CPT 67255 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 |
National average reimbursement for CPT 67255 by major payers:
$956.78
$946.22
$966.64
$1,185.76
| 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 67255 | ||||||
United | 67255 | $1530.00 | 1881024271 - DAKOTA GASTROENTEROLOGY, LTD | 383908818 - (ND) DAKOTA GASTROENTEROLOGY LTD. | ND | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 67255 | $1750.00 | 1922660109 - BANNER SURGERY CENTER | 842157389 - (AZ) BANNER SURGERY CENTER | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 67255 | $1033.00 | 1306924170 - DELMAR SURGICAL CENTER LLC | 621717312 - (MD) DELMAR SURGICAL CENTER LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 67255 | $1146.00 | 1033162631 - EYE SURGERY CENTER-NORTHLAND LLC | 201938574 - (MO) EYE SURGERY CENTERNORTHLAND LLC | MO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 67255 | $4707.00 | 1497352934 - LEXINGTON HEALTH INC, LMC LEXINGTON ASC | 852276567 - LEXINGTON HEALTH INC | SC | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 67255 | $1786.00 | 1023001377 - SOUTHERN ILLINOIS ORTHOPEDIC CENTER,LLC | 371377370 - (IL) SOUTHERN ILLINOIS ORTHOPEDIC CENTERLLC | IL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 67255 | $1276.00 | 1437736071 - SCENT ASC OPPORTUNITY FUND LLC, SCENT SURGICAL CENTER | 862520870 - (SC) SCENT ASC OPPORTUNITY FUND LLC | SC | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 67255 | $1459.00 | 1982978466 - NORTHWEST ENT SURGERY CENTER, LLC | 453307193 - (GA) NORTHWEST ENT SURGERY CENTER LLC | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 67255 | $5379.00 | 1477516979 - FAIRFAX SURGICAL CENTER, L.P. | 621861640 - (VA) FAIRFAX SURGICAL CENTER LP | VA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 67255 | $1850.00 | 1942239751 - POSADA AMBULATORY SURGERY CENTER, LP | 571140323 - (CA) POSADA AMBULATORY SURGERY CENTER, L.P. | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 67255 | $2741.00 | 1306486634 - FREDERICKSBURG ENDOSCOPY CENTER, LLC | 834398314 - (VA) FREDERICKSBURG ENDOSCOPY CENTER LLC | VA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 67255 | $1320.00 | 1689699597 - NAPA SURGERY CENTER LLC | 680366295 - (CA) NAPA SURGERY CENTER LLC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 67255 | $1156.00 | 1841342789 - SURGERY CENTER JV, THE SURGERY CENTER OF HUNTSVILLE | 621230866 - (AL) THE SURGERY CENTER OF HUNTSVILLE | AL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 67255 | $1200.00 | 1871026120 - ACCESS CARE PHYSICIANS OF NJ LLC | 203639484 | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 67255 | $1282.00 | 1235363987 - CORONADO SURGERY CENTER, LLC | 274700340 | NV | 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 67255 vs. Other Surgical Procedures on the Eye and Ocular Adnexa Codes
The CPT 67255 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 67255 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 |
|---|---|---|
| 67220 | Moderate | Destruction Of Localized Lesion Of Choroid (Eg, Choroidal Neovascularization); Photocoagulation (Eg, Laser), 1 Or More Sessions |
| 67221 | Moderate | Destruction Of Localized Lesion Of Choroid (Eg, Choroidal Neovascularization); Photodynamic Therapy (Includes Intravenous Infusion) |
| 67225 | 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) |
| 67255 | Moderate | Scleral Reinforcement; With Graft |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 67255. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 67255 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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