CPT 67516 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 | |
| Common Modifiers | |
| Complexity Level | Moderate |
National average reimbursement for CPT 67516 by major payers:
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| 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 67516 | ||||||
United | 67516 | $1000.00 | 1881001212 - AMBULATORY SURGICAL CENTER AT BASKING RIDGE | 833879253 - (NJ) LIBERTY CORNER SURGICAL CENTER LLC | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 67516 | $1173.00 | 1578515367 - BLACK CANYON SURGICAL CENTER, LLC | 510514274 - (CO) BLACK CANYON SURGICAL CENTER, LLC | CO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 67516 | $317.00 | 1275574154 - DOCTORS SURGERY CENTER OF TEXARKANA, DOCTOR'S SURGERY CENTER | 710796220 - (AR) DOCTORS SURGERY CENTER OF TEXARKANA | AR | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 67516 | $425.00 | 1093395501 - COLUMBUS ONE ENDOSCOPY LLC, HILLIARD ENDO CENTER | 824347730 - (OH) COLUMBUS ONE ENDOSCOPY LLC | OH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 67516 | $439.00 | 1770603706 - BIRMINGHAM AMBULATORY SURGICAL CENTER, PLLC, TRUVISTA SURGERY CENTER | 202208179 - (MI) BIRMINGHAM AMBULATORY SURGICAL | MI | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 67516 | $1274.00 | 1518984301 - ENDOSCOPY CENTER OF INLAND EMPIRE INC | 474733900 | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 67516 | $2989.00 | 1831360247 - SURGICAL CENTER AT COLUMBIA ORTHOPAEDIC GROUP LLC | 261150611 - (MO) SURGICAL CENTER AT COLUMBIA ORTHOPAEDIC GROUP LLC | MO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 67516 | $780.00 | 1528060704 - CMMP SURGICAL CENTER LLC | 431709558 - (MO) CMMP SURGICAL CENTER | MO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 67516 | $400.00 | 1083689749 - GAINESVILLE FL ORTHOPAEDIC ASC LLC, ORTHOPAEDIC SURGERY CENTER | 200603370 - (FL) THE GAINESVILLE FL ORTHOPAEDIC A | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 67516 | $5667.00 | 1053391870 - NORTHWEST SURGERY CENTER, LTD, NORTHWEST SURGERY CENTER RED OAK | 760452319 - (TX) NORTHWEST SURGERY CENTER LTD | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 67516 | $2508.00 | 1831274208 - MT KISCO SURGERY CENTER LLC, THE AMBULATORY SURGERY CENTER OF WESTCHESTER | 134158313 - (NY) MOUNT KISCO SURGERY CENTER, L.L.C. | NY | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 67516 | $592.00 | 1326176215 - ENDOSCOPY CENTER OF ST THOMAS LLC, NGS ENDOSCOPY CENTER | 621512411 - (TN) ENDOSCOPY CENTER OF ST THOMAS LLC | TN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 67516 | $1064.00 | 1174802045 - LEONARDTOWN SURGERY CENTER LLC | 452019132 - (MD) LEONARDTOWN SURGERY CENTER, LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 67516 | $1462.00 | 1073816690 - PENN STATE HERSHEY ENDOSCOPY CENTER LLC | 274000022 - (PA) PENN STATE HERSHEY ENDOSCOPY CENTER LLC | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 67516 | $672.00 | 1275142804 - ATLAS SURGERY CENTER, LLC, ATLAS SURGERY CENTER, LLC | 842922573 - (MN) ATLAS SURGERY CENTER LLC | MN | 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 67516 vs. Other Surgical Procedures on the Eye and Ocular Adnexa Codes
The CPT 67516 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 67516 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 |
|---|---|---|
| 67516 | Moderate | Suprachoroidal Space Injection Of Pharmacologic Agent (Separate Procedure) |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 67516. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 67516 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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