How much does Medicare pay for CPT 65426?

Medicare allowed an average of $883.70 per service and paid $695.13 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $3755.76, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 65426?

Removal or relocation of corneal conjunctiva with graft. It was billed 1,717 times to 1,533 Medicare beneficiaries by 100 providers in 2024.

Does 65426 pay differently in an office than a hospital?

Yes. The allowed amount averaged $604.85 in an office setting and $898.23 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 65426 most?

Ambulatory Surgical Center, with 1,266 services from 72 clinicians. Next are Ophthalmology.

CPT 65426

Removal or relocation of corneal conjunctiva with graft

$883.70Medicare-allowed amount per service, averaged across 1,717 services

Providers submitted

$3755.76

Asking price, not received

Medicare allowed

$883.70

The fee schedule figure

Medicare paid

$695.13

Balance is patient coinsurance

Providers submitted an average of $3755.76 for this code and Medicare allowed $883.70 — 4.3× 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 $695.13 (79%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $604.85
Hospital / facility: $898.23

The facility rate is higher for this code, which is unusual and generally means the service depends on equipment or staffing a hospital carries. 85 services were billed in an office setting and 1,632 in a facility.

Services: 1,717
Beneficiaries: 1,533
Providers billing it: 100
Total allowed: $1,517,313

What Medicare pays for CPT 65426

Across 1,717 services billed by 100 providers to 1,533 beneficiaries, Medicare allowed an average of $883.70 per service. 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 65426

Specialty	Services	Beneficiaries	Avg allowed	Providers
Ambulatory Surgical Center	1,266	1,135	$1023.92	72
Ophthalmology	451	398	$490.10	28

65426 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	723	$998.89	$659.27	43
Arizona	135	$890.34	$710.41	6
Texas	128	$826.41	$679.42	7
North Carolina	91	$719.83	$597.13	5
Illinois	55	$597.56	$444.82	3
Georgia	51	$681.30	$561.25	3
Florida	51	$735.48	$631.99	3
Indiana	49	$774.04	$624.37	3
Maryland	39	$568.36	$428.26	2
Washington	39	$822.07	$621.15	3
Idaho	37	$879.33	$741.28	3
Oklahoma	36	$547.23	$459.97	2
New Jersey	36	$1039.77	$719.25	2
Hawaii	31	$1005.08	$655.54	1
Utah	29	$906.86	$747.34	2
Virginia	28	$875.81	$749.92	2
Nevada	26	$975.48	$743.95	2
South Carolina	23	$843.58	$719.16	1
New York	23	$1123.78	$750.73	1
South Dakota	17	$869.74	$752.33	1
New Mexico	17	$885.94	$750.56	1
Michigan	14	$435.90	$353.21	1
Louisiana	13	$437.68	$369.27	1
Guam	13	$777.87	$752.61	1
Colorado	13	$950.37	$767.10	1

Related codes

65400Removal of growth of cornea$617.96
65435Removal of outer layer of cornea$70.62

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.