How much does Medicare pay for CPT 66991?

Medicare allowed an average of $2193.25 per service and paid $1744.41 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $6125.32, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 66991?

Extracapsular removal of cataract with insertion of artificial lens and insertion of drainage device in front chamber of eye. It was billed 59,663 times to 37,297 Medicare beneficiaries by 1,422 providers in 2024.

Does 66991 pay differently in an office than a hospital?

Yes. The allowed amount averaged $467.84 in an office setting and $2210.45 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 66991 most?

Ambulatory Surgical Center, with 31,486 services from 642 clinicians. Next are Ophthalmology, Optometry.

CPT 66991

Extracapsular removal of cataract with insertion of artificial lens and insertion of drainage device in front chamber of eye

$2193.25Medicare-allowed amount per service, averaged across 59,663 services

Providers submitted

$6125.32

Asking price, not received

Medicare allowed

$2193.25

The fee schedule figure

Medicare paid

$1744.41

Balance is patient coinsurance

Providers submitted an average of $6125.32 for this code and Medicare allowed $2193.25 — 2.8× 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 $1744.41 (80%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $467.84
Hospital / facility: $2210.45

The facility rate is higher for this code, which is unusual and generally means the service depends on equipment or staffing a hospital carries. 589 services were billed in an office setting and 59,074 in a facility.

Services: 59,663
Beneficiaries: 37,297
Providers billing it: 1,422
Total allowed: $130,855,875

What Medicare pays for CPT 66991

Across 59,663 services billed by 1,422 providers to 37,297 beneficiaries, Medicare allowed an average of $2193.25 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 66991

Specialty	Services	Beneficiaries	Avg allowed	Providers
Ambulatory Surgical Center	31,486	20,139	$3646.33	642
Ophthalmology	28,044	17,061	$571.89	774
Optometry	133	97	$68.34	6

66991 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	7,276	$2822.83	$1872.63	172
Texas	3,505	$2220.38	$1851.33	88
Florida	3,327	$2174.79	$1842.23	85
Pennsylvania	3,044	$2138.54	$1743.61	62
New Jersey	2,192	$2913.20	$2136.77	53
Arizona	2,067	$2199.51	$1801.56	55
Massachusetts	1,827	$2392.31	$1848.79	42
New York	1,686	$2559.88	$1842.34	50
Missouri	1,635	$1874.34	$1581.45	38
Georgia	1,578	$2344.46	$1941.17	42
Washington	1,527	$2154.20	$1697.29	30
Maryland	1,494	$2255.37	$1814.25	35
Indiana	1,454	$2054.92	$1709.83	29
Kansas	1,381	$1997.90	$1702.16	27
Minnesota	1,332	$1978.03	$1576.11	33
Illinois	1,303	$1884.26	$1545.05	32
Ohio	1,244	$1475.92	$1263.97	26
Virginia	1,218	$2045.89	$1734.19	32
Nebraska	1,171	$1929.69	$1660.84	27
Tennessee	1,157	$1877.91	$1678.46	36
North Carolina	1,144	$1827.42	$1577.72	27
South Dakota	1,100	$1857.49	$1607.86	13
Wisconsin	1,097	$1877.23	$1559.28	22
Mississippi	1,037	$1923.36	$1805.05	20
Louisiana	1,017	$1420.92	$1253.81	23
Alabama	980	$1873.26	$1739.90	22
South Carolina	979	$1918.51	$1657.99	20
Colorado	952	$2401.29	$1940.07	24
Michigan	870	$2150.86	$1832.51	27
New Hampshire	747	$2061.68	$1663.74	13
Arkansas	724	$1993.01	$1755.60	19
Iowa	713	$1766.21	$1538.76	19
Oregon	672	$2392.98	$1807.42	24
Montana	622	$1900.13	$1604.45	13
Oklahoma	592	$1902.44	$1654.56	18
Kentucky	587	$2045.82	$1796.34	15
Idaho	561	$2562.39	$2173.98	12
Utah	538	$1666.87	$1377.01	16
Nevada	481	$2430.11	$1882.03	13
Connecticut	474	$2602.18	$1950.58	14
Delaware	462	$2363.20	$1870.27	9
North Dakota	433	$2045.56	$1778.98	9
Maine	421	$1093.33	$902.17	6
Rhode Island	212	$1213.89	$962.13	6
West Virginia	208	$1574.18	$1413.67	5
Hawaii	207	$2452.33	$1789.82	4
New Mexico	185	$2952.83	$2540.63	6
Wyoming	80	$2475.79	$2082.16	3
Vermont	64	$2368.60	$2163.22	2
District of Columbia	54	$671.11	$506.05	2
Alaska	21	$3939.76	$2926.29	1
U.S. Virgin Islands	11	$428.09	$392.88	1

Related codes

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