Cost analysis for CPT 67042 — Removal of membrane of retina with removal of internal limiting membrane of retina
Average Medicare Payment
$1000.65
2023 data
Total Payments (2023)
$33.6M
Services (2023)
30.6K
Price Change (2014–2023)
-12.2%
| Year | Avg Payment | Total Payments | Services | YoY Change |
|---|---|---|---|---|
| 2014 | $1139.39 | $38.8M | 33.5K | — |
| 2015 | $931.86 | $32.7M | 33.3K | -18.2% |
| 2016 | $942.84 | $36.6M | 36.1K | +1.2% |
| 2017 | $947.11 | $37.3M | 37.0K | +0.5% |
| 2018 | $954.54 | $37.3M | 36.7K | +0.8% |
| 2019 | $954.80 | $38.4M | 37.8K | +0.0% |
| 2020 | $996.01 | $32.6M | 30.5K | +4.3% |
| 2021 | $987.27 | $35.2M | 32.8K | -0.9% |
| 2022 | $991.87 | $33.3M | 30.7K | +0.5% |
| 2023 | $1000.65 | $33.6M | 30.6K | +0.9% |
The most expensive state pays 1.5x more than the cheapest for this procedure. IN averages $1323.75 vs WI at $862.50.
| State | Avg Payment | Total Payments | Services | Providers |
|---|---|---|---|---|
| IN | $1323.75 | $751.9K | 568 | 16 |
| MN | $1290.91 | $672.6K | 521 | 14 |
| NJ | $1254.20 | $481.6K | 384 | 16 |
| GA | $1213.84 | $591.1K | 487 | 19 |
| CA | $1195.61 | $2.5M | 2.1K | 87 |
| HI | $1184.31 | $152.8K | 129 | 4 |
| WA | $1182.71 | $1.5M | 1.3K | 38 |
| FL | $1174.69 | $2.9M | 2.5K | 79 |
| MA | $1172.31 | $643.6K | 549 | 25 |
| AZ | $1160.18 | $1.8M | 1.6K | 39 |
| CO | $1153.77 | $946.1K | 820 | 32 |
| KY | $1150.45 | $280.7K | 244 | 12 |
| TX | $1146.99 | $3.5M | 3.1K | 85 |
| SC | $1146.58 | $808.3K | 705 | 25 |
| SD | $1140.08 | $270.2K | 237 | 7 |
| KS | $1131.86 | $637.2K | 563 | 20 |
| CT | $1130.90 | $180.9K | 160 | 8 |
| NE | $1118.07 | $355.5K | 318 | 12 |
| VA | $1115.43 | $812.0K | 728 | 24 |
| OR | $1106.57 | $329.8K | 298 | 12 |
| PA | $1098.74 | $1.6M | 1.5K | 51 |
| LA | $1088.13 | $504.9K | 464 | 19 |
| UT | $1084.84 | $394.9K | 364 | 15 |
| MO | $1082.09 | $858.1K | 793 | 32 |
| NV | $1066.89 | $145.1K | 136 | 7 |
| MD | $1042.22 | $686.8K | 659 | 27 |
| NY | $1037.15 | $793.4K | 765 | 35 |
| ND | $1018.60 | $111.0K | 109 | 3 |
| MI | $1016.55 | $521.5K | 513 | 28 |
| TN | $1002.40 | $1.3M | 1.3K | 39 |
| NC | $1001.23 | $736.9K | 736 | 31 |
| MS | $984.69 | $307.2K | 312 | 11 |
| NM | $972.86 | $250.0K | 257 | 8 |
| OK | $972.52 | $408.5K | 420 | 11 |
| ME | $959.00 | $101.7K | 106 | 6 |
| AL | $952.84 | $565.0K | 593 | 23 |
| OH | $952.29 | $1.5M | 1.6K | 51 |
| IA | $900.09 | $604.0K | 671 | 21 |
| IL | $886.11 | $1.0M | 1.2K | 47 |
| WI | $862.50 | $395.0K | 458 | 19 |
| Provider | Specialty | State | Payments | Services | Avg/Service |
|---|---|---|---|---|---|
| Scottsdale Eye Surgery Center, P.C | Ambulatory Surgical Center | AZ | $508.1K | 340 | $1494.42 |
| Surgicare Of Minneapolis Ltd | Ambulatory Surgical Center | MN | $396.3K | 250 | $1585.27 |
| Main Line Surgery Center, Llc | Ambulatory Surgical Center | PA | $379.4K | 248 | $1529.87 |
| Ophthalmology Surgery Center Of Dallas, Llc | Ambulatory Surgical Center | TX | $352.3K | 234 | $1505.50 |
| Amarillo Cataract And Eye Surgery | Ambulatory Surgical Center | TX | $340.9K | 245 | $1391.45 |
| Beltway Surgery Centers, Llc | Ambulatory Surgical Center | IN | $334.1K | 220 | $1518.73 |
| The Retina Surgery Center Llc | Ambulatory Surgical Center | WA | $290.8K | 178 | $1633.70 |
| Cleveland Eye And Laser Surgery Center Llc | Ambulatory Surgical Center | OH | $284.9K | 199 | $1431.71 |
| Northern California Advanced Surgery Center Lp | Ambulatory Surgical Center | CA | $277.4K | 136 | $2039.99 |
| Spokane Eye Clinic Inc, Ps | Ambulatory Surgical Center | WA | $235.6K | 148 | $1591.78 |
| Westside Surgery Center Llc | Ambulatory Surgical Center | FL | $226.7K | 164 | $1382.38 |
| Centennial Surgery Center Lp | Ambulatory Surgical Center | TN | $211.5K | 149 | $1419.15 |
| Georgia Retina Surgery Center, Llc | Ambulatory Surgical Center | GA | $205.6K | 137 | $1501.09 |
| Wolfe Surgery Center, Llc | Ambulatory Surgical Center | IA | $197.5K | 138 | $1431.01 |
| Surgery Affiliates, Llc | Ambulatory Surgical Center | CO | $196.3K | 131 | $1498.38 |
| Gramercy Surgery Center, Ltd | Ambulatory Surgical Center | TX | $187.2K | 124 | $1509.99 |
| Knoxville Eye Surgery Center Llc | Ambulatory Surgical Center | TN | $185.3K | 143 | $1295.85 |
| Cei Physicians Psc Llc | Ambulatory Surgical Center | OH | $181.9K | 124 | $1466.67 |
| Santa Rosa Surgery Center L P | Ambulatory Surgical Center | CA | $174.7K | 82 | $2130.01 |
| Hamilton Eye Institute Surgery Center, L.P. | Ambulatory Surgical Center | TN | $166.8K | 120 | $1389.66 |
Based on the data, CPT 67042 shows a 1.5x variation in pricing across states — moderate variation by Medicare standards.
Costs have decreased 12.2% since 2014. Medicare's fee schedule attempts to standardize pricing, though some variation is expected due to geographic cost-of-living adjustments and practice expense differences.
This analysis is based on publicly available CMS data and does not account for patient complexity, comorbidities, or facility-specific factors that may justify pricing differences.
Note: All data is from publicly available Medicare records. OpenMedicare is an independent journalism project not affiliated with CMS.