How much does Medicare pay for CPT 67041?

Medicare allowed an average of $1398.21 per service and paid $1111.76 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $5018.97, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 67041?

Removal of membrane of retina. It was billed 10,076 times to 9,748 Medicare beneficiaries by 454 providers in 2024.

Does 67041 pay differently in an office than a hospital?

Yes. The allowed amount averaged $1071.09 in an office setting and $1399.61 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 67041 most?

Ophthalmology, with 5,915 services from 300 clinicians. Next are Ambulatory Surgical Center, Physician Assistant.

CPT 67041

Removal of membrane of retina

$1398.21Medicare-allowed amount per service, averaged across 10,076 services

Providers submitted

$5018.97

Asking price, not received

Medicare allowed

$1398.21

The fee schedule figure

Medicare paid

$1111.76

Balance is patient coinsurance

Providers submitted an average of $5018.97 for this code and Medicare allowed $1398.21 — 3.6× 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 $1111.76 (80%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $1071.09
Hospital / facility: $1399.61

The facility rate is higher for this code, which is unusual and generally means the service depends on equipment or staffing a hospital carries. 43 services were billed in an office setting and 10,033 in a facility.

Services: 10,076
Beneficiaries: 9,748
Providers billing it: 454
Total allowed: $14,088,364

What Medicare pays for CPT 67041

Across 10,076 services billed by 454 providers to 9,748 beneficiaries, Medicare allowed an average of $1398.21 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 67041

Specialty	Services	Beneficiaries	Avg allowed	Providers
Ophthalmology	5,915	5,722	$1012.52	300
Ambulatory Surgical Center	4,121	3,986	$1963.65	152
Physician Assistant	40	40	$177.92	2

67041 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	1,163	$1405.85	$943.11	48
Florida	833	$1422.13	$1162.29	37
Arizona	761	$1562.38	$1273.80	24
Texas	686	$1457.31	$1196.51	32
New York	415	$1365.27	$977.63	22
Ohio	392	$1440.51	$1171.29	20
Wisconsin	310	$1286.44	$1061.28	13
Virginia	305	$1388.19	$1167.64	13
Illinois	281	$1370.27	$1096.52	14
Kentucky	276	$1348.00	$1118.35	12
Pennsylvania	247	$1329.42	$1094.77	11
Maryland	240	$1464.51	$1140.66	10
Kansas	219	$1314.17	$1106.63	9
Massachusetts	218	$1610.41	$1220.64	11
New Jersey	211	$1290.96	$937.93	12
Mississippi	202	$1448.77	$1273.72	7
Indiana	200	$1293.70	$1055.66	9
South Dakota	199	$1460.26	$1265.61	7
Minnesota	193	$1406.28	$1090.50	9
Tennessee	192	$1483.35	$1302.69	9
Georgia	179	$1309.72	$1129.40	7
North Carolina	177	$1329.62	$1099.69	10
Oklahoma	165	$1214.62	$1000.61	10
Alabama	158	$1242.62	$1116.56	8
Utah	153	$1349.07	$1101.10	5
Nebraska	151	$1528.48	$1260.36	7
Idaho	150	$1472.63	$1271.75	8
Oregon	143	$1272.80	$970.02	7
New Mexico	138	$1531.12	$1299.25	3
Michigan	135	$1165.39	$948.75	8
Colorado	114	$1617.87	$1274.98	5
South Carolina	112	$1393.34	$1152.72	5
Arkansas	99	$1019.88	$878.86	6
Missouri	96	$1395.55	$1126.14	6
Iowa	82	$1154.31	$959.35	6
New Hampshire	74	$1254.16	$1005.14	3
Alaska	66	$1941.68	$1384.50	2
Louisiana	51	$1099.34	$879.81	3
District of Columbia	51	$217.00	$153.36	2
Montana	48	$1456.00	$1270.47	2
Maine	48	$1548.16	$1237.63	3
Nevada	44	$1103.27	$869.54	3
Wyoming	36	$1504.62	$1195.39	2
Washington	32	$1119.05	$880.55	2
Vermont	18	$1972.18	$1603.15	1
Connecticut	13	$2194.17	$1587.62	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
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.