How do Medicare & Medicaid Rates affect fee schedules?

Medicare & Medicaid rates are government-set reimbursement amounts for healthcare services.

How do Private Insurance Rates affect fee schedules?

Private insurance rates are negotiated rates between healthcare providers and individual insurance companies.

How does Geographic Location affect fee schedules?

Costs for healthcare services may be higher in urban areas compared to rural areas due to geographic location.

How does Provider Type affect fee schedules?

Different provider types, such as hospital providers versus private practices, may have varying fee schedules for the same services.

What is a CPT code and why is it important?

CPT stands for Current Procedural Terminology. CPT codes are a standardized set of five-digit numeric codes used by healthcare providers, payers, and government agencies to describe medical, surgical, and diagnostic services and procedures. They are crucial for accurate billing, claims processing, and for ensuring consistent communication about healthcare services across the industry.

How can I find the cost of a medical procedure using a CPT code?

To find the cost of a specific medical procedure using its CPT code, you'll need to consider that prices can vary significantly based on your location, healthcare provider, and insurance plan. For an estimate tailored to your situation, you can use a fee schedule lookup tool like Payerprice. Payerprice allows you to search by CPT code and specific location to get an idea of potential costs. For precise out-of-pocket expenses, it's always best to contact your insurance provider directly and speak with the billing department of your chosen healthcare facility.

What is the difference between CPT codes and ICD-10 codes?

CPT codes and ICD-10 codes serve different but complementary purposes in healthcare. CPT codes (Current Procedural Terminology) describe the *procedures* or services performed by healthcare providers, such as an office visit, surgery, or diagnostic test. ICD-10 codes (International Classification of Diseases, 10th Revision) describe the *diagnosis* or medical condition that necessitated the service. For example, a CPT code might be used for a knee replacement surgery, while an ICD-10 code would specify the diagnosis, such as osteoarthritis of the knee. Both are essential for accurate medical billing and documentation.

Are CPT codes free to access?

CPT codes are proprietary to the American Medical Association (AMA) and are protected by copyright. While general information about CPT codes is widely available, full access to the complete, official CPT code set, including detailed descriptions and guidelines, requires purchasing an AMA license or subscribing to authorized coding manuals or software. Some resources may offer limited lookup capabilities for common codes. For specific cost information related to CPT codes in your area, you can use a tool like Payerprice.

CPT codes are widely used across the healthcare industry by a variety of stakeholders. Healthcare providers, including physicians, hospitals, and clinics, use them to document services and bill insurance companies. Insurance payers use CPT codes to process claims, determine reimbursement rates, and ensure medical necessity. Government agencies, such as Medicare and Medicaid, also rely on CPT codes for claims processing, data analysis, and regulatory compliance. Researchers and public health organizations may also use CPT data for statistical analysis and health policy development.

CPT 65820 Fee Schedule

Last Verified: October 2026

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.

Goniotomy Wo Goniopuncture

Key Fact	Detail
Service Type	Surgery Surgical Procedures on the Eye and Ocular Adnexa
Common Place of Service	24 - Ambulatory Surgical Center 22 - On Campus Outpatient Hospital
Common Modifiers	None RT - Right side of body LT - Left side of body
Complexity Level	High
Medicare Fee Schedule	View Medicare rates for 65820
Medicaid Fee Schedule	View Medicaid rates for 65820

National average reimbursement for CPT 65820 by major payers:

$1,037.44

$983.75

$1,079.95

$1,279.60

Compare published rates across providers.

Choose a payer to see a sample of rates for CPT 65820.

CPT 65820

5 of 25 sample ratesHigher to lower in this preview

North State Surgery Centers Lp, Court Street Surgery Center
CAAmbulatory Surgical Clinic/CenterNPI 1629249172Tax ID 30-0197423
$6,021.00Published rate
Hss Palm Beach Ambulatory Surgery Center, LLC
Hss Palm Beach Ambulatory Surgery Center LLC
FLAmbulatory Surgical Clinic/CenterNPI 1790241073Tax ID 30-1015589
$2,859.00Published rate
Pacific Vascucare Surgery Center
CAAmbulatory Surgical Clinic/CenterNPI 1770072803Tax ID 82-3288521
$1,925.00Published rate
Comprehensive Digestive Surgicenter, LLC, Comprehensive Digestive Surgical Center
Comprehensive Digestive Surgicenter LLC
NVAmbulatory Surgical Clinic/CenterNPI 1164012142Tax ID 85-4015524
$1,148.00Published rate
Midwest Eye Center
ILAmbulatory Surgical Clinic/CenterNPI 1720833163Tax ID 36-3010536
$526.00Published rate

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Summit Women's CareDenver, Colorado

September 2, 2026

Contracting Manager
UnitedHealthcare
Commercial PPO

Re: Request for fee schedule renegotiation

We request a formal review of our Commercial PPO fee schedule. The comparison below summarizes our current rate alongside published rates for comparable Denver-area practices.

Market evidence · CPT 59485

Current rate: $152.40
Market median: $147.00
Market position: 61st percentile

The comparison includes 1,284 published rates from 96 provider groups, scoped to OB/GYN providers in a professional, office-based setting.

We would welcome a discussion of our fee schedule and the supporting July 2026 market analysis. Please let us know a suitable time to review the comparison together.

Sincerely,
Summit Women's Care

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CPT 65820 vs. Other Surgical Procedures on the Eye and Ocular Adnexa Codes

The CPT 65820 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 65820 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
65800-CPT	Low	Remove Fluid Or Blood From Eye, Surgery To Aspirate (Remove Using A Needle) Blood Or Fluid From The Anterior Chamber Of The Eye (Space Between The Iris And Cornea).
65810-CPT	Moderate	Paracentesis Of Anterior Chamb, Paracentesis Of Anterior Chamber Of Eye (Separateprocedure) With Removal Of Vitreous Andor Discission Of Anterior Hyaloid Membrane With Or Withoutair Injection
65815-CPT	Moderate	Remove Fluid Or Blood From Eye, Surgery To Aspirate (Remove Using A Needle) Blood Or Fluid From The Anterior Chamber Of The Eye (Space Between The Iris And Cornea).
65820-CPT	High	Goniotomy Wo Goniopuncture

What is a fee schedule?

A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 65820. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.

Understanding the 65820 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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CPT 65820 Fee Schedule

Compare published rates across providers.

North State Surgery Centers Lp, Court Street Surgery Center

Hss Palm Beach Ambulatory Surgery Center, LLC

Pacific Vascucare Surgery Center

Comprehensive Digestive Surgicenter, LLC, Comprehensive Digestive Surgical Center

Midwest Eye Center