CPT 65860 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 | • LT - Left side of body • None • RT - Right side of body |
| Complexity Level | Moderate |
National average reimbursement for CPT 65860 by major payers:
$373.64
$405.51
$424.36
$511.91
| Payer | Code | Rate | NPI | Tax ID | State | Specialty |
|---|---|---|---|---|---|---|
Select a payer to view fee schedule data Choose a payer from the options above to see rates for CPT 65860 | ||||||
United | 65860 | $550.00 | 1528196888 - NORTHWEST PLAZA ASC LLC | 205818059 - (GA) NORTHWEST PLAZA ASC LLC | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 65860 | $934.00 | 1396174454 - SURGERY CENTER OF SCOTTSDALE LLC | 731553441 - (AZ) SURGERY CENTER OF SCOTTSDALE LLC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 65860 | $192.00 | 1831153527 - THE SURGICAL CENTER OF GREATER ANNAPOLIS, INC. | 521532190 - (MD) THE SURGICAL CENTER OF GREATER ANNAPOLIS INC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 65860 | $800.00 | 1750420147 - INTERVENTIONAL SPINE AND PAIN MANAGEMENT AMBULATORY SURGICAL CENTER, ISPM ASC | 205896580 - (GA) INTERVENTIONAL SPINE AND PAIN MANAGEMENT AMBULATORY SURGICAL CENTER | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 65860 | $953.00 | 1083938765 - MEDICAL PARK TOWER SURGERY CENTER, LLC, MEDICAL PARK TOWER SURGERY CENTER | 270543475 - (TX) MEDICAL PARK TOWER SURGERY CENTER LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 65860 | $967.00 | 1407275282 - SURGCENTER CAMELBACK LLC | 464169482 - (AZ) SURGCENTER CAMELBACK LLC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 65860 | $553.00 | 1720566433 - PAVILION SURGICENTER, LLC, PHYSICIANS PAVILION SURGERY CENTER | 830619935 | TN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 65860 | $759.00 | 1134663677 - CASTLE HILLS SURGICARE, LLC | 813020487 - (TX) CASTLE HILLS SURGICARE LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 65860 | $384.00 | 1972831998 - SAN DIEGO SKIN, INC. | 203245033 - (CA) SAN DIEGO SKIN, INC M MARK MOFID MD APC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 65860 | $426.00 | 1083615470 - RIVER FOREST SURGERY CENTER LLC | 753007736 - (IL) RIVER FOREST SURGERY CENTER LLC | IL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 65860 | $286.00 | 1659409241 - EYE SURGERY CENTER, LOREN BARRUS & PAUL SCHULTZ PTRS | 931126853 - (OR) EYE SURGERY CENTER | OR | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 65860 | $877.00 | 1083946149 - METHODIST ENDOSCOPY CENTER LLC | 263765679 - (NE) METHODIST ENDOSCOPY CENTER, LLC | NE | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 65860 | $338.00 | 1366635609 - APPLE SURGERY CENTER, INC | 260423287 - (CA) APPLE SURGERY CENTER INC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 65860 | $2958.00 | 1730212879 - TEXAS HEALTH HARRIS METHODIST HOSPITAL SOUTHWEST FORT WORTH | 752678857 - (TX) TEXAS HEALTH HARRIS METHODIST HOSPITAL SOUTHWEST FORT WORTH | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 65860 | $934.00 | 1255577045 - MAPLE LAWN SURGERY CENTER | 262739529 - (MD) MAPLE LAWN SURGERY CENTER, LLC | MD | 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 65860 vs. Other Surgical Procedures on the Eye and Ocular Adnexa Codes
The CPT 65860 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 65860 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 |
|---|---|---|
| 65860 | Moderate | Sever Adhesions Ant Seg Laser Tech |
| 65865 | Moderate | Severing Adhesions Of Anterior Segment Of Eye, Incisional Technique (With Or Without Injection Of Air Or Liquid) (Separate Procedure); Goniosynechiae |
| 65870 | Moderate | Severing Adhesions Of Anterior Segment Of Eye, Incisional Technique (With Or Without Injection Of Air Or Liquid) (Separate Procedure); Anterior Synechiae, Except Goniosynechiae |
| 65875 | Moderate | Severing Adhesions Of Anterior Segment Of Eye, Incisional Technique (With Or Without Injection Of Air Or Liquid) (Separate Procedure); Posterior Synechiae |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 65860. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 65860 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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