Rate Benchmarking
Compare your rates with similar providers.
Select a published rate, define comparable providers, and see where that rate falls in your market.
See a sample rate comparisonCPT 65430 Fee Schedule
Last Verified: October 2026
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.
Surgery For Cornea Biopsy, Surgery On The Middle Portion Of The Eye Membrane (Cornea). The Procedure Removes A Sample Of Tissue For Testing (Biopsy).
| Key Fact | Detail |
|---|---|
| Service Type | Surgery Surgical Procedures on the Eye and Ocular Adnexa |
| Common Place of Service | 11 - Office 22 - On Campus Outpatient Hospital |
| Common Modifiers | None LT - Left side of body RT - Right side of body |
| Complexity Level | Low |
| Medicare Fee Schedule | View Medicare rates for 65430 |
| Medicaid Fee Schedule | View Medicaid rates for 65430 |
National average reimbursement for CPT 65430 by major payers:
$147.03
$155.28
$159.72
$176.72
Compare published rates across providers.
Choose a payer to see a sample of rates for CPT 65430.
CPT 65430
5 of 25 sample ratesHigher to lower in this preview
Beltway Surgery Centers, LLC, East Washington Surgery Center
$4,613.00Published rateSurgical Center At Columbia Orthopaedic Group LLC
$431.00Published rateSurgical Care Center, Inc.
Surgical Care Center Inc
$210.00Published rateNovant Health Brunswick Endoscopy Center, LLC, Novant Health Brunswick Endoscopy
Novant Health Brunswick Endoscopy Center LLC
$122.00Published ratePhysicians' Surgery Center, LLC
Physicians Surgery Center, L.L.C.
$62.00Published rate
Get a free rate benchmark for your specialty.
Choose your state and specialty to build a report from payer-published rates.
Use market rates to prepare your payer proposal.
Payer Contract Negotiation
Draft a fee schedule renegotiation letter.
Use your fee schedule and market benchmarks to set target rates and draft a letter for your payer.
See a sample payer proposalCPT 65430 vs. Other Surgical Procedures on the Eye and Ocular Adnexa Codes
The CPT 65430 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 65430 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 |
|---|---|---|
| 65400-CPT | Moderate | Remove Lesion From Cornea, Surgery To Remove Abnormal Tissue (Lesion) On Cornea (Clear Tissue That Covers The Front Of The Eyeball). |
| 65410-CPT | Low | Surgery For Cornea Biopsy, Surgery On The Middle Portion Of The Eye Membrane (Cornea). The Procedure Removes A Sample Of Tissue For Testing (Biopsy). |
| 65420-CPT | Moderate | Exc/Transpose Pterygium |
| 65430-CPT | Low | Surgery For Cornea Biopsy, Surgery On The Middle Portion Of The Eye Membrane (Cornea). The Procedure Removes A Sample Of Tissue For Testing (Biopsy). |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 65430. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 65430 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.
FREE SAMPLE MARKET COMPARISON
Let's review your payer contracts side-by-side with the market.
Bring your top codes (like CPT 65430) and we'll show you how you compare in 15 minutes or less.