CPT 67039 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 | • 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 |
National average reimbursement for CPT 67039 by major payers:
$1,334.60
$1,347.31
$1,413.18
$1,666.02
| 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 67039 | ||||||
United | 67039 | $2497.00 | 1336553833 - CENTER FOR CARDIOVASCULAR RESEARCH AND EDUCATION LLC | 465327973 - (AZ) CENTER FOR CARDIOVASCULAR RESEARCH AND EDUCATION LLC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 67039 | $2555.00 | 1043272750 - WEST PARK SURGERY CENTER LLC | 260092101 - (FL) WEST PARK SURGERY CENTER LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 67039 | $4588.00 | 1346207875 - GREENSBORO SPECIALTY SURGERY CENTER LIMITED PARTNERSHIP | 364053840 - (NC) GREENSBORO SPECIALTY SURGERY CENTER LIMITED PARTNERSHIP | NC | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 67039 | $1885.00 | 1336112200 - MERCER COUNTY SURGERY CENTER LLC, MERCER COUNTY SURGERY CENTER | 223774069 - (NJ) MERCER COUNTY SURGERY CENTER, LLC | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 67039 | $2600.00 | 1073987053 - SERENITY SURGICAL, LLC | 471546645 - (IN) SERENITY SURGICAL, LLC | IN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 67039 | $2969.00 | 1063427706 - PROHEALTH AMBULATORY SURGERY CENTER INC | 113447394 - (NY) PROHEALTH AMBULATORY SURGERY CENTER INC | NY | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 67039 | $2100.00 | 1356616064 - CORONA SURGICAL LLC, CORONA SUMMIT SURGICAL CENTER | 900722404 - (CA) CORONA SURGICAL LLC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 67039 | $2100.00 | 1902284045 - MURRIETA SPECIALTY SURGERY CENTER PC A PROFESSIONAL CORPORATION | 463493543 - (CA) MURRIETA SPECIALTY SURGERY CENTER PC A PROFESSIONAL CORPORATION | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 67039 | $4000.00 | 1497791040 - CANYON PINOLE SURGERY CENTER, LP | 201582302 - (CA) CANYON PINOLE SURGERY CENTER | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 67039 | $1012.00 | 1902863723 - OAK & MAIN SURGICENTER LLC | 223532371 - (NJ) OAK MAIN SURGICENTER LLC | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 67039 | $4703.00 | 1942267893 - GASTROENTEROLOGY DIAGNOSTICS OF NORTHERN NEW JERSEY, PA | 223345724 - (NJ) GASTROENTEROLOGY DIAGNOSTICS OF NORTHERN NEW JERSEY, P.A. | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 67039 | $5433.00 | 1275198673 - UROLOGY ASC- PHOENIX, LLC, UROLOGIC SURGERY CENTER OF ARIZONA | 320586987 | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 67039 | $1091.00 | 1720268279 - PEARL ROAD SURGERY CENTER, LLC | 260812886 - (OH) PEARL ROAD SURGERY CENTER LLC | OH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 67039 | $1500.00 | 1689632051 - ROSS SURGERY CENTER INC | 743085621 - (OH) ROSS SURGERY CENTER INC | OH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 67039 | $1328.02 | 1750358453 - CENTER FOR DIGESTIVE HEALTH LTD | 391738062 - (WI) THE CENTER FOR DIGESTIVE HEALTH LTD | WI | 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 67039 vs. Other Surgical Procedures on the Eye and Ocular Adnexa Codes
The CPT 67039 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 67039 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 |
|---|---|---|
| 67036 | High | Vitrectomy Mechan Pars Plana Appr |
| 67039 | High | Vitrect. W Focal Endolaser Photocoag. |
| 67040 | High | Vitrec,Mech;Endolasr Panretin.Photo |
| 67042 | High | Vitrectomy, Mechanical, Pars Plana Approach; With Removal Of Internal Limiting Membrane Of Retina (Eg, For Repair Of Macular Hole, Diabetic Macular Edema), Includes, If Performed, Intraocular Tamponade (Ie, Air, Gas Or Silicone Oil) |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 67039. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 67039 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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