CPT 67005 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 | • 24 - Ambulatory Surgical Center • 22 - On Campus Outpatient Hospital |
| Common Modifiers | • None • RT - Right side of body • LT - Left side of body |
| Complexity Level | Moderate |
| Medicare Fee Schedule | View Medicare rates for 67005 |
National average reimbursement for CPT 67005 by major payers:
$608.19
$605.12
$646.35
$782.30
| 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 67005 | ||||||
United | 67005 | $1345.00 | 1326388000 - SOUTHEASTERN ORTHOPAEDICS SURGERY CENTER | 352467951 - (GA) SOUTHEASTERN ORTHOPAEDICS SURGERY CENTER | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 67005 | $2814.00 | 1336204668 - PHYSICIANS SURGICENTER LLC | 223550463 - (NJ) PHYSICIANS' SURGICENTER, LLC | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 67005 | $814.00 | 1649957168 - BLUE ASH ENDOSCOPY CENTER, LLC | 931613837 | OH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 67005 | $624.00 | 1013980317 - LOS ANGELES-INGLEWOOD ENDOSCOPY LP, AIRPORT ENDOSCOPY CENTER | 621814135 - (CA) LOS ANGELESINGLEWOOD ENDOSCOPY LP | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 67005 | $4286.00 | 1619245230 - AMBULATORY SURGICAL PAVILION AT ROBERT WOOD JOHNSON LLC | 800768614 - (NJ) AMBULATORY SURGICAL PAVILION AT ROBERT WOOD JOHNSON LLC | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 67005 | $950.00 | 1386604908 - MATTAX NEU PRATER SURGERY CENTER, LLC | 431842771 - (MO) MATTAX NEU PRATER SURGERY CENTER LLC | MO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 67005 | $1658.00 | 1790265999 - MUVE | 822351627 - (PA) MUVE | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 67005 | $682.00 | 1427020213 - TOLEDO ENDOSCOPY ASC LLC, NORTHWEST OHIO ENDOSCOPY CENTER | 621734002 - (OH) TOLEDO ENDOSCOPY ASC LLC | OH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 67005 | $908.00 | 1043497019 - PIKESVILLE MD ENDOSCOPY ASC LLC, ENDOCENTRE OF BALTIMORE | 261467040 | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 67005 | $1280.00 | 1518280684 - NORTHWEST SURGERY CENTER, INC. | 364663721 - (CA) NORTHWEST SURGERY CENTER INC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 67005 | $2076.00 | 1720215320 - EAST SIDE ENDOSCOPY LLC | 263006590 - (NY) EAST SIDE ENDOSCOPY LLC | NY | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 67005 | $2101.00 | 1548784556 - NORTH ATLANTIC SURGICAL SUITES, LLC | 821540859 - (NH) NORTH ATLANTIC SURGICAL SUITES, LLC | NH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 67005 | $994.00 | 1487608071 - SAN BERNARDINO EYE SURGERY CENTER, LLC, THE EYE SURGERY CENTER | 330991348 - SAN BERNARDINO EYE SURGERY CENTER LLC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 67005 | $3653.00 | 1821242488 - SPECIALTY SURGICAL CENTER OF NORTH BRUNSWICK, LLC | 208770654 - (NJ) SPECIALTY SURGICAL CENTER OF N | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 67005 | $1575.00 | 1689605826 - LAUREL SURGERY & ENDOSCOPY CENTER, LLC | 412044822 - (MS) LAUREL SURGERY AND ENDOSCOPY CENTER, LLC | MS | 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 67005 vs. Other Surgical Procedures on the Eye and Ocular Adnexa Codes
The CPT 67005 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 67005 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 |
|---|---|---|
| 67005-CPT | Moderate | Rem Vitreous Partial |
| 67010-CPT | Moderate | Removal Of Vitreous, Anterior Approach (Open Sky Technique Or Limbal Incision); Subtotal Removal With Mechanical Vitrectomy |
| 67015-CPT | Moderate | Aspirate/Release Vitreous Fluid |
| 67025-CPT | High | Injection Of Vitreous Substitute, Pars Plana Or Limbal Approach (Fluid-Gas Exchange), With Or Without Aspiration (Separate Procedure) |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 67005. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 67005 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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