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Data Sources: Centers for Medicare & Medicaid Services (CMS), Medicare Provider Utilization and Payment Data
Disclaimer: This site is an independent journalism project. Data analysis and editorial content are not affiliated with or endorsed by CMS or any government agency. All spending figures are based on publicly available Medicare payment records.
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Methodology•Download Data
  1. Home
  2. Procedures
  3. 67042
  4. Cost Analysis

How Much Does Removal of membrane of retina with removal of internal limiting membrane of retina Cost on Medicare?

Cost analysis for CPT 67042 — Removal of membrane of retina with removal of internal limiting membrane of retina

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Average Medicare Payment

$1000.65

2023 data

Total Payments (2023)

$33.6M

Services (2023)

30.6K

Price Change (2014–2023)

-12.2%

📈 Year-over-Year Cost Trend

YearAvg PaymentTotal PaymentsServicesYoY Change
2014$1139.39$38.8M33.5K—
2015$931.86$32.7M33.3K-18.2%
2016$942.84$36.6M36.1K+1.2%
2017$947.11$37.3M37.0K+0.5%
2018$954.54$37.3M36.7K+0.8%
2019$954.80$38.4M37.8K+0.0%
2020$996.01$32.6M30.5K+4.3%
2021$987.27$35.2M32.8K-0.9%
2022$991.87$33.3M30.7K+0.5%
2023$1000.65$33.6M30.6K+0.9%

🗺️ State-by-State Cost Variation

The most expensive state pays 1.5x more than the cheapest for this procedure. IN averages $1323.75 vs WI at $862.50.

StateAvg PaymentTotal PaymentsServicesProviders
IN$1323.75$751.9K56816
MN$1290.91$672.6K52114
NJ$1254.20$481.6K38416
GA$1213.84$591.1K48719
CA$1195.61$2.5M2.1K87
HI$1184.31$152.8K1294
WA$1182.71$1.5M1.3K38
FL$1174.69$2.9M2.5K79
MA$1172.31$643.6K54925
AZ$1160.18$1.8M1.6K39
CO$1153.77$946.1K82032
KY$1150.45$280.7K24412
TX$1146.99$3.5M3.1K85
SC$1146.58$808.3K70525
SD$1140.08$270.2K2377
KS$1131.86$637.2K56320
CT$1130.90$180.9K1608
NE$1118.07$355.5K31812
VA$1115.43$812.0K72824
OR$1106.57$329.8K29812
PA$1098.74$1.6M1.5K51
LA$1088.13$504.9K46419
UT$1084.84$394.9K36415
MO$1082.09$858.1K79332
NV$1066.89$145.1K1367
MD$1042.22$686.8K65927
NY$1037.15$793.4K76535
ND$1018.60$111.0K1093
MI$1016.55$521.5K51328
TN$1002.40$1.3M1.3K39
NC$1001.23$736.9K73631
MS$984.69$307.2K31211
NM$972.86$250.0K2578
OK$972.52$408.5K42011
ME$959.00$101.7K1066
AL$952.84$565.0K59323
OH$952.29$1.5M1.6K51
IA$900.09$604.0K67121
IL$886.11$1.0M1.2K47
WI$862.50$395.0K45819

💰 Who Bills the Most for This Procedure?

ProviderSpecialtyStatePaymentsServicesAvg/Service
Scottsdale Eye Surgery Center, P.CAmbulatory Surgical CenterAZ$508.1K340$1494.42
Surgicare Of Minneapolis LtdAmbulatory Surgical CenterMN$396.3K250$1585.27
Main Line Surgery Center, LlcAmbulatory Surgical CenterPA$379.4K248$1529.87
Ophthalmology Surgery Center Of Dallas, LlcAmbulatory Surgical CenterTX$352.3K234$1505.50
Amarillo Cataract And Eye SurgeryAmbulatory Surgical CenterTX$340.9K245$1391.45
Beltway Surgery Centers, LlcAmbulatory Surgical CenterIN$334.1K220$1518.73
The Retina Surgery Center LlcAmbulatory Surgical CenterWA$290.8K178$1633.70
Cleveland Eye And Laser Surgery Center LlcAmbulatory Surgical CenterOH$284.9K199$1431.71
Northern California Advanced Surgery Center LpAmbulatory Surgical CenterCA$277.4K136$2039.99
Spokane Eye Clinic Inc, PsAmbulatory Surgical CenterWA$235.6K148$1591.78
Westside Surgery Center LlcAmbulatory Surgical CenterFL$226.7K164$1382.38
Centennial Surgery Center LpAmbulatory Surgical CenterTN$211.5K149$1419.15
Georgia Retina Surgery Center, LlcAmbulatory Surgical CenterGA$205.6K137$1501.09
Wolfe Surgery Center, LlcAmbulatory Surgical CenterIA$197.5K138$1431.01
Surgery Affiliates, LlcAmbulatory Surgical CenterCO$196.3K131$1498.38
Gramercy Surgery Center, LtdAmbulatory Surgical CenterTX$187.2K124$1509.99
Knoxville Eye Surgery Center LlcAmbulatory Surgical CenterTN$185.3K143$1295.85
Cei Physicians Psc LlcAmbulatory Surgical CenterOH$181.9K124$1466.67
Santa Rosa Surgery Center L PAmbulatory Surgical CenterCA$174.7K82$2130.01
Hamilton Eye Institute Surgery Center, L.P.Ambulatory Surgical CenterTN$166.8K120$1389.66

🤔 Is Removal of membrane of retina with removal of internal limiting membrane of retina Overpriced?

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.

Data Sources

  • • Centers for Medicare & Medicaid Services (CMS)
  • • Medicare Provider Utilization and Payment Data (2014-2023)
  • • Medicare Physician Fee Schedule

Note: All data is from publicly available Medicare records. OpenMedicare is an independent journalism project not affiliated with CMS.