How much does Medicare pay for CPT 67040?

Medicare allowed an average of $1465.17 per service and paid $1165.68 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $6267.77, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 67040?

Destruction of eye fluid (vitreous) between lens and retina and all of retina using a laser. It was billed 2,801 times to 2,646 Medicare beneficiaries by 142 providers in 2024.

Which specialty bills 67040 most?

Ambulatory Surgical Center, with 1,571 services from 74 clinicians. Next are Ophthalmology, Physician Assistant.

CPT 67040

Destruction of eye fluid (vitreous) between lens and retina and all of retina using a laser

$1465.17Medicare-allowed amount per service, averaged across 2,801 services

Providers submitted

$6267.77

Asking price, not received

Medicare allowed

$1465.17

The fee schedule figure

Medicare paid

$1165.68

Balance is patient coinsurance

Providers submitted an average of $6267.77 for this code and Medicare allowed $1465.17 — 4.3× 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 $1165.68 (80%); the rest is the patient’s coinsurance and deductible.

Services: 2,801
Beneficiaries: 2,646
Providers billing it: 142
Total allowed: $4,103,941

What Medicare pays for CPT 67040

Across 2,801 services billed by 142 providers to 2,646 beneficiaries, Medicare allowed an average of $1465.17 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 67040

Specialty	Services	Beneficiaries	Avg allowed	Providers
Ambulatory Surgical Center	1,571	1,493	$1948.85	74
Ophthalmology	1,205	1,128	$862.27	66
Physician Assistant	25	25	$130.11	2

67040 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
Texas	443	$1530.85	$1263.74	22
California	439	$1473.02	$996.07	20
Georgia	176	$1514.10	$1213.79	6
Alabama	164	$1413.59	$1281.33	6
Ohio	161	$1400.06	$1232.64	8
North Carolina	143	$1283.52	$1064.49	7
Missouri	139	$1311.18	$1065.68	5
Tennessee	136	$1294.93	$1142.48	6
Florida	128	$1551.02	$1302.54	8
Arizona	122	$1504.17	$1235.70	7
Kentucky	96	$1291.70	$1130.02	5
Indiana	93	$1904.31	$1593.89	3
Virginia	47	$1634.31	$1416.45	3
Washington	46	$1692.52	$1207.89	3
Oklahoma	44	$1304.47	$1095.31	3
New Mexico	39	$1536.21	$1312.77	2
New York	39	$1832.91	$1252.68	2
Nebraska	38	$1235.45	$1076.20	3
South Carolina	32	$1432.87	$1245.92	2
Maine	26	$1581.72	$1255.39	2
Utah	26	$1486.13	$1227.88	2
Arkansas	25	$917.20	$774.52	2
Illinois	25	$1579.36	$1220.54	2
Pennsylvania	23	$1278.04	$975.46	2
Mississippi	19	$967.68	$787.34	1
Hawaii	17	$2323.82	$1603.16	1
Maryland	15	$2036.73	$1591.50	1
Alaska	15	$2172.06	$1603.13	1
Guam	14	$1626.48	$1396.76	1
Colorado	14	$1927.90	$1631.79	1
Iowa	12	$143.44	$130.25	1
Kansas	12	$1925.57	$1597.95	1
Minnesota	11	$2013.13	$1618.19	1
New Jersey	11	$253.90	$188.49	1
Oregon	11	$177.92	$127.16	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
67031Release of scar tissue between lens and retina$364.90
67039Destruction of eye fluid (vitreous) between lens and retina$1404.42

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.