CPT 67042
Removal of membrane of retina with removal of internal limiting membrane of retina
Asking price, not received
The fee schedule figure
Balance is patient coinsurance
Providers submitted an average of $6100.77 for this code and Medicare allowed $1420.62 — 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 $1129.75 (80%); the rest is the patient’s coinsurance and deductible.
Office pays differently to hospital
- Office / non-facility
- $968.78
- Hospital / facility
- $1425.52
The facility rate is higher for this code, which is unusual and generally means the service depends on equipment or staffing a hospital carries. 314 services were billed in an office setting and 28,949 in a facility.
- Services
- 29,263
- Beneficiaries
- 28,417
- Providers billing it
- 1,037
- Total allowed
- $41,571,603
Medicare Part B, 2024
Services × allowed amount
What Medicare pays for CPT 67042
Across 29,263 services billed by 1,037 providers to 28,417 beneficiaries, Medicare allowed an average of $1420.62 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 67042
| Specialty | Services | Beneficiaries | Avg allowed | Providers |
|---|---|---|---|---|
| Ophthalmology | 15,641 | 15,201 | $992.45 | 719 |
| Ambulatory Surgical Center | 13,222 | 12,820 | $1964.30 | 307 |
| Physician Assistant | 350 | 347 | $151.69 | 9 |
| Nurse Practitioner | 33 | 32 | $148.95 | 1 |
| Pediatric Medicine | 17 | 17 | $1104.12 | 1 |
67042 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 | 3,073 | $1513.26 | $1237.76 | 88 |
| Florida | 2,625 | $1503.08 | $1253.24 | 72 |
| California | 2,122 | $1545.51 | $1028.63 | 87 |
| Ohio | 1,638 | $1229.99 | $1029.98 | 47 |
| Pennsylvania | 1,476 | $1286.65 | $1015.99 | 51 |
| Arizona | 1,475 | $1490.83 | $1203.99 | 40 |
| Tennessee | 1,189 | $1308.79 | $1151.84 | 35 |
| Washington | 999 | $1554.70 | $1161.37 | 36 |
| Illinois | 888 | $1140.50 | $894.94 | 38 |
| Missouri | 828 | $1244.30 | $1014.65 | 31 |
| Colorado | 808 | $1532.44 | $1199.87 | 31 |
| South Carolina | 668 | $1501.59 | $1262.58 | 25 |
| North Carolina | 665 | $1343.65 | $1130.81 | 25 |
| New York | 657 | $1316.09 | $958.76 | 31 |
| Maryland | 657 | $1414.29 | $1108.26 | 25 |
| Minnesota | 609 | $1560.46 | $1201.07 | 20 |
| Indiana | 607 | $1661.97 | $1352.04 | 18 |
| Virginia | 585 | $1552.37 | $1272.97 | 23 |
| Georgia | 574 | $1512.81 | $1235.70 | 21 |
| New Jersey | 521 | $1468.70 | $1076.67 | 23 |
| Alabama | 518 | $1165.91 | $1034.06 | 20 |
| Massachusetts | 476 | $1439.87 | $1103.48 | 21 |
| Kansas | 469 | $1515.52 | $1255.89 | 17 |
| Iowa | 449 | $1213.44 | $1031.44 | 15 |
| Wisconsin | 381 | $1326.71 | $1091.93 | 12 |
| Oklahoma | 365 | $1264.69 | $1031.56 | 11 |
| Michigan | 362 | $1331.21 | $1081.91 | 23 |
| Nebraska | 350 | $1483.91 | $1240.58 | 12 |
| Utah | 343 | $1386.77 | $1142.85 | 13 |
| Kentucky | 329 | $1507.18 | $1281.33 | 13 |
| Oregon | 320 | $1173.35 | $911.53 | 14 |
| Mississippi | 312 | $1312.17 | $1187.73 | 11 |
| Louisiana | 290 | $1407.90 | $1204.26 | 14 |
| South Dakota | 196 | $1456.53 | $1272.12 | 6 |
| Nevada | 179 | $1103.48 | $860.22 | 9 |
| Montana | 159 | $1513.46 | $1239.75 | 6 |
| New Mexico | 145 | $1316.71 | $1080.45 | 6 |
| Maine | 132 | $1547.35 | $1246.61 | 6 |
| North Dakota | 124 | $1439.94 | $1194.29 | 3 |
| Connecticut | 108 | $1913.02 | $1429.17 | 7 |
| Hawaii | 96 | $1808.36 | $1274.44 | 4 |
| Arkansas | 87 | $1009.00 | $876.40 | 6 |
| Idaho | 77 | $1577.64 | $1349.70 | 4 |
| West Virginia | 69 | $1212.72 | $1015.50 | 5 |
| New Hampshire | 65 | $836.21 | $664.42 | 3 |
| District of Columbia | 34 | $236.14 | $190.19 | 2 |
| Rhode Island | 33 | $2013.52 | $1594.43 | 1 |
| Guam | 32 | $1853.25 | $1541.42 | 1 |
| AE | 29 | $1080.37 | $874.53 | 1 |
| Alaska | 27 | $2172.06 | $1573.45 | 1 |
| Vermont | 20 | $1972.40 | $1593.77 | 1 |
| Wyoming | 12 | $1964.31 | $1587.71 | 1 |
| Delaware | 11 | $1099.31 | $878.43 | 1 |
Related codes
- 67028Injection of drug into eye$122.07
- 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
- 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.