How much does Medicare pay for CPT 65820?

Medicare allowed an average of $1292.86 per service and paid $1027.75 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $3844.49, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 65820?

Incision to improve eye fluid flow. It was billed 45,046 times to 29,197 Medicare beneficiaries by 1,172 providers in 2024.

Does 65820 pay differently in an office than a hospital?

Yes. The allowed amount averaged $812.08 in an office setting and $1297.38 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 65820 most?

Ophthalmology, with 23,488 services from 709 clinicians. Next are Ambulatory Surgical Center, Optometry, Osteopathic Manipulative Medicine.

CPT 65820

Incision to improve eye fluid flow

$1292.86Medicare-allowed amount per service, averaged across 45,046 services

Providers submitted

$3844.49

Asking price, not received

Medicare allowed

$1292.86

The fee schedule figure

Medicare paid

$1027.75

Balance is patient coinsurance

Providers submitted an average of $3844.49 for this code and Medicare allowed $1292.86 — 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 $1027.75 (79%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $812.08
Hospital / facility: $1297.38

The facility rate is higher for this code, which is unusual and generally means the service depends on equipment or staffing a hospital carries. 419 services were billed in an office setting and 44,627 in a facility.

Services: 45,046
Beneficiaries: 29,197
Providers billing it: 1,172
Total allowed: $58,238,172

What Medicare pays for CPT 65820

Across 45,046 services billed by 1,172 providers to 29,197 beneficiaries, Medicare allowed an average of $1292.86 per service. That is 1.5 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 65820

Specialty	Services	Beneficiaries	Avg allowed	Providers
Ophthalmology	23,488	14,966	$776.58	709
Ambulatory Surgical Center	21,496	14,193	$1858.73	461
Optometry	37	23	$654.49	1
Osteopathic Manipulative Medicine	25	15	$740.39	1

65820 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	4,148	$1538.95	$1047.02	106
New York	3,565	$1504.26	$1061.55	86
Florida	3,517	$1283.04	$1070.60	100
Texas	3,474	$1281.36	$1054.67	91
Virginia	2,586	$1390.37	$1142.58	50
New Jersey	2,380	$1428.80	$1062.28	53
Ohio	2,309	$922.25	$785.99	53
Maryland	1,929	$1430.94	$1122.12	45
Illinois	1,770	$1193.01	$933.85	57
North Carolina	1,415	$1074.55	$903.02	39
South Carolina	1,412	$1362.70	$1155.96	31
Pennsylvania	1,370	$1276.75	$1049.22	39
Georgia	1,116	$1350.61	$1127.58	28
Michigan	1,077	$1171.93	$981.82	36
Indiana	1,067	$1196.92	$984.24	24
Massachusetts	1,041	$1371.27	$1032.10	28
Missouri	752	$1063.25	$915.13	24
Arizona	682	$1304.09	$1066.34	17
Tennessee	592	$1259.94	$1118.74	17
Kansas	582	$988.52	$871.62	11
Mississippi	531	$937.56	$864.81	12
Louisiana	526	$1136.45	$1034.43	13
Wisconsin	524	$1078.26	$878.99	11
Oklahoma	490	$1223.30	$1053.37	14
Washington	485	$1355.56	$1018.89	14
Nebraska	463	$1216.66	$1016.95	12
Iowa	463	$994.32	$846.53	12
Nevada	438	$1427.05	$1127.26	13
Colorado	399	$1145.09	$896.51	14
Minnesota	372	$1167.46	$932.92	13
Alabama	342	$1120.91	$1061.41	11
Connecticut	319	$1204.10	$866.77	9
New Hampshire	319	$1468.82	$1169.54	7
Arkansas	290	$1278.01	$1136.57	10
Utah	272	$1062.26	$880.84	8
Kentucky	251	$1000.77	$890.41	6
Oregon	241	$1216.44	$913.07	10
Rhode Island	235	$1083.88	$845.06	7
South Dakota	196	$1257.39	$1097.03	5
Delaware	185	$1356.09	$1136.90	4
Maine	183	$1379.95	$1121.72	6
Montana	139	$1291.06	$1063.53	4
West Virginia	136	$956.35	$820.28	5
Hawaii	115	$1639.70	$1157.88	3
North Dakota	113	$1423.39	$1179.71	3
Idaho	70	$1634.01	$1364.50	3
Wyoming	45	$1402.96	$1165.32	2
Vermont	42	$776.24	$632.73	2
District of Columbia	38	$913.39	$628.61	2
U.S. Virgin Islands	23	$769.56	$639.98	1
New Mexico	17	$1733.62	$1508.83	1

Related codes

65855Laser repair to improve eye fluid flow$212.04
65800Removal of eye fluid$196.66

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.