CPT 65820: Limbal Incision for Glaucoma Drainage
Medicare pays $748 and commercial payers pay $1121 on average nationally for this procedure.
CPT code 65820 describes a surgical procedure in which the provider makes an incision at the limbus to improve aqueous humor drainage, typically performed as a glaucoma surgery to treat congenital or childhood glaucoma; service type: ophthalmic surgical procedure; typical site of service: operating room or ambulatory surgical center for pediatric ophthalmology care.
For related coverage guidance, see recent payer policy updates: Intravenous Anesthetics for the Treatment of Chronic Pain and Psychiatric or Substance Use Disorders, Intravenous Anesthetics for the Treatment of Chronic Pain and Psychiatric or Substance Use Disorders, Intravenous Anesthetics for the Treatment of Chronic Pain and Psychiatric or Substance Use Disorders.
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National Reimbursement Benchmarks
Nationally, the average commercial benchmark represented by BUCA ($1,120.90) exceeds Medicare's mean rate ($747.70) by $373.20, indicating materially higher commercial reimbursement for CPT 65820 versus the Medicare average. Blue Cross Blue Shield and UnitedHealth Group sit above both BUCA and Medicare on mean rates, while Aetna and Medicare are lower on the mean spectrum, framing a tiered payer landscape.
Dispersion (P75 minus P25) highlights where rates concentrate: Blue Cross Blue Shield and UnitedHealth Group show the widest spread at $793.10 and $840.70 respectively, signaling greater variability in commercial contracting. Aetna is relatively tight with a spread of $760.00. Cigna and BUCA have spreads of $849.10 and $830.00 respectively, placing them nearer the upper end of variability. Medicare’s interquartile spread is $68.00, the tightest of the group, reflecting limited geographic variation in the Medicare locality set.