How much does Medicare pay for CPT 65435?

Medicare allowed an average of $70.62 per service and paid $54.39 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $239.52, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 65435?

Removal of outer layer of cornea. It was billed 2,946 times to 1,391 Medicare beneficiaries by 62 providers in 2024.

Does 65435 pay differently in an office than a hospital?

Yes. The allowed amount averaged $75.78 in an office setting and $42.23 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 65435 most?

Ophthalmology, with 2,733 services from 53 clinicians. Next are Ambulatory Surgical Center, Optometry.

CPT 65435

Removal of outer layer of cornea

$70.62Medicare-allowed amount per service, averaged across 2,946 services

Providers submitted

$239.52

Asking price, not received

Medicare allowed

$70.62

The fee schedule figure

Medicare paid

$54.39

Balance is patient coinsurance

Providers submitted an average of $239.52 for this code and Medicare allowed $70.62 — 3.4× 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 $54.39 (77%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $75.78
Hospital / facility: $42.23

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. 2,493 services were billed in an office setting and 453 in a facility.

Services: 2,946
Beneficiaries: 1,391
Providers billing it: 62
Total allowed: $208,047

What Medicare pays for CPT 65435

Across 2,946 services billed by 62 providers to 1,391 beneficiaries, Medicare allowed an average of $70.62 per service. That is 2.1 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 65435

Specialty	Services	Beneficiaries	Avg allowed	Providers
Ophthalmology	2,733	1,216	$73.43	53
Ambulatory Surgical Center	200	164	$32.77	8
Optometry	13	11	$62.40	1

65435 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	1,901	$73.22	$58.96	9
Virginia	130	$72.59	$54.05	4
Pennsylvania	112	$62.79	$45.80	7
Texas	99	$68.98	$52.10	5
Indiana	74	$31.43	$26.24	3
Ohio	71	$61.64	$48.19	4
Oklahoma	63	$54.04	$47.88	2
South Carolina	48	$72.00	$58.22	2
California	47	$72.67	$51.03	1
Iowa	43	$82.61	$67.32	2
Illinois	42	$78.99	$53.83	3
Montana	38	$27.97	$23.04	2
Massachusetts	37	$89.35	$54.58	2
Michigan	22	$47.24	$36.35	1
Kentucky	21	$74.29	$61.08	1
Missouri	20	$78.93	$36.27	1
Alabama	18	$73.09	$54.52	1
New Mexico	16	$64.98	$41.11	1
Kansas	15	$70.00	$52.10	1
Colorado	15	$85.92	$62.42	1
Utah	14	$90.61	$58.15	1
New Jersey	14	$85.00	$48.00	1
Arizona	14	$84.04	$64.06	1
Tennessee	13	$85.60	$61.09	1
North Carolina	13	$62.40	$51.85	1
Nebraska	12	$93.45	$72.69	1
Oregon	12	$55.62	$40.52	1
Georgia	11	$68.75	$53.43	1
Minnesota	11	$33.42	$27.01	1

Related codes

65400Removal of growth of cornea$617.96
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.