How much does Medicare pay for CPT 67515?

Medicare allowed an average of $46.53 per service and paid $35.05 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $262.56, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 67515?

Injection of drug or substance into membrane covering eyeball. It was billed 7,548 times to 4,952 Medicare beneficiaries by 253 providers in 2024.

Does 67515 pay differently in an office than a hospital?

Yes. The allowed amount averaged $48.71 in an office setting and $24.22 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 67515 most?

Ophthalmology, with 7,364 services from 249 clinicians. Next are Ambulatory Surgical Center.

CPT 67515

Injection of drug or substance into membrane covering eyeball

$46.53Medicare-allowed amount per service, averaged across 7,548 services

Providers submitted

$262.56

Asking price, not received

Medicare allowed

$46.53

The fee schedule figure

Medicare paid

$35.05

Balance is patient coinsurance

Providers submitted an average of $262.56 for this code and Medicare allowed $46.53 — 5.6× 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 $35.05 (75%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $48.71
Hospital / facility: $24.22

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. 6,876 services were billed in an office setting and 672 in a facility.

Services: 7,548
Beneficiaries: 4,952
Providers billing it: 253
Total allowed: $351,208

What Medicare pays for CPT 67515

Across 7,548 services billed by 253 providers to 4,952 beneficiaries, Medicare allowed an average of $46.53 per service. That is 1.5 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 67515

Specialty	Services	Beneficiaries	Avg allowed	Providers
Ophthalmology	7,364	4,809	$47.41	249
Ambulatory Surgical Center	184	143	$11.05	4

67515 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	1,729	$44.52	$26.64	32
Florida	1,099	$49.44	$35.89	31
Pennsylvania	418	$50.48	$37.01	9
North Carolina	376	$35.58	$27.18	12
Texas	366	$41.73	$31.08	18
New York	283	$54.46	$36.17	8
Maryland	251	$45.38	$30.64	6
Virginia	208	$47.83	$34.96	9
Ohio	207	$49.50	$37.11	10
Mississippi	163	$47.17	$36.69	6
Arizona	161	$50.30	$37.30	7
Indiana	160	$49.05	$36.04	9
Missouri	158	$46.32	$33.66	7
Minnesota	145	$51.86	$37.48	4
Illinois	137	$52.18	$38.42	6
Tennessee	131	$36.37	$28.54	7
Louisiana	123	$48.94	$38.93	4
New Jersey	116	$52.79	$35.89	5
Kansas	107	$47.96	$37.24	5
Oklahoma	106	$43.54	$33.10	6
Michigan	103	$51.35	$36.28	4
South Carolina	102	$50.71	$37.19	3
Utah	88	$39.88	$29.87	4
Massachusetts	86	$53.22	$38.58	5
Oregon	85	$38.27	$29.43	4
Hawaii	84	$41.83	$28.50	2
Alabama	79	$47.50	$37.88	5
Wisconsin	78	$32.83	$25.04	3
Arkansas	73	$44.13	$37.80	4
Idaho	62	$39.83	$31.10	3
Georgia	60	$49.72	$34.38	3
West Virginia	44	$50.85	$36.98	3
Kentucky	40	$50.92	$36.63	3
Iowa	28	$49.96	$39.28	2
Colorado	27	$54.08	$40.51	1
New Hampshire	27	$53.93	$34.68	1
Montana	23	$50.34	$35.52	1
Connecticut	15	$52.80	$37.18	1

Related codes

67500Injection of drug into cavity behind eye$46.76

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.