CPT 65779 Fee Schedule
Healthcare providers use this code to document and receive reimbursement for visits that address high-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 | High |
National average reimbursement for CPT 65779 by major payers:
$1,273.78
$1,590.94
$1,639.32
$2,015.18
| Payer | Code | Rate | NPI | Tax ID | State | Specialty |
|---|---|---|---|---|---|---|
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CPT 65779 vs. Other Surgical Procedures on the Eye and Ocular Adnexa Codes
The CPT 65779 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 65779 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 |
|---|---|---|
| 65778 | High | Placement Of Amniotic Membrane On The Ocular Surface; Without Sutures- Rn Review>=6/30/2019; Deny Inv/N10<=3/9/2011 |
| 65779 | High | Placement Of Amniotic Membrane On The Ocular Surface; Single Layer, Sutured- Rn Review>=6/30/2019; Deny Inv/N10<=3/9/2011 |
| 65780 | Moderate | Ocular Surface Reconstruction; Amniotic Membrane Transplantation, Multiple Layers |
| 65781 | High | Ocular Surface Reconstruction; Limbal Stem Cell Allograft (Eg, Cadaveric Or Living Donor) |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 65779. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 65779 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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