CPT 67250 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 | • RT - Right side of body • LT - Left side of body • None |
| Complexity Level | High |
National average reimbursement for CPT 67250 by major payers:
$1,120.08
$1,050.62
$1,190.35
$1,421.14
| 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 67250 | ||||||
United | 67250 | $1368.00 | 1235240813 - NORTH MISSISSIPPI AMBULATORY SURGERY CENTER LLC | 200145190 - (MS) NORTH MISSISSIPPI AMBULATORY SURGERY CENTER LLC | MS | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 67250 | $3273.00 | 1659473924 - MID-AMERICA SURGERY INSTITUTE LLC | 50564556 - (KS) MIDAMERICA SURGERY INSTITUTE LLC | KS | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 67250 | $3344.00 | 1861825986 - VADNAIS HEIGHTS SURGERY CENTER LLC, VADNAIS HEIGHTS SURGERY CENTER | 371866891 | MN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 67250 | $1550.00 | 1326444688 - BRYAN COLLEGE STATION ASC, LP, THE HEART AND VASCULAR SURGERY CENTER | 471615354 | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 67250 | $1575.00 | 1841955358 - ADVENTIST HEALTHCARE SC AT NATIONAL HARBOR, LLC | 852814304 - (MD) ADVENTIST HEALTHCARE SC AT NATIONAL HARBOR LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 67250 | $1305.00 | 1124091897 - PADUCAH OPHTHALMOLOGY ASC LLC, THE EYE SURGERY CENTER OF PADUCAH | 943428567 - (KY) PADUCAH OPHTHALMOLOGY ASC LLC | KY | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 67250 | $1652.00 | 1437250248 - GEORGIA SURGICAL CENTER ON PEACHTREE, LLC | 582394271 - (GA) GEORGIA SURGICAL CENTER ON PEACHTREE LLC | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 67250 | $2353.00 | 1952749491 - HAYMARKET SURGERY CENTER, LLC | 462874962 - (VA) HAYMARKET SURGERY CENTER | VA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 67250 | $2762.00 | 1548446669 - INNOVIS HEALTH, LLC, ESSENTIA HEALTH WAHPETON ASC | 261175213 - INNOVIS HEALTH LLC | ND | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 67250 | $1320.00 | 1023005600 - PSHS BETA PARTNERS LTD, THE GABLES SURGICAL CENTER | 650848650 - (FL) PSHS BETA PARTNERS LTD | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 67250 | $2101.00 | 1568867075 - POTOMAC VIEW SURGERY CENTER, LLC | 471352116 - (MD) POTOMAC VIEW SURGERY CENTER LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 67250 | $936.00 | 1821074485 - SURGERY CENTER OF FARMINGTON, L.L.C. | 431811835 - (MO) SURGERY CENTER OF FARMINGTON | MO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 67250 | $2730.00 | 1992752224 - SPRINGFIELD CLINIC LLP, SPRINGFIELD CLINIC AMBULATORY SURGERY CENTER | 370701328 - (IL) SPRINGFIELD CLINIC, LLP | IL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 67250 | $1077.00 | 1760196984 - JACKSON HEART AND VASCULAR CENTER LLC | 870947298 - (MS) JACKSON HEART AND VASCULAR CENTER LLC | MS | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 67250 | $2206.00 | 1205949245 - MEMORIAL SURGERY CENTER, LLC | 201167151 - (OK) MEMORIAL SURGERY CENTER LLC | OK | 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 67250 vs. Other Surgical Procedures on the Eye and Ocular Adnexa Codes
The CPT 67250 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 67250 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 |
|---|---|---|
| 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 |
| 67229-CPT | High | Treatment Of Extensive Or Progressive Retinopathy One Or More Sessions; Preterm Infant (Less Than 37 Weeks Gestation At Birth) Performed From Birth Up To 1 Year Of Age (Eg Retinopathy Of Prematurity) Photocoagulationor Cryotherapy |
| 67250-CPT | High | Reinforce Sclera Wo Graft |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 67250. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 67250 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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