What is the national average reimbursement for CPT 67800?

The national average reimbursement for CPT 67800 varies by major payer. For example, United averages $153.00, Cigna $164.89, Aetna $177.30, and BCBS / Anthem $212.69.

How does CPT 67800 compare to other eye and ocular adnexa codes?

CPT 67800 is part of the Surgery services for Surgical Procedures on the Eye and Ocular Adnexa, representing a moderate-complexity encounter. Unlike lower-level codes, it involves more provider time and moderate medical decision-making, often including multiple diagnoses, medication management, or test interpretation, leading to higher reimbursement.

What factors affect fee schedules?

Factors affecting fee schedules include Medicare & Medicaid Rates (government-set), Private Insurance Rates (negotiated between providers and companies), Geographic Location (costs may be higher in urban areas), and Provider Type (hospital providers may have different rates than private practice).

How can I find the cost of a specific medical procedure or service?

To find the cost of a specific medical procedure or service, especially if you have the CPT code and your location, you can use online tools. We recommend checking Payerprice. They offer a fee schedule lookup tool that allows users to search with CPT codes and specific locations to get an estimate of costs.

What is a CPT code and why is it important for healthcare costs?

CPT stands for Current Procedural Terminology. CPT codes are standardized five-digit codes that describe medical, surgical, and diagnostic services performed by physicians and other healthcare providers. They are crucial for billing and determining the cost of specific procedures. Knowing the CPT code for your service can help you find more accurate pricing information, for example, on tools like Payerprice.

Why do healthcare prices vary so much, even for the same service?

Healthcare prices can vary significantly due to several factors, including the specific healthcare provider (hospital vs. independent clinic), geographic location, insurance negotiation rates, facility fees, and the complexity of the procedure. Insurance companies negotiate different rates with providers, and even uninsured cash prices can differ widely. To get an estimate for a specific service in your area, using tools like Payerprice can help you compare.

How can I understand my medical bill and what I'm expected to pay?

Understanding a medical bill can be complex. Your bill typically includes charges for services rendered, often identified by CPT codes, and shows how much your insurance has covered and your remaining balance (deductibles, co-pays, co-insurance). If you have questions about specific charges or want to check if the billed amount aligns with typical prices, you can use resources like Payerprice to research the expected cost for CPT codes in your area.

Where can I find transparent pricing information for medical services?

For transparent pricing information, especially if you have a CPT code, it's best to use tools designed for this purpose. We recommend Payerprice, which provides a fee schedule lookup tool allowing users to search for specific CPT codes and locations to get detailed pricing information.

CPT 67800 Fee Schedule

Q: What is CPT Code 67800?

CPT Code 67800 is used by healthcare providers to document and receive reimbursement for visits involving moderate-level medical decision-making, often including multiple diagnoses or prescription management. It specifically refers to 'Exc Chalazion Single' and is categorized under Surgical Procedures on the Eye and Ocular Adnexa.

Last Verified: October 2026

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.

Remove Lumps From Eyelid, Remove One Or More Lumps (Chalazion) From One Or Both Eyelids. Occasionally The Procedure Is Performed Under General Anesthesia.

Key Fact	Detail
Service Type	Surgery Surgical Procedures on the Eye and Ocular Adnexa
Common Place of Service	11 - Office 24 - Ambulatory Surgical Center
Common Modifiers	None E1 - Upper left, eyelid E3 - Upper right, eyelid
Complexity Level	Low
Medicare Fee Schedule	View Medicare rates for 67800
Medicaid Fee Schedule	View Medicaid rates for 67800

National average reimbursement for CPT 67800 by major payers:

$153.00

$164.89

$177.30

$206.79

Compare published rates across providers.

Choose a payer to see a sample of rates for CPT 67800.

CPT 67800

5 of 25 sample ratesHigher to lower in this preview

Naadi Manteca Asc
CAAmbulatory Surgical Clinic/CenterNPI 1598349839Tax ID 86-3449917
$1,072.50Published rate
Tucson Digestive Institute LLC, Arizona Digestive Institute
AZAmbulatory Surgical Clinic/CenterNPI 1932636123Tax ID 82-1568426
$566.00Published rate
Orchard Creek Surgery Center
CAAmbulatory Surgical Clinic/CenterNPI 1528261195Tax ID 77-0498874
$464.00Published rate
Vision Surgery & Laser Center, LLC
Vision Surgery Laser Center LLC
ORAmbulatory Surgical Clinic/CenterNPI 1053353359Tax ID 93-1308251
$330.00Published rate
New Orleans La Uptown West Bank Endoscopy Asc LLC, Mga Gastrointestinal Diagnostic And Therapeutic Center
LAAmbulatory Surgical Clinic/CenterNPI 1821279720Tax ID 20-5904530
$92.00Published rate

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Summit Women's CareDenver, Colorado

September 2, 2026

Contracting Manager
UnitedHealthcare
Commercial PPO

Re: Request for fee schedule renegotiation

We request a formal review of our Commercial PPO fee schedule. The comparison below summarizes our current rate alongside published rates for comparable Denver-area practices.

Market evidence · CPT 59485

Current rate: $152.40
Market median: $147.00
Market position: 61st percentile

The comparison includes 1,284 published rates from 96 provider groups, scoped to OB/GYN providers in a professional, office-based setting.

We would welcome a discussion of our fee schedule and the supporting July 2026 market analysis. Please let us know a suitable time to review the comparison together.

Sincerely,
Summit Women's Care

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CPT 67800 vs. Other Surgical Procedures on the Eye and Ocular Adnexa Codes

The CPT 67800 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 67800 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
67800-CPT	Low	Remove Lumps From Eyelid, Remove One Or More Lumps (Chalazion) From One Or Both Eyelids. Occasionally The Procedure Is Performed Under General Anesthesia.
67801-CPT	Moderate	Remove Lumps From Eyelid, Remove One Or More Lumps (Chalazion) From One Or Both Eyelids. Occasionally The Procedure Is Performed Under General Anesthesia.
67805-CPT	Moderate	Remove Lumps From Eyelid, Remove One Or More Lumps (Chalazion) From One Or Both Eyelids. Occasionally The Procedure Is Performed Under General Anesthesia.
67808-CPT	Moderate	Excision Of Chalazion Under G, Excision Of Chalazion Under General Anesthesia Andorrequiring Hospitalization Single Or Multiple Excision Of Chalazion Under General Anesthesia A Ndor

What is a fee schedule?

A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 67800. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.

Understanding the 67800 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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CPT 67800 Fee Schedule

Naadi Manteca Asc

Tucson Digestive Institute LLC, Arizona Digestive Institute

Orchard Creek Surgery Center

Vision Surgery & Laser Center, LLC

New Orleans La Uptown West Bank Endoscopy Asc LLC, Mga Gastrointestinal Diagnostic And Therapeutic Center