How much does Medicare pay for CPT 65855?

Medicare allowed an average of $212.04 per service and paid $160.86 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $1046.66, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 65855?

Laser repair to improve eye fluid flow. It was billed 137,817 times to 94,675 Medicare beneficiaries by 2,913 providers in 2024.

Does 65855 pay differently in an office than a hospital?

Yes. The allowed amount averaged $249.69 in an office setting and $164.98 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 65855 most?

Ophthalmology, with 104,147 services from 2,391 clinicians. Next are Ambulatory Surgical Center, Optometry, General Surgery.

CPT 65855

Laser repair to improve eye fluid flow

$212.04Medicare-allowed amount per service, averaged across 137,817 services

Providers submitted

$1046.66

Asking price, not received

Medicare allowed

$212.04

The fee schedule figure

Medicare paid

$160.86

Balance is patient coinsurance

Providers submitted an average of $1046.66 for this code and Medicare allowed $212.04 — 4.9× 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 $160.86 (76%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $249.69
Hospital / facility: $164.98

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. 76,569 services were billed in an office setting and 61,248 in a facility.

Services: 137,817
Beneficiaries: 94,675
Providers billing it: 2,913
Total allowed: $29,222,717

What Medicare pays for CPT 65855

Across 137,817 services billed by 2,913 providers to 94,675 beneficiaries, Medicare allowed an average of $212.04 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 65855

Specialty	Services	Beneficiaries	Avg allowed	Providers
Ophthalmology	104,147	72,494	$238.03	2,391
Ambulatory Surgical Center	32,360	21,370	$127.49	481
Optometry	1,220	767	$234.62	39
General Surgery	63	26	$234.59	1
Internal Medicine	27	18	$227.45	1

65855 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	16,003	$247.81	$165.09	316
Florida	13,144	$208.91	$160.32	244
Texas	7,396	$204.87	$156.79	165
Pennsylvania	7,178	$212.18	$161.19	163
New York	6,916	$228.83	$155.55	149
Massachusetts	5,926	$208.89	$147.84	114
Virginia	5,175	$218.33	$165.37	97
Arizona	5,025	$181.64	$139.10	74
New Jersey	4,684	$229.69	$156.97	97
Illinois	4,617	$226.97	$167.44	101
Ohio	4,224	$180.56	$142.51	93
Maryland	3,691	$227.67	$160.36	75
Georgia	3,589	$193.26	$150.30	77
North Carolina	3,385	$232.03	$181.76	69
Indiana	3,301	$182.51	$144.05	73
Michigan	3,251	$216.93	$167.38	82
Washington	3,164	$210.45	$152.84	81
South Carolina	2,910	$213.25	$167.33	58
Kansas	2,542	$176.08	$144.72	38
Oklahoma	2,067	$217.29	$175.00	39
Tennessee	2,022	$172.77	$142.28	54
Wisconsin	1,794	$214.66	$165.26	44
Missouri	1,793	$203.00	$156.27	50
Nevada	1,711	$187.00	$147.74	20
Mississippi	1,615	$166.87	$141.62	29
Colorado	1,513	$211.38	$156.50	37
Nebraska	1,481	$180.35	$147.30	34
Minnesota	1,463	$223.08	$169.32	41
Louisiana	1,373	$184.88	$151.57	38
New Hampshire	1,324	$211.96	$154.63	24
Arkansas	1,271	$165.84	$137.35	22
Connecticut	1,191	$255.56	$180.12	32
Alabama	1,127	$198.59	$165.36	28
Oregon	1,009	$196.68	$143.32	34
Hawaii	783	$218.09	$158.80	14
Kentucky	781	$210.87	$168.37	29
Iowa	779	$205.08	$164.55	21
Utah	719	$218.02	$170.79	17
Delaware	676	$191.61	$142.37	12
Idaho	634	$150.72	$121.59	13
South Dakota	631	$187.09	$148.28	13
Montana	569	$200.38	$153.60	12
New Mexico	543	$193.84	$151.56	12
West Virginia	539	$205.43	$164.88	17
District of Columbia	537	$253.39	$181.33	9
Rhode Island	371	$229.22	$171.41	8
Wyoming	333	$175.65	$142.38	7
North Dakota	223	$168.20	$134.87	8
Maine	217	$193.34	$152.38	9
Vermont	216	$238.65	$173.87	9
U.S. Virgin Islands	179	$230.67	$176.92	2
Alaska	170	$312.36	$188.84	7
Guam	42	$245.67	$183.22	2

Related codes

65820Incision to improve eye fluid flow$1292.86
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.