CPT 67904 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 • 11 - Office |
| Common Modifiers | • None • 50 - Bilateral Procedure • LT - Left side of body |
| Complexity Level | Moderate |
| Medicare Fee Schedule | View Medicare rates for 67904 |
National average reimbursement for CPT 67904 by major payers:
$893.35
$942.96
$1,022.90
$1,198.94
| 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 67904 | ||||||
United | 67904 | $1400.00 | 1821379538 - THE AESTHETIC SURGERY CENTRE, PLLC, CEDAR LASER AND SURGERY CENTER | 900210545 - (WA) AESTHETIC SURGERY CENTRE, PLLC | WA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 67904 | $870.00 | 1982637492 - TOMOKA SURGERY CENTER, LLC | 201218596 - (FL) TOMOKA SURGERY CENTER LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 67904 | $2849.00 | 1639804248 - WILLIS SURGICENTER, LLC | 842342776 - (TX) WILLIS SURGICENTER LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 67904 | $958.00 | 1124075940 - ADVANCE ENDOSCOPY CENTER LLC | 510405251 - (DE) ADVANCE ENDOSCOPY CENTER LLC | DE | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 67904 | $2388.00 | 1366449571 - SHORE OUTPATIENT SURGICENTER LLC | 582252127 - (NJ) SHORE OUTPATIENT SURGICENTER LLC | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 67904 | $743.00 | 1720044522 - SURGICARE OF MOBILE LTD | 752459715 - (AL) SURGICARE OF MOBILE LTD | AL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 67904 | $749.00 | 1710032842 - MSC AMBULATORY SURGICAL CENTER | 202155076 | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 67904 | $1968.00 | 1760907919 - BANNER SUN CITY WEST SURGERY CENTER LLC | 901182684 - (AZ) BANNER SUN CITY WEST SURGERY CENTER LLC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 67904 | $1100.00 | 1689639262 - OAKWOOD SURGERY CENTER, LTD., LLP | 621641024 - (TX) OAKWOOD SURGERY CENTER LTD LLP | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 67904 | $1450.00 | 1891722609 - EYE MDS OF PUGET SOUND PLLC, NARROWS EYE SURGERY CENTER | 43700768 - (WA) EYE M.D.S OF PUGET SOUND, PLLC | WA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 67904 | $1497.00 | 1619469244 - RUSH OAK BROOK SURGERY CENTER, LLC | 371832312 - (IL) RUSH OAK BROOK SURGERY CENTER, LLC | IL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 67904 | $5048.00 | 1760412803 - MEMORIAL HERMANN SURGERY CENTER KATY LLP | 203360737 - (TX) MEMORIAL HERMANN SURGERY CENTER KATY LLP | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 67904 | $1923.00 | 1801443320 - ST. LUKE'S SURGERY CENTER OF CHESTERFIELD, LLC | 384106846 - (MO) ST LUKES SURGERY CENTER OF CHESTERFIELD LLC | MO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 67904 | $2056.00 | 1104907328 - ANDREWS INSTITUTE ASC LLC | 352274952 - (FL) ANDREWS INSTITUTE ASC, LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 67904 | $1225.00 | 1477559839 - SURGERY CENTER OF NORTHERN COLORADO, EYE CENTER OF NORTHEN COLORADO SURGERY CENTER | 841420378 - (CO) SURGERY CENTER OF NORTHERN COLORADO | CO | 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 |
Want to see your competitors' rates?
Start your trial today to unlock complete access to provider rates and fee schedules in your area.
Here's what you can do with PayerPrice
Renegotiate your managed care contracts
Benchmark your current rates against market averages to identify opportunities for rate optimization.
Prospect for new business using fee schedules
Access every provider's negotiated rates for every billing code in your market to inform your prospecting strategies.
Integrate real-time payer data into your workflows
Automatically keep fee schedules up-to-date without adding yet another log-in to your insurance systems. Connect via API or SQL.
PayerPrice shows you the exact negotiated rates that insurers publish under federal transparency rules.
We display the raw data directly from insurers' files, giving you the same information they make public. Learn more about Price Transparency.
CPT 67904 vs. Other Surgical Procedures on the Eye and Ocular Adnexa Codes
The CPT 67904 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 67904 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 67904. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 67904 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.
Let's review your payer contracts side-by-side with the market.
Bring your top codes (like CPT 67904) and we'll show you how you compare in 15 minutes or less.