CPT 68505 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 | • 24 - Ambulatory Surgical Center • 22 - On Campus Outpatient Hospital |
| Common Modifiers | • None • RT - Right side of body • LT - Left side of body |
| Complexity Level | High |
National average reimbursement for CPT 68505 by major payers:
$1,275.34
$1,273.80
$1,414.70
$1,681.93
| 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 68505 | ||||||
United | 68505 | $3305.00 | 1447932769 - PRO SURGERY CENTER LLC | 931484998 - (WA) PRO SURGERY CENTER LLC | WA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 68505 | $1150.00 | 1164734232 - MIDSOUTH INTERVENTIONAL PAIN INSTITUTE, LLC | 261545635 - MIDSOUTH INTERVENTIONAL PAIN INSTITUTE LLC | TN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 68505 | $3000.00 | 1558327338 - DANBURY SURGICAL CENTER LP, SURGICAL CENTER OF RIDGEFIELD | 631263704 - (CT) DANBURY SURGICAL CENTER LP | CT | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 68505 | $2282.00 | 1558983833 - TRIAD CENTER FOR SURGERY, KIMEL PARK SURGERY CENTER | 844248237 - (NC) TRIAD CENTER FOR SURGERY LLC | NC | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 68505 | $2924.00 | 1497706626 - CHICAGO PROSTATE CANCER SURGERY CENTER, LLC, DUPAGE MEDICAL GROUP SURGERY CENTER, WESTMONT | 204403852 - (IL) CHICAGO PROSTATE CANCER SURGERY CENTER LLC | IL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 68505 | $3354.00 | 1205545860 - PROVIDENCE SURGERY AND PROCEDURE CENTER LLC | 881232814 - (WA) PROVIDENCE SURGERY AND PROCEDURE CENTER LLC | WA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 68505 | $2050.00 | 1154034429 - CROSSINGS SURGERY CENTER, LLC | 881346867 - (RI) CROSSINGS SURGERY CENTER LLC | RI | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 68505 | $1025.00 | 1871536763 - ROCKFORD GASTROENTEROLOGY ASSOCIATES, LTD., ROCKFORD ENDOSCOPY CENTER | 363081482 - (IL) ROCKFORD GASTROENTEROLOGY ASSOCIATES, LTD. | IL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 68505 | $3500.00 | 1184714214 - GAINESVILLE ENDOSCOPY CENTER, LLC | 10750801 - (GA) GAINESVILLE ENDOSCOPY CENTER LLC | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 68505 | $1378.00 | 1790167740 - TIDALHEALTH SURGERY CENTER, LLC | 474184623 | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 68505 | $3422.00 | 1528340213 - UNIVERSITY CENTER FOR AMBULATORY SURGERY, LLC | 453017917 - (NJ) UNIVERSITY CENTER FOR AMBULATORY SURGERY LLC | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 68505 | $675.00 | 1780661967 - CJ ELMWOOD PARTNERS L P | 911793912 - CJ ELMWOOD PARTNERS L P | IA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 68505 | $1735.09 | 1104313444 - JAHNAVI TRIVEDI | 350593390 - DEACONESS HOSPITAL INC | IN | Anesthesiology Physician (207L00000X) |
United | 68505 | $1735.09 | 1588749204 - JOHN HOLEMAN | 350593390 - DEACONESS HOSPITAL INC | SC | Hospitalist Physician (208M00000X) |
United | 68505 | $847.00 | 1396738936 - WARREN GASTRO ENDOSCOPY CTR INC | 341850936 - (OH) WARREN GASTRO ENDOSCOPY CTR INC | PA | 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 68505 vs. Other Surgical Procedures on the Eye and Ocular Adnexa Codes
The CPT 68505 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 68505 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 68505. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 68505 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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