How much does Medicare pay for CPT 66988?

Medicare allowed an average of $1349.13 per service and paid $1072.15 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $4247.26, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 66988?

Removal of cataract with insertion of prosthetic lens and laser treatment to decrease fluid production in eye. It was billed 3,284 times to 2,104 Medicare beneficiaries by 94 providers in 2024.

Does 66988 pay differently in an office than a hospital?

Yes. The allowed amount averaged $252.18 in an office setting and $1366.09 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 66988 most?

Ambulatory Surgical Center, with 1,792 services from 45 clinicians. Next are Ophthalmology.

CPT 66988

Removal of cataract with insertion of prosthetic lens and laser treatment to decrease fluid production in eye

$1349.13Medicare-allowed amount per service, averaged across 3,284 services

Providers submitted

$4247.26

Asking price, not received

Medicare allowed

$1349.13

The fee schedule figure

Medicare paid

$1072.15

Balance is patient coinsurance

Providers submitted an average of $4247.26 for this code and Medicare allowed $1349.13 — 3.1× 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 $1072.15 (79%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $252.18
Hospital / facility: $1366.09

The facility rate is higher for this code, which is unusual and generally means the service depends on equipment or staffing a hospital carries. 50 services were billed in an office setting and 3,234 in a facility.

Services: 3,284
Beneficiaries: 2,104
Providers billing it: 94
Total allowed: $4,430,543

What Medicare pays for CPT 66988

Across 3,284 services billed by 94 providers to 2,104 beneficiaries, Medicare allowed an average of $1349.13 per service. That is 1.6 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 66988

Specialty	Services	Beneficiaries	Avg allowed	Providers
Ambulatory Surgical Center	1,792	1,151	$1998.63	45
Ophthalmology	1,492	953	$569.04	49

66988 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	629	$1542.07	$1122.68	11
Michigan	528	$1248.57	$1047.51	12
New York	295	$1555.11	$1105.83	9
Florida	254	$1370.30	$1138.04	8
New Jersey	209	$1369.06	$1081.18	7
Pennsylvania	199	$1151.75	$978.59	6
Virginia	166	$1096.13	$937.64	5
Indiana	158	$1070.93	$883.49	4
Tennessee	96	$1058.00	$953.70	3
Maryland	79	$1523.34	$1256.86	3
Wisconsin	73	$1534.37	$1222.93	2
Massachusetts	66	$1575.42	$1231.31	2
Illinois	64	$1567.56	$1300.54	3
Ohio	63	$1371.57	$1113.94	2
Missouri	62	$1382.60	$1156.32	3
Colorado	56	$1285.84	$1088.26	2
North Carolina	50	$252.18	$203.35	1
Washington	50	$1304.72	$1090.68	2
Texas	43	$1202.80	$1068.12	2
South Dakota	37	$1245.95	$1072.20	2
District of Columbia	30	$651.40	$508.73	1
Guam	21	$1973.06	$1598.46	1
Oregon	20	$2033.48	$1603.18	1
Kentucky	19	$1835.83	$1603.12	1
New Hampshire	17	$1970.16	$1603.14	1

Related codes

66984Removal of cataract$304.21
66982Complex removal of cataract$728.10
66991Extracapsular removal of cataract$2193.25
66986Exchange of prosthetic lens$806.71
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.