How much does Medicare pay for CPT 66250?

Medicare allowed an average of $704.45 per service and paid $554.22 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $2274.54, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 66250?

Revision or repair of operative wound of eye. It was billed 2,054 times to 1,787 Medicare beneficiaries by 102 providers in 2024.

Does 66250 pay differently in an office than a hospital?

Yes. The allowed amount averaged $744.33 in an office setting and $683.06 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 66250 most?

Ophthalmology, with 1,244 services from 57 clinicians. Next are Ambulatory Surgical Center, General Surgery.

CPT 66250

Revision or repair of operative wound of eye

$704.45Medicare-allowed amount per service, averaged across 2,054 services

Providers submitted

$2274.54

Asking price, not received

Medicare allowed

$704.45

The fee schedule figure

Medicare paid

$554.22

Balance is patient coinsurance

Providers submitted an average of $2274.54 for this code and Medicare allowed $704.45 — 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 $554.22 (79%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $744.33
Hospital / facility: $683.06

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. 717 services were billed in an office setting and 1,337 in a facility.

Services: 2,054
Beneficiaries: 1,787
Providers billing it: 102
Total allowed: $1,446,940

What Medicare pays for CPT 66250

Across 2,054 services billed by 102 providers to 1,787 beneficiaries, Medicare allowed an average of $704.45 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 66250

Specialty	Services	Beneficiaries	Avg allowed	Providers
Ophthalmology	1,244	1,057	$610.09	57
Ambulatory Surgical Center	774	701	$849.28	44
General Surgery	36	29	$851.38	1

66250 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	312	$626.71	$513.78	14
California	249	$789.49	$518.22	13
Texas	163	$692.59	$565.04	9
Ohio	115	$776.39	$642.78	5
New York	102	$850.93	$574.82	3
Pennsylvania	96	$586.10	$468.67	6
Nevada	91	$840.90	$678.40	2
Arkansas	85	$675.51	$580.46	4
New Jersey	82	$811.83	$584.46	3
Indiana	72	$614.81	$496.60	3
Michigan	64	$645.04	$508.57	4
Arizona	61	$722.74	$598.68	4
Massachusetts	59	$821.24	$589.15	4
Virginia	59	$732.94	$596.06	4
Kansas	50	$649.01	$541.01	2
Nebraska	48	$679.10	$562.59	2
Oklahoma	46	$662.51	$552.66	2
North Carolina	45	$543.89	$425.48	2
Wisconsin	39	$474.37	$396.37	2
Minnesota	38	$593.37	$467.82	3
Illinois	29	$747.14	$576.24	2
Montana	28	$795.43	$636.51	2
Washington	26	$947.75	$722.85	1
Rhode Island	20	$634.37	$478.36	1
Connecticut	20	$551.10	$402.73	1
Mississippi	16	$676.31	$743.12	1
South Carolina	15	$351.45	$303.66	1
Utah	13	$746.98	$619.58	1
Tennessee	11	$782.41	$732.23	1

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.