CPT 67316 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 67316 by major payers:
$930.12
$1,019.19
$1,066.64
$1,231.57
| 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 67316 | ||||||
United | 67316 | $1523.50 | 1982674065 - HEMET HEALTHCARE SURGICENTER, INC. | 330526203 - (CA) HEMET HEALTHCARE SURGICENTER | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 67316 | $1116.00 | 1871538694 - SOUTHWEST ENDOSCOPY LTD | 850452091 - (NM) SOUTHWEST ENDOSCOPY LTD | NM | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 67316 | $2206.00 | 1295479780 - ADVENTHEALTH SURGERY CENTER DAVENPORT LLC | 881811228 | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 67316 | $1682.00 | 1174010011 - DTC SURGERY CENTER, LLC, OCC SURGERY CENTER AT INVERNESS | 825181311 - (CO) DTC SURGERY CENTER LLC | CO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 67316 | $1760.00 | 1710127774 - NORTHERN CALIFORNIA ADVANCED SURGERY CENTER LP | 264264927 - (CA) NORTHERN CALIFORNIA ADVANCED SURGERY CENTER, LP | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 67316 | $2795.00 | 1881667368 - FLORHAM PARK ENDOSCOPY ASC LLC, FLORHAM PARK ENDOSCOPY CENTER | 621774936 - (NJ) FLORHAM PARK ENDOSCOPY CENTER, LLC | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 67316 | $2100.00 | 1326309394 - ADVANCED SURGERY CENTER OF ORLANDO LLC | 453785008 - (FL) ADVANCED SURGERY CENTER OF ORLANDO LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 67316 | $4304.00 | 1770810798 - MIDTOWN SURGERY CENTER, LLC | 271462435 - (NY) MIDTOWN SURGERY CENTER, LLC | NY | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 67316 | $4141.00 | 1487399168 - WILLOW PARK ENDOSCOPY CENTER, LLC | 881643733 - (TX) WILLOW PARK ENDOSCOPY CENTER LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 67316 | $5729.00 | 1952331092 - MEMORIAL HERMANN SURGERY CENTER SUGAR LAND LLP | 203233617 - (TX) MEMORIAL HERMANN SURGERY CENTER SUGAR LAND LLP | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 67316 | $645.00 | 1548655053 - MISSISSIPPI UROLOGY OUTPATIENT SURGERY CENTER, LLC | 640884577 - (MS) MISSISSIPPI UROLOGY CLINIC, PLLC | MS | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 67316 | $3273.00 | 1710910922 - SURGERY CENTER OF INDEPENDENCE LP | 200670748 - (MO) SURGERY CENTER OF INDEPENDENCE LP | MO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 67316 | $1523.50 | 1750582797 - BAY AREA LASER SURGERY CENTER, A MEDICAL CORPORATION | 208712646 - (CA) BAY AREA LASER SURGERY CENTER A MEDICAL CORPORATION | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 67316 | $3500.00 | 1992037352 - BAYLOR SURGICARE AT MANSFIELD, LLC, BAYLOR SCOTT & WHITE SURGICARE - MANSFIELD | 271835675 | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 67316 | $3099.00 | 1003119470 - MOUNTAIN WEST SURGERY CENTER, LLC | 371614424 | UT | 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 67316 vs. Other Surgical Procedures on the Eye and Ocular Adnexa Codes
The CPT 67316 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 67316 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 |
|---|---|---|
| 67311-CPT | Moderate | Strab. Surag.;1 Horiz. Muscle |
| 67312-CPT | Moderate | Op For Strabismus 2 Muscles |
| 67314-CPT | Moderate | Strabismus Surgery, Recession Or Resection Procedure (Patient Not Previously Operated On); One Vertical Muscle (Excludi |
| 67316-CPT | Moderate | Strabismus Surgery, Recession Or Resection Procedure (Patient Not Previously Operated On); Two Or More Vertical Muscles |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 67316. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 67316 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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