How much does Medicare pay for CPT 66986?

Medicare allowed an average of $806.71 per service and paid $640.78 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $4099.94, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 66986?

Exchange of prosthetic lens. It was billed 4,433 times to 4,193 Medicare beneficiaries by 206 providers in 2024.

Does 66986 pay differently in an office than a hospital?

Yes. The allowed amount averaged $832.99 in an office setting and $806.65 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 66986 most?

Ambulatory Surgical Center, with 2,757 services from 122 clinicians. Next are Ophthalmology.

CPT 66986

Exchange of prosthetic lens

$806.71Medicare-allowed amount per service, averaged across 4,433 services

Providers submitted

$4099.94

Asking price, not received

Medicare allowed

$806.71

The fee schedule figure

Medicare paid

$640.78

Balance is patient coinsurance

Providers submitted an average of $4099.94 for this code and Medicare allowed $806.71 — 5.1× 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 $640.78 (79%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $832.99
Hospital / facility: $806.65

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. 11 services were billed in an office setting and 4,422 in a facility.

Services: 4,433
Beneficiaries: 4,193
Providers billing it: 206
Total allowed: $3,576,145

What Medicare pays for CPT 66986

Across 4,433 services billed by 206 providers to 4,193 beneficiaries, Medicare allowed an average of $806.71 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 66986

Specialty	Services	Beneficiaries	Avg allowed	Providers
Ambulatory Surgical Center	2,757	2,616	$807.83	122
Ophthalmology	1,676	1,577	$804.88	84

66986 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	626	$713.06	$580.73	26
Texas	358	$775.14	$627.46	15
California	346	$1002.42	$654.41	14
Pennsylvania	233	$834.96	$640.35	7
Arizona	202	$669.81	$537.61	8
New York	187	$932.02	$636.36	11
Ohio	178	$785.66	$642.79	7
New Jersey	164	$935.94	$715.00	6
Tennessee	156	$741.04	$664.78	8
Massachusetts	153	$829.79	$628.23	7
Utah	148	$896.33	$748.73	7
Oklahoma	123	$717.88	$679.14	4
Indiana	121	$746.55	$602.82	4
North Carolina	119	$796.83	$660.08	5
Washington	119	$893.18	$666.27	7
Virginia	112	$804.26	$672.56	7
Maryland	110	$854.00	$656.16	7
Colorado	110	$856.49	$680.09	6
Minnesota	96	$664.91	$516.54	6
New Mexico	90	$815.67	$673.52	3
South Carolina	86	$760.93	$630.93	5
Alabama	70	$698.76	$630.64	2
Georgia	63	$851.73	$690.15	4
Mississippi	59	$760.97	$772.22	3
Michigan	57	$861.50	$714.21	4
Missouri	53	$836.67	$679.77	3
Iowa	52	$752.04	$646.67	3
Connecticut	45	$795.62	$580.00	3
Arkansas	30	$692.39	$604.34	2
Louisiana	28	$780.51	$637.19	2
Illinois	27	$855.37	$696.39	2
Kansas	19	$782.87	$663.92	1
Montana	17	$657.24	$573.14	1
Hawaii	13	$672.53	$463.98	1
Maine	13	$666.44	$535.37	1
Kentucky	13	$1010.20	$856.57	1
Nevada	13	$957.69	$699.33	1
New Hampshire	13	$918.89	$589.83	1
Delaware	11	$869.81	$657.75	1

Related codes

66984Removal of cataract$304.21
66982Complex removal of cataract$728.10
66991Extracapsular removal of cataract$2193.25
66988Removal of cataract$1349.13
66989Complex extracapsular removal of cataract$2460.11

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.