How much does Medicare pay for CPT 67966?

Medicare allowed an average of $684.96 per service and paid $542.62 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $2821.41, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 67966?

Removal of over 1/4 of eyelid margin and repair of eyelid. It was billed 4,231 times to 3,803 Medicare beneficiaries by 162 providers in 2024.

Does 67966 pay differently in an office than a hospital?

Yes. The allowed amount averaged $777.25 in an office setting and $673.89 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 67966 most?

Ophthalmology, with 2,392 services from 94 clinicians. Next are Ambulatory Surgical Center, Plastic and Reconstructive Surgery.

CPT 67966

Removal of over 1/4 of eyelid margin and repair of eyelid

$684.96Medicare-allowed amount per service, averaged across 4,231 services

Providers submitted

$2821.41

Asking price, not received

Medicare allowed

$684.96

The fee schedule figure

Medicare paid

$542.62

Balance is patient coinsurance

Providers submitted an average of $2821.41 for this code and Medicare allowed $684.96 — 4.1× 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 $542.62 (79%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $777.25
Hospital / facility: $673.89

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. 453 services were billed in an office setting and 3,778 in a facility.

Services: 4,231
Beneficiaries: 3,803
Providers billing it: 162
Total allowed: $2,898,066

What Medicare pays for CPT 67966

Across 4,231 services billed by 162 providers to 3,803 beneficiaries, Medicare allowed an average of $684.96 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 67966

Specialty	Services	Beneficiaries	Avg allowed	Providers
Ophthalmology	2,392	2,218	$612.09	94
Ambulatory Surgical Center	1,752	1,501	$786.56	64
Plastic and Reconstructive Surgery	87	84	$642.40	4

67966 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
New York	490	$716.83	$488.24	12
Texas	483	$635.82	$520.32	16
Florida	475	$681.11	$552.09	14
California	235	$807.02	$511.43	14
Virginia	228	$681.21	$544.45	4
Mississippi	225	$659.14	$578.10	6
New Jersey	198	$778.08	$566.13	7
Tennessee	163	$660.00	$562.59	7
Indiana	153	$661.70	$536.33	8
Delaware	139	$759.80	$591.06	4
Arizona	138	$577.09	$478.76	5
Ohio	133	$592.86	$466.76	7
Nevada	107	$754.73	$587.24	4
North Carolina	90	$645.20	$503.84	4
Arkansas	89	$641.18	$552.31	4
Massachusetts	85	$815.76	$622.75	4
Michigan	81	$804.14	$661.14	5
Maryland	65	$742.06	$584.16	1
Kansas	62	$605.26	$521.46	3
Washington	56	$681.94	$548.83	2
Missouri	55	$782.12	$638.51	2
Colorado	52	$641.33	$480.62	4
Idaho	48	$720.33	$592.11	2
Utah	47	$506.11	$419.88	2
Nebraska	43	$658.48	$547.32	2
Alaska	35	$610.59	$425.83	2
South Carolina	34	$764.85	$644.53	3
Georgia	31	$719.10	$535.99	2
Pennsylvania	29	$525.75	$336.39	1
Oklahoma	28	$548.07	$424.21	2
Oregon	27	$522.53	$376.46	1
Illinois	26	$630.25	$476.13	2
Wisconsin	23	$621.62	$514.47	2
Kentucky	22	$576.82	$452.85	1
Maine	13	$411.55	$315.61	1
Minnesota	12	$573.15	$463.42	1
West Virginia	11	$782.68	$662.78	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
67950Reconstruction of eyelid margin$489.92
67924Extensive repair of turning-inward eyelid defect$625.44
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.