CPT 67430 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 | • 20 - Urgent Care Facility • 22 - On Campus Outpatient Hospital |
| Common Modifiers | • None • LT - Left side of body • RT - Right side of body |
| Complexity Level | High |
National average reimbursement for CPT 67430 by major payers:
$1,716.45
$1,645.78
$1,835.75
$2,194.30
| 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 67430 | ||||||
United | 67430 | $1800.00 | 1811095136 - GROSSMONT OUTPATIENT SURGICAL CENTER | 953337109 - (CA) GROSSMONT OUTPATIENT SURGICAL CE | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 67430 | $1301.00 | 1093053381 - NORTH COUNTRY EC LLC, NORTHEASTERN NEW YORK SURGICAL CENTER | 453715451 - (NY) NORTH COUNTRY EC LLC | NY | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 67430 | $1075.00 | 1992741300 - LINCOLN ENDOSCOPY CENTER, LLC | 470807741 - (NE) LINCOLN ENDOSCOPY CENTER LLC | NE | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 67430 | $2717.00 | 1932164852 - MAY STREET SURGI CENTER, LLC, MAY STREET SURGI CENTER | 223777533 - (NJ) MAY STREET SURGI CENTER, LLC | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 67430 | $4276.00 | 1104006006 - PACIFIC ENDOSCOPY AND SURGERY CENTER, LLC | 205755383 - (CA) PACIFIC ENDOSCOPY AND SURGERY CENTER, LLC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 67430 | $2542.00 | 1497090740 - OLOL PONTCHARTRAIN SURGERY CENTER, LLC, OUR LADY OF THE LAKE PONTCHARTRAIN SURGERY CENTER | 461379031 - (LA) OLOL PONTCHARTRAIN SURGERY CENTE | LA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 67430 | $756.00 | 1407131949 - LEE SURGERY CENTER LLC | 453606333 - (OH) LEE SURGERY CENTER LLC | OH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 67430 | $1658.00 | 1487609335 - THE CENTER FOR AESTHETIC SURGERY LLC | 200431536 - (MD) THE CENTER FOR AESTHETIC SURGERY LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 67430 | $2924.00 | 1306135298 - DMG PAIN MANAGEMENT SURGERY CENTER, LLC | 271322187 - (IL) DMG PAIN MANAGEMENT SURGERY CENTER LLC | IL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 67430 | $2112.00 | 1619979580 - PORT ORANGE ENDOSCOPY & SURGERY CENTER LLC, ADVENTHEALTH SURGERY CENTER PORT ORANGE | 201388947 | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 67430 | $2500.00 | 1649416231 - CLINTON PARTNERS, LLC, SURGERY CENTER OF CLINTON TOWNSHIP | 202236024 | MI | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 67430 | $3623.00 | 1346289428 - PROLIANCE SURGEONS, INC., P.S., PROLIANCE SURGEONS SEATTLE ORTHOPEDIC CENTER-ASC | 911606533 - (WA) PROLIANCE SURGEONS, INC., P.S. | WA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 67430 | $3623.00 | 1770180986 - AUDUBON AMBULATORY SURGERY CENTER LLC, AUDUBON ASC AT ST. FRANCIS | 841482638 - (CO) AUDUBON AMBULATORY SURGERY CENTER, LLC. | CO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 67430 | $864.00 | 1427051796 - SOUTH BEND IN ENDOSCOPY ASC LLC, MICHIANA ENDOSCOPY CENTER | 352011366 - (IN) SOUTH BEND IN ENDOSCOPY ASC LLC | IN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 67430 | $1133.00 | 1225440969 - COPPEL SURGICAL SOLUTIONS, NEVADA SURGICAL SUITES | 460641933 - (NV) COPPEL SURGICAL SOLUTIONS | 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 67430 vs. Other Surgical Procedures on the Eye and Ocular Adnexa Codes
The CPT 67430 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 67430 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.
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 67430. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 67430 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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