CPT 65286 Fee Schedule
Healthcare providers use this code to document and receive reimbursement for visits that address moderate-level medical decision-making, often including multiple diagnoses or prescription management.
| Key Fact | Detail |
|---|---|
| Service Type | Surgery Surgical Procedures on the Eye and Ocular Adnexa |
| Common Place of Service | 11 - Office 24 - Ambulatory Surgical Center |
| Common Modifiers | None LT - Left side of body RT - Right side of body |
| Complexity Level | Moderate |
| Medicare Fee Schedule | View Medicare rates for 65286 |
National average reimbursement for CPT 65286 by major payers:
$827.36
$892.73
$962.20
$1,099.68
| Payer | Code | Rate | NPI | Tax ID | State | Specialty |
|---|---|---|---|---|---|---|
United | 65286 | $831.00 | 1780764829 - NOVAMED SURGERY CENTER OF ST PETERS LLC, ST PETERS AMBULATORY SURGERY CENTER | 205579933 - (MO) NOVAMED SURGERY CENTER OF ST PETERS LLC | MO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 65286 | $1179.00 | 1093772840 - THE SURGERY CENTER AT JENSEN BEACH, LLC | 651198731 - (FL) THE SURGERY CENTER AT JENSEN B | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 65286 | $1313.00 | 1700492170 - MERCY HEALTH BOARDMAN SURGERY | 863462441 - (OH) BSMH AMBULATORY VENTURES II LLC | OH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 65286 | $600.00 | 1417362831 - J. GRAFF SURGERY CENTER INC, WILLOW BEND SURGERY CENTER OF PLANO | 463194833 - (TX) J GRAFF SURGERY CENTER INC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 65286 | $1025.00 | 1538389812 - IRONBOUND ENDO SURGICAL CENTER, INC. | 223651393 | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 65286 | $520.00 | 1649270075 - NORTHEAST REGIONAL SURGERY CENTER LLC | 200159751 - (PA) NORTHEAST REGIONAL SURGERY CENTER LLC | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 65286 | $441.00 | 1386603173 - EYE CARE SURGERY CENTER, INC | 721470732 - (LA) EYE CARE SURGERY CENTER INC | LA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 65286 | $3008.00 | 1184051088 - SAN ANTONIO SURGICENTER, LLC, THE CENTER FOR SPECIAL SURGERY AT TCA | 300796793 | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 65286 | $550.00 | 1477803724 - VALENCIA SPECIALTY SURGERY PC | 460979296 - (CA) VALENCIA SPECIALTY SURGERY PC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 65286 | $580.00 | 1346581105 - MD LASER SURGERY CENTER, LLC | 462169227 - (MD) MD LASER SURGERY CENTER LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 65286 | $328.00 | 1740264811 - EYES OF YORK SURGICAL CENTER LLC | 200930310 - (PA) EYES OF YORK SURGICAL CENTER LLC | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 65286 | $1276.00 | 1114302353 - POINT OF ROCKS SURGERY CENTER, LLC | 464992977 - (MD) POINT OF ROCKS SURGERY CENTER, LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 65286 | $1233.00 | 1811515034 - SALMON SURGERY CENTER LLC | 844895716 - (WA) SALMON SURGERY CENTER LLC | WA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 65286 | $347.00 | 1033223367 - SOUTHEASTERN OUTPATIENT SURGERY CENTER LLC | 201379958 - (FL) SOUTHEASTERN OUTPATIENT SURGERY CENTER LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 65286 | $1016.00 | 1528261195 - ORCHARD CREEK SURGERY CENTER | 770498874 - (CA) ORCHARD CREEK SURGERY CENTER | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
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CPT 65286 vs. Other Surgical Procedures on the Eye and Ocular Adnexa Codes
The CPT 65286 code is part of the Surgery services used for Surgical Procedures on the Eye and Ocular Adnexa. It represents a moderate-complexity encounter and is one of several codes that vary based on time spent, level of medical decision-making, and documentation requirements.
The CPT 65286 code involves more provider time and moderate medical decision-making, unlike lower-level codes that require less time and simpler assessments. It typically includes multiple diagnoses, medication management, or test interpretation, leading to higher reimbursement and more detailed documentation requirements.
| Code | Complexity | Description |
|---|---|---|
| 65275-CPT | Moderate | Rpair Of Lacerat; Cornea Nonperforating W//W/O Remval, Repair Of Laceration; Cornea Nonperforating With Or Without Removal |
| 65280-CPT | Moderate | Rpair Of Lacerat; Cornea &/Or Sclera Perforating Not Invol, Repair Of Laceration; Cornea And/Or Sclera Perforating Not Involving |
| 65285-CPT | High | Rpair Of Lacerat; Cornea &/Or Sclera Perforating W/ Repositi, Repair Of Laceration; Cornea And/Or Sclera Perforating With Repositi |
| 65286-CPT | Moderate | Repair Deep Cut In Eyeball, Surgical Repair Of Laceration (Deep Cut) Of The Cornea (Clear Tissue That Covers The Front Of The Eyeball) Or Sclera (White Part Of The Eye). |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 65286. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 65286 fee schedule helps patients estimate costs and providers optimize billing for accurate reimbursements.
Factors that affect fee schedules
Medicare & Medicaid Rates
Government-set reimbursement amounts
Private Insurance Rates
Negotiated rates between providers and insurance companies
Geographic Location
Costs may be higher in urban areas.
Provider Type
Hospital providers may have different rates than private practice.
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