How much does Medicare pay for CPT 66180?

Medicare allowed an average of $1714.60 per service and paid $1363.22 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $5569.37, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 66180?

Creation of shunt to improve eye fluid flow using tissue graft. It was billed 7,683 times to 7,227 Medicare beneficiaries by 396 providers in 2024.

Does 66180 pay differently in an office than a hospital?

Yes. The allowed amount averaged $990.80 in an office setting and $1743.00 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 66180 most?

Ophthalmology, with 4,313 services from 239 clinicians. Next are Ambulatory Surgical Center, Physician Assistant.

CPT 66180

Creation of shunt to improve eye fluid flow using tissue graft

$1714.60Medicare-allowed amount per service, averaged across 7,683 services

Providers submitted

$5569.37

Asking price, not received

Medicare allowed

$1714.60

The fee schedule figure

Medicare paid

$1363.22

Balance is patient coinsurance

Providers submitted an average of $5569.37 for this code and Medicare allowed $1714.60 — 3.2× 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 $1363.22 (80%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $990.80
Hospital / facility: $1743.00

The facility rate is higher for this code, which is unusual and generally means the service depends on equipment or staffing a hospital carries. 290 services were billed in an office setting and 7,393 in a facility.

Services: 7,683
Beneficiaries: 7,227
Providers billing it: 396
Total allowed: $13,173,272

What Medicare pays for CPT 66180

Across 7,683 services billed by 396 providers to 7,227 beneficiaries, Medicare allowed an average of $1714.60 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 66180

Specialty	Services	Beneficiaries	Avg allowed	Providers
Ophthalmology	4,313	4,048	$1047.50	239
Ambulatory Surgical Center	3,347	3,157	$2584.79	156
Physician Assistant	23	22	$180.62	1

66180 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	953	$1990.31	$1290.02	48
Florida	695	$1735.92	$1429.87	38
Texas	560	$1680.10	$1368.02	26
Pennsylvania	485	$1484.67	$1189.52	20
New York	392	$1695.50	$1239.78	19
Virginia	380	$1787.08	$1480.49	19
Maryland	318	$1773.71	$1378.22	16
Ohio	305	$1658.37	$1370.13	14
North Carolina	295	$1283.85	$1093.60	14
Indiana	249	$1760.00	$1447.87	6
Illinois	246	$1611.17	$1272.33	13
South Carolina	216	$1704.86	$1489.99	9
Georgia	211	$1847.85	$1490.62	15
New Jersey	207	$1798.48	$1346.88	11
Tennessee	170	$1654.13	$1431.42	11
Oklahoma	159	$1713.49	$1475.87	7
Washington	147	$2150.23	$1632.44	7
Nevada	127	$1801.64	$1388.95	5
Arizona	118	$1837.62	$1545.49	7
Minnesota	115	$1587.92	$1240.90	7
Wisconsin	113	$1548.83	$1278.71	7
Alabama	111	$1466.24	$1274.56	6
Nebraska	106	$1896.98	$1554.12	7
Mississippi	87	$1557.34	$1388.35	6
Missouri	80	$1239.86	$1039.32	5
Massachusetts	79	$1937.86	$1448.42	6
Arkansas	75	$1537.99	$1351.01	5
Iowa	73	$1561.25	$1308.14	4
Montana	64	$1642.21	$1340.84	3
Michigan	56	$1825.37	$1541.80	4
Delaware	54	$1955.00	$1518.09	3
Kansas	53	$1744.02	$1530.90	3
Utah	51	$1339.49	$1123.93	4
Louisiana	49	$1480.39	$1352.44	3
South Dakota	39	$1868.75	$1665.62	3
Kentucky	38	$2009.31	$1681.28	3
New Mexico	29	$1686.29	$1388.10	2
District of Columbia	29	$319.37	$231.81	1
West Virginia	29	$1089.28	$870.75	2
North Dakota	23	$1055.86	$887.62	1
Colorado	23	$2522.76	$2054.74	1
Connecticut	21	$1321.17	$882.45	1
New Hampshire	18	$2557.61	$2056.26	1
Guam	13	$2533.74	$2044.08	1
Oregon	11	$1151.67	$881.83	1
U.S. Virgin Islands	11	$1002.66	$853.81	1

Related codes

66174Dilation of fluid outflow drainage within eye$1015.39
66183Insertion of eye fluid drainage device$1844.09
66170Creation of eye fluid drainage tract for treatment of glaucoma$1014.77
66172Creation of eye fluid drainage tract for treatment of glaucoma$1111.47

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.