How much does Medicare pay for CPT 67036?

Medicare allowed an average of $1259.65 per service and paid $1002.09 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $5024.80, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 67036?

Removal of eye fluid (vitreous) between lens and retina. It was billed 23,148 times to 21,105 Medicare beneficiaries by 874 providers in 2024.

Does 67036 pay differently in an office than a hospital?

Yes. The allowed amount averaged $757.08 in an office setting and $1265.60 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 67036 most?

Ophthalmology, with 12,596 services from 584 clinicians. Next are Ambulatory Surgical Center, Physician Assistant, Nurse Practitioner.

CPT 67036

Removal of eye fluid (vitreous) between lens and retina

$1259.65Medicare-allowed amount per service, averaged across 23,148 services

Providers submitted

$5024.80

Asking price, not received

Medicare allowed

$1259.65

The fee schedule figure

Medicare paid

$1002.09

Balance is patient coinsurance

Providers submitted an average of $5024.80 for this code and Medicare allowed $1259.65 — 4.0× 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 $1002.09 (80%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $757.08
Hospital / facility: $1265.60

The facility rate is higher for this code, which is unusual and generally means the service depends on equipment or staffing a hospital carries. 271 services were billed in an office setting and 22,877 in a facility.

Services: 23,148
Beneficiaries: 21,105
Providers billing it: 874
Total allowed: $29,158,378

What Medicare pays for CPT 67036

Across 23,148 services billed by 874 providers to 21,105 beneficiaries, Medicare allowed an average of $1259.65 per service. 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 67036

Specialty	Services	Beneficiaries	Avg allowed	Providers
Ophthalmology	12,596	11,504	$715.62	584
Ambulatory Surgical Center	10,230	9,289	$1965.41	278
Physician Assistant	301	293	$119.73	11
Nurse Practitioner	21	19	$103.11	1

67036 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
Florida	2,323	$1310.16	$1088.09	71
California	2,124	$1324.98	$879.35	84
Texas	2,036	$1342.44	$1093.69	63
Arizona	1,257	$1388.14	$1127.70	34
New York	1,151	$1162.53	$840.04	46
Ohio	1,070	$1088.65	$891.36	43
Colorado	900	$1395.09	$1101.10	26
Pennsylvania	840	$1078.45	$868.49	32
South Carolina	825	$1394.57	$1178.55	21
Illinois	568	$1062.33	$854.00	26
New Jersey	562	$1205.80	$888.08	26
Missouri	552	$1107.40	$932.29	25
Washington	540	$1507.65	$1116.41	22
Kentucky	483	$1358.60	$1148.15	13
Virginia	474	$1352.61	$1134.56	21
Tennessee	467	$1280.83	$1131.48	16
Mississippi	457	$1176.05	$1060.58	15
Massachusetts	448	$1202.41	$891.53	22
Maryland	407	$1190.95	$903.81	20
Utah	398	$1245.15	$1017.32	16
Indiana	382	$1406.24	$1145.39	11
North Carolina	378	$992.37	$831.74	22
Georgia	327	$1345.58	$1102.11	15
Oregon	316	$1238.16	$944.61	14
Louisiana	301	$1293.07	$1111.42	14
Iowa	277	$925.94	$782.30	10
Alabama	276	$757.14	$662.91	16
South Dakota	273	$1332.64	$1131.83	10
Idaho	268	$1344.90	$1170.45	5
Michigan	246	$1028.78	$856.98	17
Kansas	240	$1204.94	$996.81	10
Minnesota	239	$1369.37	$1063.28	10
Nebraska	208	$1194.44	$1012.74	8
Wisconsin	190	$1155.50	$930.52	8
Connecticut	172	$1605.44	$1172.64	11
Oklahoma	162	$1242.02	$1027.06	7
New Mexico	155	$1355.54	$1161.86	4
Hawaii	116	$1556.45	$1092.88	4
Nevada	106	$923.49	$711.35	7
New Hampshire	93	$1085.99	$850.84	5
District of Columbia	90	$174.16	$110.02	3
Arkansas	88	$861.20	$746.47	4
North Dakota	78	$1250.00	$1031.40	2
Montana	77	$1632.72	$1401.14	4
Alaska	68	$1966.77	$1430.59	2
Delaware	40	$1227.31	$957.23	2
Wyoming	24	$1385.49	$1086.95	2
Rhode Island	18	$2013.33	$1603.17	1
West Virginia	17	$703.35	$567.39	1
AE	16	$700.96	$570.72	1
Vermont	14	$727.41	$591.97	1
Maine	11	$1995.78	$1603.21	1

Related codes

67028Injection of drug into eye$122.07
67042Removal of membrane of retina$1420.62
67041Removal of membrane of retina$1398.21
67031Release of scar tissue between lens and retina$364.90
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.