How much does Medicare pay for CPT 67113?

Medicare allowed an average of $1795.43 per service and paid $1428.46 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $7154.58, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 67113?

Complex repair of detached retina and drainage of eye fluid between lens and retina. It was billed 6,106 times to 5,337 Medicare beneficiaries by 279 providers in 2024.

Does 67113 pay differently in an office than a hospital?

Yes. The allowed amount averaged $1215.83 in an office setting and $1799.06 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 67113 most?

Ambulatory Surgical Center, with 3,278 services from 124 clinicians. Next are Ophthalmology, Physician Assistant.

CPT 67113

Complex repair of detached retina and drainage of eye fluid between lens and retina

$1795.43Medicare-allowed amount per service, averaged across 6,106 services

Providers submitted

$7154.58

Asking price, not received

Medicare allowed

$1795.43

The fee schedule figure

Medicare paid

$1428.46

Balance is patient coinsurance

Providers submitted an average of $7154.58 for this code and Medicare allowed $1795.43 — 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 $1428.46 (80%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $1215.83
Hospital / facility: $1799.06

The facility rate is higher for this code, which is unusual and generally means the service depends on equipment or staffing a hospital carries. 38 services were billed in an office setting and 6,068 in a facility.

Services: 6,106
Beneficiaries: 5,337
Providers billing it: 279
Total allowed: $10,962,896

What Medicare pays for CPT 67113

Across 6,106 services billed by 279 providers to 5,337 beneficiaries, Medicare allowed an average of $1795.43 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 67113

Specialty	Services	Beneficiaries	Avg allowed	Providers
Ambulatory Surgical Center	3,278	2,845	$2464.85	124
Ophthalmology	2,776	2,442	$1035.22	151
Physician Assistant	52	50	$179.81	4

67113 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	779	$1849.26	$1543.38	35
Texas	721	$2011.49	$1659.78	28
California	683	$1758.10	$1217.33	32
Arizona	544	$1906.36	$1572.38	17
Ohio	275	$1766.24	$1473.24	12
Tennessee	249	$1687.19	$1527.63	9
Pennsylvania	225	$1193.08	$924.12	14
Missouri	201	$1673.21	$1362.54	11
Washington	183	$1896.41	$1413.88	8
Mississippi	166	$1649.15	$1483.43	8
Illinois	165	$1072.88	$846.84	9
New York	160	$1919.69	$1536.93	9
Maryland	140	$1782.27	$1407.68	6
Oklahoma	125	$1357.52	$1122.63	6
South Carolina	114	$1902.76	$1660.20	6
Indiana	109	$2459.45	$2024.25	3
Massachusetts	95	$1088.66	$790.33	6
South Dakota	92	$1896.82	$1626.01	3
Georgia	84	$2199.32	$1849.12	4
Virginia	81	$2079.24	$1829.44	4
New Jersey	77	$1363.57	$1019.15	4
New Mexico	73	$1491.30	$1237.82	5
Iowa	71	$1236.07	$1064.30	4
Utah	70	$1867.59	$1535.19	4
Minnesota	69	$2626.24	$2026.89	1
North Carolina	65	$2154.14	$1840.01	4
Kentucky	64	$2138.31	$1837.73	3
Nebraska	53	$1700.74	$1432.28	3
Kansas	52	$2434.40	$2026.87	2
Maine	49	$1796.19	$1754.93	2
Louisiana	44	$1620.55	$1358.85	3
North Dakota	35	$1343.96	$1023.91	2
Colorado	30	$2483.98	$2023.09	1
Alabama	20	$1164.38	$973.97	1
Hawaii	18	$2856.45	$1967.87	1
Wisconsin	17	$1079.49	$898.63	1
Idaho	15	$1255.85	$1003.65	1
Connecticut	14	$2680.36	$2023.10	1
Montana	14	$2428.15	$2022.87	1
Nevada	14	$2437.82	$1990.69	1
Michigan	14	$1304.35	$958.03	1
Arkansas	13	$1122.26	$975.17	1
Guam	12	$2494.78	$2011.20	1
West Virginia	12	$1246.70	$1000.75	1

Related codes

67145Photocoagulation treatment to prevent detachment of retina$235.48
67108Repair of detached retina$1401.34

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.