How much does Medicare pay for CPT 65800?

Medicare allowed an average of $196.66 per service and paid $154.46 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $713.39, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 65800?

Removal of eye fluid. It was billed 7,367 times to 2,786 Medicare beneficiaries by 99 providers in 2024.

Does 65800 pay differently in an office than a hospital?

Yes. The allowed amount averaged $121.29 in an office setting and $857.70 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 65800 most?

Ophthalmology, with 6,829 services from 94 clinicians. Next are Ambulatory Surgical Center, Optometry.

CPT 65800

Removal of eye fluid

$196.66Medicare-allowed amount per service, averaged across 7,367 services

Providers submitted

$713.39

Asking price, not received

Medicare allowed

$196.66

The fee schedule figure

Medicare paid

$154.46

Balance is patient coinsurance

Providers submitted an average of $713.39 for this code and Medicare allowed $196.66 — 3.6× 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 $154.46 (79%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $121.29
Hospital / facility: $857.70

The facility rate is higher for this code, which is unusual and generally means the service depends on equipment or staffing a hospital carries. 6,613 services were billed in an office setting and 754 in a facility.

Services: 7,367
Beneficiaries: 2,786
Providers billing it: 99
Total allowed: $1,448,794

What Medicare pays for CPT 65800

Across 7,367 services billed by 99 providers to 2,786 beneficiaries, Medicare allowed an average of $196.66 per service. That is 2.6 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 65800

Specialty	Services	Beneficiaries	Avg allowed	Providers
Ophthalmology	6,829	2,609	$119.08	94
Ambulatory Surgical Center	511	151	$1238.03	3
Optometry	27	26	$111.56	2

65800 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	1,836	$211.30	$142.08	21
Maryland	1,281	$105.07	$85.28	3
Pennsylvania	791	$122.19	$87.82	2
New York	718	$137.46	$90.20	10
Florida	700	$123.71	$93.00	12
New Jersey	485	$953.55	$710.11	2
Wisconsin	369	$122.32	$92.88	3
Illinois	260	$124.41	$92.41	6
Texas	173	$112.41	$86.29	8
Virginia	140	$104.60	$83.26	3
Arizona	139	$115.06	$87.63	7
Michigan	80	$102.19	$76.84	3
Connecticut	62	$117.98	$92.36	2
Missouri	49	$112.20	$81.25	3
Massachusetts	48	$159.68	$109.32	2
Alabama	44	$96.79	$48.72	1
North Carolina	41	$118.17	$93.57	2
Ohio	38	$112.28	$81.69	2
Oklahoma	30	$102.58	$81.99	1
Washington	29	$112.63	$91.53	2
Utah	16	$107.20	$78.97	1
Montana	13	$107.88	$78.21	1
Delaware	13	$115.63	$81.66	1
New Mexico	12	$107.54	$77.71	1

Related codes

65855Laser repair to improve eye fluid flow$212.04
65820Incision to improve eye fluid flow$1292.86

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.