How much does Medicare pay for CPT 67031?

Medicare allowed an average of $364.90 per service and paid $280.58 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $1061.98, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 67031?

Release of scar tissue between lens and retina using a laser. It was billed 5,128 times to 3,457 Medicare beneficiaries by 117 providers in 2024.

Does 67031 pay differently in an office than a hospital?

Yes. The allowed amount averaged $383.70 in an office setting and $319.08 in a facility. The office rate is generally higher because the practice supplies the room, staff and equipment out of that single payment; in a hospital those are billed separately by the facility.

Which specialty bills 67031 most?

Ophthalmology, with 4,044 services from 87 clinicians. Next are Ambulatory Surgical Center, Optometry, General Surgery.

CPT 67031

Release of scar tissue between lens and retina using a laser

$364.90Medicare-allowed amount per service, averaged across 5,128 services

Providers submitted

$1061.98

Asking price, not received

Medicare allowed

$364.90

The fee schedule figure

Medicare paid

$280.58

Balance is patient coinsurance

Providers submitted an average of $1061.98 for this code and Medicare allowed $364.90 — 2.9× less. That gap is normal and means nothing on its own: Medicare pays its fee schedule regardless of what is billed, so the submitted figure describes a hospital chargemaster, not a price anyone paid. Of the allowed amount Medicare paid $280.58 (77%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $383.70
Hospital / facility: $319.08

The office rate is higher because the practice supplies the room, staff and equipment out of that payment. In a hospital the facility bills those separately, so the clinician's share is smaller — the total cost to Medicare is usually higher, not lower. 3,636 services were billed in an office setting and 1,492 in a facility.

Services: 5,128
Beneficiaries: 3,457
Providers billing it: 117
Total allowed: $1,871,207

What Medicare pays for CPT 67031

Across 5,128 services billed by 117 providers to 3,457 beneficiaries, Medicare allowed an average of $364.90 per service. That is 1.5 services per beneficiary, so this is a code patients typically receive more than once. The allowed amount is the figure that matters: it is what Medicare and the patient together owe, set by the fee schedule and adjusted for local practice costs. What a provider chose to submit has no bearing on it.

Who bills 67031

Specialty	Services	Beneficiaries	Avg allowed	Providers
Ophthalmology	4,044	2,728	$378.91	87
Ambulatory Surgical Center	742	495	$293.83	24
Optometry	307	210	$351.23	5
General Surgery	35	24	$371.90	1

67031 reimbursement by state

Two different numbers. Allowed is what Medicare actually allowed in that state, which includes the local practice-cost adjustment. Standardized strips that geographic adjustment out of the payment, so it is the column to use when comparing states — a difference there reflects how the code was billed, not what it costs to run a practice locally.

State	Services	Allowed	Standardized pmt	Providers
California	1,348	$393.88	$279.18	13
Florida	415	$338.92	$267.75	15
Indiana	290	$320.98	$263.17	6
Louisiana	254	$352.46	$283.47	3
Colorado	246	$366.09	$274.82	7
Oklahoma	239	$343.14	$282.18	5
Illinois	226	$390.27	$288.73	6
New York	207	$422.50	$286.03	4
Texas	196	$356.46	$281.61	6
Ohio	189	$322.83	$250.36	5
Michigan	176	$354.51	$282.23	4
Connecticut	162	$371.41	$288.95	1
Maryland	150	$330.65	$252.34	2
Virginia	128	$383.55	$289.12	5
Arizona	108	$332.76	$272.88	2
Wisconsin	104	$322.13	$266.39	4
Kansas	97	$312.50	$259.57	4
New Jersey	97	$404.71	$289.26	4
Nevada	95	$367.98	$282.65	3
South Dakota	81	$407.88	$299.36	2
Tennessee	72	$375.64	$294.83	1
North Carolina	61	$368.30	$301.61	3
Nebraska	34	$288.19	$252.88	2
Minnesota	31	$306.33	$250.12	2
Alabama	30	$259.78	$247.27	2
Oregon	27	$399.28	$321.91	1
North Dakota	25	$302.08	$244.85	2
Mississippi	14	$324.26	$243.99	1
Utah	13	$390.45	$315.69	1
Massachusetts	13	$427.49	$298.25	1

Related codes

67028Injection of drug into eye$122.07
67042Removal of membrane of retina$1420.62
67036Removal of eye fluid (vitreous) between lens and retina$1259.65
67041Removal of membrane of retina$1398.21
67039Destruction of eye fluid (vitreous) between lens and retina$1404.42
67040Destruction of eye fluid (vitreous) between lens and retina and all of$1465.17

Billing this code is not the same as earning it

An allowed amount is revenue to a practice, not income to a clinician. It funds staff, premises, equipment and supplies before anyone is paid. What clinicians actually earn is published separately by the Department of Labor, and what industry pays them is published separately again by CMS — this site carries both.

What doctors are paid →·Look up a clinician →·All procedure codes →

Where this comes from. CMS Medicare Physician & Other Practitioners, by Provider and Service, 2024. It covers fee-for-service Original Medicare Part B only — not Medicare Advantage, not Medicaid, and not commercial insurance, which typically pays more for the same code.

How it is averaged. CMS publishes one average per provider per code. Every figure here is re-weighted by the number of services, so a clinician who billed the code 4,000 times counts 4,000 times more than one who billed it twice. CMS also suppresses any provider-code pair with fewer than 11 beneficiaries, so low-volume practice is missing from these totals by design.