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Medicare Reimbursement Dashboard
CPT 65778 reimbursement rates by MAC contractor and state — searchable, sortable, and always current.
Medicare Reimbursement
2026 Medicare reimbursement levels for CPT 65778 by state. Select any row to view locality and MAC details.
State | Max Allowable | Localities | Tier |
|---|---|---|---|
California CA | $1078.00/eye | 16 | High |
New York NY | $1068.00/eye | 4 | High |
Alaska AK | $1063.00/eye | 1 | High |
Massachusetts MA | $1018.00/eye | 2 | High |
District of Columbia DC | $1008.00/eye | 1 | High |
Hawaii HI | $1008.00/eye | 1 | High |
New Jersey NJ | $1008.00/eye | 1 | High |
Virginia VA | $1008.00/eye | 2 | High |
Illinois IL | $988.00/eye | 2 | Average |
Pennsylvania PA | $988.00/eye | 2 | Average |
Connecticut CT | $968.00/eye | 1 | Average |
Maryland MD | $958.00/eye | 2 | Average |
Washington WA | $958.00/eye | 1 | Average |
Rhode Island RI | $948.00/eye | 1 | Average |
Florida FL | $938.00/eye | 3 | Average |
Michigan MI | $938.00/eye | 2 | Average |
New Hampshire NH | $918.00/eye | 1 | Average |
Oregon OR | $918.00/eye | 1 | Average |
Delaware DE | $912.00/eye | 1 | Average |
Colorado CO | $878.00/eye | 1 | Lower |
Minnesota MN | $878.00/eye | 1 | Lower |
Nevada NV | $878.00/eye | 1 | Lower |
Texas TX | $878.00/eye | 8 | Lower |
Vermont VT | $878.00/eye | 1 | Lower |
Wisconsin WI | $878.00/eye | 1 | Lower |
Ohio OH | $858.00/eye | 1 | Lower |
Alabama AL | $827.00/eye | 1 | Lower |
Arizona AZ | $827.00/eye | 1 | Lower |
Arkansas AR | $827.00/eye | 1 | Lower |
Georgia GA | $827.00/eye | 1 | Lower |
Idaho ID | $827.00/eye | 1 | Lower |
Indiana IN | $827.00/eye | 1 | Lower |
Iowa IA | $827.00/eye | 1 | Lower |
Kansas KS | $827.00/eye | 1 | Lower |
Kentucky KY | $827.00/eye | 1 | Lower |
Louisiana LA | $827.00/eye | 1 | Lower |
Maine ME | $827.00/eye | 1 | Lower |
Mississippi MS | $827.00/eye | 1 | Lower |
Missouri MO | $827.00/eye | 1 | Lower |
Montana MT | $827.00/eye | 1 | Lower |
Nebraska NE | $827.00/eye | 1 | Lower |
New Mexico NM | $827.00/eye | 1 | Lower |
North Carolina NC | $827.00/eye | 1 | Lower |
North Dakota ND | $827.00/eye | 1 | Lower |
Oklahoma OK | $827.00/eye | 1 | Lower |
South Carolina SC | $827.00/eye | 1 | Lower |
South Dakota SD | $827.00/eye | 1 | Lower |
Tennessee TN | $827.00/eye | 1 | Lower |
Utah UT | $827.00/eye | 1 | Lower |
West Virginia WV | $827.00/eye | 1 | Lower |
Wyoming WY | $827.00/eye | 1 | Lower |
Select a State
Click any row to view CPT 65778 reimbursement details, MAC contractor, and locality breakdown for that state.
COLOR GUIDE
Disclaimer: Reimbursement amounts shown are based on the 2026 Medicare Physician Fee Schedule for CPT 65778 and reflect non-facility (office) allowables with Geographic Practice Cost Index (GPCI) adjustments applied. Actual reimbursement may vary based on payer contracts, patient deductibles, and local coverage determinations. Always verify current rates with your MAC. Download the full 2026 fee schedule PDF.
Ocular Surface Coding Guide
CPT codes for amniotic membrane transplantation and ocular surface procedures — with product applicability, care setting, and payer notes.
Placement of amniotic membrane on the ocular surface; without sutures
Most commonly used code for office-based AMT. The amniotic membrane (HCPCS V2790) is included in the reimbursement and cannot be billed separately under Medicare. Commercial payers often reimburse substantially higher.
Placement of amniotic membrane on the ocular surface; single layer, sutured
Used for surgical AMT application with suture fixation. Appropriate for pterygium excision, conjunctival repair, and complex surface reconstruction.
Ocular surface reconstruction; amniotic membrane transplantation, multiple layers
Used when multiple layers of amniotic membrane are required for ocular surface reconstruction. Appropriate for severe ocular surface disease, limbal stem cell deficiency, or extensive conjunctival defects.
Billing Documentation Checklist
Ensure your chart notes include each of these elements to support medical necessity and reduce claim denials.
Supported Diagnosis Codes
Common ICD-10 codes paired with CPT 65778–65780 for amniotic membrane procedures.
| ICD-10 Code | Description |
|---|---|
| H04.123 | Dry eye syndrome, bilateral |
| H04.121 | Dry eye syndrome, right eye |
| H04.122 | Dry eye syndrome, left eye |
| H16.009 | Unspecified corneal ulcer, unspecified eye |
| H16.001 | Unspecified corneal ulcer, right eye |
| H16.002 | Unspecified corneal ulcer, left eye |
| H16.239 | Neurotrophic keratoconjunctivitis, unspecified eye |
| H16.231 | Neurotrophic keratoconjunctivitis, right eye |
| H16.232 | Neurotrophic keratoconjunctivitis, left eye |
| H18.89 | Other specified disorders of cornea |
| H18.833 | Recurrent erosion of cornea, bilateral |
| H18.831 | Recurrent erosion of cornea, right eye |
| H18.832 | Recurrent erosion of cornea, left eye |
| H11.009 | Unspecified pterygium of unspecified eye |
| H11.001 | Unspecified pterygium of right eye |
| H11.002 | Unspecified pterygium of left eye |
| T26.10XA | Burn of cornea and conjunctival sac, unspecified eye, initial encounter |
| T26.11XA | Burn of cornea and conjunctival sac, right eye, initial encounter |
| T26.12XA | Burn of cornea and conjunctival sac, left eye, initial encounter |
| H16.419 | Unspecified superficial keratitis, unspecified eye |
| H16.411 | Unspecified superficial keratitis, right eye |
| H16.412 | Unspecified superficial keratitis, left eye |
| H11.159 | Pinguecula, unspecified eye |
| H16.309 | Unspecified interstitial and deep keratitis, unspecified eye |
| H16.269 | Vernal keratoconjunctivitis, with limbar and corneal involvement, unspecified eye |
Billing questions? We have answers.
The Ophthalogix billing support team can review your coding setup, answer payer-specific questions, and provide appeal language for denied claims.