1
Minnesota	14	$673.89	$536.54	1
Louisiana	14	$631.88	$527.11	1
Oregon	13	$586.52	$449.59	1
Arkansas	11	$542.89	$453.33	1

Related codes

65435Removal of outer layer of cornea$70.62
65426Removal or relocation of corneal conjunctiva$883.70

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.