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See a sample rate comparisonCPT 67040 Fee Schedule
Last Verified: October 2026
Healthcare providers use this code to document and receive reimbursement for visits that address high-level medical decision-making, often including multiple diagnoses or prescription management.
Remove Fluid From The Eye, Surgery To Remove Some Or All Of The Vitreous Humor The Gelatinous Clear Fluid Between The Pupil And The Back Of The Eye. The Procedure May Include Replacing The Fluid With A Synthetic Vitreous.
| Key Fact | Detail |
|---|---|
| Service Type | Surgery Surgical Procedures on the Eye and Ocular Adnexa |
| Common Place of Service | 24 - Ambulatory Surgical Center 22 - On Campus Outpatient Hospital |
| Common Modifiers | None RT - Right side of body LT - Left side of body |
| Complexity Level | High |
| Medicare Fee Schedule | View Medicare rates for 67040 |
| Medicaid Fee Schedule | View Medicaid rates for 67040 |
National average reimbursement for CPT 67040 by major payers:
$1,505.50
$1,489.52
$1,543.94
$1,780.86
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CPT 67040
5 of 25 sample ratesHigher to lower in this preview
Hospital For Special Surgery West Side Ambulatory Surgery Center, LLC, Hss West Side Asc, LLC
$10,406.00Published rateNorthridge Surgery Center, Lp, Northridge Surgery Center
Northridge Surgery Center Lp
$4,325.00Published rateMesquite Tx Endoscopy Asc LLC, Texas Gi Endoscopy Center
The Mesquite Tx Endoscopy Asc, LLC D.B.A
$2,920.00Published rateM/S Surgery Center LLC, M/S Surgery Center LLC Whit
Ms Surgery Center LLC
$2,100.00Published ratePlastic Surgery Specialists, PC, North Arundel Plastic Surgery Specialists
Plastic Surgery Specialists, P.C.
$1,125.00Published rate
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See a sample payer proposalCPT 67040 vs. Other Surgical Procedures on the Eye and Ocular Adnexa Codes
The CPT 67040 code is part of the Surgery services used for Surgical Procedures on the Eye and Ocular Adnexa. It represents a moderate-complexity encounter and is one of several codes that vary based on time spent, level of medical decision-making, and documentation requirements.
The CPT 67040 code involves more provider time and moderate medical decision-making, unlike lower-level codes that require less time and simpler assessments. It typically includes multiple diagnoses, medication management, or test interpretation, leading to higher reimbursement and more detailed documentation requirements.
| Code | Complexity | Description |
|---|---|---|
| 67039-CPT | High | Remove Fluid From The Eye, Surgery To Remove Some Or All Of The Vitreous Humor The Gelatinous Clear Fluid Between The Pupil And The Back Of The Eye. The Procedure May Include Replacing The Fluid With A Synthetic Vitreous. |
| 67040-CPT | High | Remove Fluid From The Eye, Surgery To Remove Some Or All Of The Vitreous Humor The Gelatinous Clear Fluid Between The Pupil And The Back Of The Eye. The Procedure May Include Replacing The Fluid With A Synthetic Vitreous. |
| 67042-CPT | High | Vit For Macular Hole, Vitrectomy Mechanical Pars Plana Approach With Removal Of Internal Limiting Membrane Of Retina Eg For Repair Of Macular Hole Diabetic Macular Edema Includes If Performed Intraocular Tamponade Ie Air Gas Or Silicone Oil |
| 67043-CPT | High | Vit For Membrane Dissect, Vitrectomy Mechanical Pars Plana Approach With Removal Of Subretinal Membrane Eg Choroidal Neovascularization Includes If Performed Intraocular Tamponade Ie Air Gas Or Silicone Oil And Laser Photocoagulation |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 67040. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 67040 fee schedule helps patients estimate costs and providers optimize billing for accurate reimbursements.
Factors that affect fee schedules
Medicare & Medicaid Rates
Government-set reimbursement amounts
Private Insurance Rates
Negotiated rates between providers and insurance companies
Geographic Location
Costs may be higher in urban areas.
Provider Type
Hospital providers may have different rates than private practice.
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