How much does Medicare pay for CPT 67950?

Medicare allowed an average of $489.92 per service and paid $388.52 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $2608.76, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 67950?

Reconstruction of eyelid margin. It was billed 5,669 times to 4,784 Medicare beneficiaries by 178 providers in 2024.

Does 67950 pay differently in an office than a hospital?

Yes. The allowed amount averaged $478.11 in an office setting and $491.32 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 67950 most?

Ophthalmology, with 3,139 services from 110 clinicians. Next are Ambulatory Surgical Center, Plastic and Reconstructive Surgery.

CPT 67950

Reconstruction of eyelid margin

$489.92Medicare-allowed amount per service, averaged across 5,669 services

Providers submitted

$2608.76

Asking price, not received

Medicare allowed

$489.92

The fee schedule figure

Medicare paid

$388.52

Balance is patient coinsurance

Providers submitted an average of $2608.76 for this code and Medicare allowed $489.92 — 5.3× 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 $388.52 (79%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $478.11
Hospital / facility: $491.32

The facility rate is higher for this code, which is unusual and generally means the service depends on equipment or staffing a hospital carries. 601 services were billed in an office setting and 5,068 in a facility.

Services: 5,669
Beneficiaries: 4,784
Providers billing it: 178
Total allowed: $2,777,356

What Medicare pays for CPT 67950

Across 5,669 services billed by 178 providers to 4,784 beneficiaries, Medicare allowed an average of $489.92 per service. That is 1.2 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 67950

Specialty	Services	Beneficiaries	Avg allowed	Providers
Ophthalmology	3,139	3,003	$377.48	110
Ambulatory Surgical Center	2,365	1,622	$653.17	62
Plastic and Reconstructive Surgery	165	159	$288.94	6

67950 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	1,788	$475.56	$347.24	36
Florida	363	$484.02	$389.81	15
Tennessee	314	$547.33	$470.66	9
Illinois	299	$479.15	$377.50	7
Texas	270	$422.20	$332.67	12
Pennsylvania	266	$452.22	$360.10	10
Arizona	240	$502.55	$421.65	6
Ohio	213	$450.40	$377.44	7
Colorado	209	$565.01	$446.31	10
New York	176	$592.21	$422.55	9
New Hampshire	163	$546.07	$435.81	4
Washington	141	$460.86	$356.98	3
Maine	114	$533.34	$460.19	2
Georgia	110	$605.47	$485.60	3
Oklahoma	106	$436.93	$369.04	4
Louisiana	105	$359.97	$307.31	6
North Carolina	102	$528.39	$442.47	5
Alaska	74	$728.77	$509.79	2
Oregon	53	$491.58	$370.35	3
Virginia	51	$458.75	$378.51	3
Nebraska	47	$830.02	$689.57	1
Kansas	47	$611.34	$558.99	2
Wisconsin	45	$393.96	$332.58	1
Kentucky	45	$363.52	$293.90	2
New Jersey	41	$657.87	$498.20	3
Minnesota	40	$585.25	$464.66	1
Michigan	38	$336.80	$267.60	2
Idaho	37	$526.51	$495.16	2
Nevada	31	$452.91	$344.65	1
Massachusetts	24	$349.99	$264.69	1
South Carolina	24	$362.95	$307.65	1
Arkansas	23	$234.14	$205.43	1
Maryland	22	$355.85	$264.26	1
Alabama	21	$205.10	$178.59	1
Utah	16	$228.71	$189.40	1
West Virginia	11	$314.23	$267.73	1

Related codes

67904Repair of tendon of upper eyelid$756.97
67917Extensive repair of turning-outward eyelid defect$572.32
67900Repair of brow paralysis$549.88
67908Removal of tissue$669.86
67903Shortening or advancement of upper eyelid muscle to correct drooping o$672.04
67924Extensive repair of turning-inward eyelid defect$625.44
67966Removal of over 1/4 of eyelid margin and repair of eyelid$684.96
67938Removal of embedded foreign body in eyelid$316.68
67961Removal of up to 1/4 of eyelid margin and repair of eyelid$560.01
67911Correction of widely-opened upper eyelid$512.98

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.