CPT 67040 Fee Schedule
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.
| 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 |
National average reimbursement for CPT 67040 by major payers:
$1,505.50
$1,489.52
$1,543.94
$1,822.88
| Payer | Code | Rate | NPI | Tax ID | State | Specialty |
|---|---|---|---|---|---|---|
Select a payer to view fee schedule data Choose a payer from the options above to see rates for CPT 67040 | ||||||
United | 67040 | $530.00 | 1023551413 - MID-BRONX ENDOSCOPY CENTER LLC | 471156630 - (NY) MIDBRONX ENDOSCOPY CENTER LLC | NY | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 67040 | $3365.00 | 1336437482 - HEALTHONE RIDGE VIEW ENDOSCOPY CENTER, LLC, RIDGE VIEW ENDOSCOPY CENTER | 800688043 | CO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 67040 | $1856.59 | 1154519650 - RYAN TUCKER | 350593390 - DEACONESS HOSPITAL INC | IN | Emergency Medicine Physician (207P00000X) |
United | 67040 | $2965.00 | 1316536352 - UROLOGICAL INSTITUTE OF MARYLAND | 352636464 - (MD) UROLOGICAL INSTITUTE OF MARYLAND | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 67040 | $2100.00 | 1811447246 - VIRGIL ENDOSCOPY CENTER LLC | 813981623 - (CA) VIRGIL ENDOSCOPY CENTER LLC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 67040 | $2100.00 | 1578994265 - M/S SURGERY CENTER LLC, M/S SURGERY CENTER LLC WHIT | 205219388 - (CA) MS SURGERY CENTER LLC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 67040 | $2375.00 | 1255607628 - MINIMALLY INVASIVE NEUROSPINE AND PAIN INSTITUTE, PC, ALLSPINE SURGERY CENTER | 274395849 - (GA) MINIMALLY INVASIVE NEUROSPINE AND PAIN INSTITUTE PC | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 67040 | $6506.00 | 1205361052 - MINIMALLY INVASIVE SURGERY CENTER OF N.E., LLC | 815005653 | NH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 67040 | $743.00 | 1336272657 - ARIZONA DIGESTIVE CENTER, P.C. | 201544723 - (AZ) ARIZONA DIGESTIVE CENTER PC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 67040 | $2900.00 | 1154839678 - R&R SURGICAL INSTITUTE | 820815470 - (CA) RR SURGICAL INSTITUTE | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 67040 | $2100.00 | 1356080642 - LEGENT OUTPATIENT SURGERY SINGING HILLS, LLC, LEGENT OUTPATIENT SURGERY SINGING HILLS | 861677359 - (TX) LEGENT OUTPATIENT SURGERY SINGING HILLS LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 67040 | $2225.00 | 1174588206 - CHARLESTON SURGERY CENTER LIMITED PARTNERSHIP | 581709761 - (SC) CHARLESTON SURGERY CENTER LIMITED PARTNERSHIP | SC | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 67040 | $4781.00 | 1942264619 - METROPOLITAN MEDICAL PARTNERS LLC, SURGERY CENTER OF CHEVY CHASE | 522303928 - (MD) METROPOLITAN MEDICAL PARTNERS LL | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 67040 | $702.00 | 1841290103 - CENTRAL FLORIDA EYE INSTITUTE PL | 421621290 - (FL) CENTRAL FLORIDA EYE INSTITUTE PL | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 67040 | $2100.00 | 1316190077 - CERRITOS SURGERY CENTER, LLC, CERRITOS SURGERY CENTER, LLC | 651211028 - (CA) CERRITOS SURGERY CENTER LLC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
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CPT 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 | High | Vitrect. W Focal Endolaser Photocoag. |
| 67040 | High | Vitrec,Mech;Endolasr Panretin.Photo |
| 67042 | High | 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 | High | 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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