CPT 67225 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 • 22 - On Campus Outpatient Hospital |
| Common Modifiers | • None • LT - Left side of body • RT - Right side of body |
| Complexity Level | Low |
National average reimbursement for CPT 67225 by major payers:
$38.72
$39.12
$41.02
$48.32
| 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 67225 | ||||||
United | 67225 | $736.00 | 1033351119 - SSM ST CLARE SURGICAL CENTER LLC, SSM ST CLARE SURGICAL CENTER | 261439695 - (MO) SSM ST CLARE SURGICAL CENTER LLC | MO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 67225 | $282.00 | 1215978945 - SAPLING GROVE AMBULATORY SURGERY CENTER, LLC | 204450153 - (TN) SAPLING GROVE AMBULATORY SURGERY CENTER LLC | TN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 67225 | $180.00 | 1265816003 - CLEARVIEW SURGERY CENTER, LLC | 474123527 - (ID) CLEARVIEW SURGERY CENTER LLC | ID | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 67225 | $54.00 | 1215263082 - NCBH OUTPATIENT ENDOSCOPY CENTER, L.L.C., WFUBMC ENDOSCOPY CENTER | 270668137 - (NC) NCBH OUTPATIENT ENDOSCOPY CENTER LLC | NC | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 67225 | $1446.00 | 1336459353 - LONE STAR ENDOSCOPY CENTER LLC | 273635726 | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 67225 | $574.00 | 1588260343 - ADVENTHEALTH SURGERY CENTER WELLSWOOD LLC, ADVENTHEALTH SURGERY CENTER WELLSWOOD | 854111089 - (FL) ADVENTHEALTH SURGERY CENTER WELLSWOOD LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 67225 | $1886.00 | 1669446852 - VOORHEES NJ ENDOSCOPY ASC LLC, THE ENDO CENTER AT VOORHEES | 510446274 - (NJ) THE VOORHEES NJ ENDOSCOPY ASC LLC | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 67225 | $97.00 | 1831109875 - M-S SURGERY CENTER LLC | 205219388 - (CA) MS SURGERY CENTER LLC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 67225 | $52.00 | 1235117052 - ALLEGANY AMBULATORY SURGERY CENTER LLC | 522268598 - (MD) ALLEGANY AMBULATORY SURGERY CENTER LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 67225 | $47.00 | 1164734232 - MIDSOUTH INTERVENTIONAL PAIN INSTITUTE, LLC | 272910652 - MIDSOUTH INTERVENTIONAL PAIN INSTITUTE LLC | TN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 67225 | $181.00 | 1528053311 - AMERICAN ENDOSCOPY CENTER, P.C. | 593795864 - (TN) AMERICAN ENDOSCOPY CENTER PC | TN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 67225 | $190.00 | 1053688036 - SUNSET SURGICAL CENTRE LLC | 270224735 - (OR) SUNSET SURGICAL CENTRE LLC | OR | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 67225 | $72.00 | 1598419509 - UOI EAST BAY SURGERY CENTER LLC | 873506992 | RI | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 67225 | $1310.00 | 1881678662 - SURGERY AFFILIATE OF EL PASO, LLC, FOUNDATION SURGERY AFFILIATE OF EL PASO, LLC | 742797719 - (TX) SURGERY AFFILIATE OF EL PASO LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 67225 | $187.00 | 1346237237 - LUFKIN ENDOSCOPY CENTER LTD | 204411582 - (TX) LUFKIN ENDOSCOPY CENTER LTD | TX | 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 67225 vs. Other Surgical Procedures on the Eye and Ocular Adnexa Codes
The CPT 67225 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 67225 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 |
|---|---|---|
| 67221-CPT | Moderate | Destruction Of Localized Lesion Of Choroid (Eg, Choroidal Neovascularization); Photodynamic Therapy (Includes Intravenous Infusion) |
| 67225-CPT | Low | Destruction Of Localized Lesion Of Choroid (Eg, Choroidal Neovascularization); Photodynamic Therapy, Second Eye, At Single Session (List Separately In Addition To Code For Primary Eye Treatment) |
| 67227-CPT | Moderate | Destruction Of Extensive Or Progressive Retinopathy (Eg Diabetic Retinopathy) Cryotherapy Diathermy Revised 01/01/2016 |
| 67228-CPT | Moderate | Treatment Of Extensive Or Progressive Retinopathy, One Or More Sessions (Eg Diabetic Retinopathy), Photocoagulation |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 67225. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 67225 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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