CPT 67042 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 • LT - Left side of body • RT - Right side of body |
| Complexity Level | High |
National average reimbursement for CPT 67042 by major payers:
$1,623.26
$1,608.03
$1,687.92
$1,992.59
| 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 67042 | ||||||
United | 67042 | $10317.00 | 1548400070 - COMMUNITY ENDOSCOPY CENTER LLC | 611464136 - (IN) COMMUNITY ENDOSCOPY CENTER LLC | IN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 67042 | $2052.00 | 1164764577 - MARCELLE STUCKY | 350593390 - DEACONESS HOSPITAL INC | IN | Cardiovascular Disease Physician (207RC0000X) |
United | 67042 | $3500.00 | 1114552338 - GEORGIA INTERVENTIONAL PAIN | 842028147 - (GA) GEORGIA INTERVENTIONAL PAIN | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 67042 | $5020.00 | 1831420694 - TITUSVILLE CENTER FOR SURGICAL EXCELLENCE LLC | 263531997 - (FL) TITUSVILLE CENTER FOR SURGICAL | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 67042 | $2163.00 | 1154034429 - CROSSINGS SURGERY CENTER, LLC | 472361569 - (RI) ORTHOPEDICS RHODE ISLAND, INC. | RI | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 67042 | $5433.00 | 1841231792 - NORTH HAVEN SURGERY CENTER LLC, NORTH HAVEN PAIN MEDICINE CENTER, LLC | 770656233 - (CT) NORTH HAVEN SURGERY CENTER LLC | CT | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 67042 | $5149.00 | 1487246229 - PRESBYTERIAN RUST MEDICAL CENTER ASC LLC, NEW MEXICO SURGERY CENTER-MULTI SPECIALTY | 861495452 | NM | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 67042 | $4200.00 | 1679913552 - SPINE SPORTS SURGERY CENTER, LLC, SPINE AND SPORTS SURGERY CENTER | 461141188 | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 67042 | $774.00 | 1619967726 - JOHN P LYDON DPM, BETHESDA AMBULATORY SURGICAL CENTER | 521248448 - (MD) JOHN P LYDON, DPM | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 67042 | $1550.00 | 1720278047 - ARIZONA INSTITUTE OF EYE SURGERY LLC, PRESCOTT VISION & EYE SURGERY CENTER | 142002653 - (AZ) ARIZONA INSTITUTE OF EYE SURGERY, LLC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 67042 | $2700.00 | 1932613643 - GRAND VIEW SURGERY CENTER AT HARLEYSVILLE, LLC | 822907231 - (PA) GRAND VIEW SURGERY CENTER AT HAR | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 67042 | $1810.00 | 1740264811 - EYES OF YORK SURGICAL CENTER LLC | 200930310 - (PA) EYES OF YORK SURGICAL CENTER LLC | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 67042 | $3788.00 | 1508818634 - MONTEREY BAY ENDOSCOPY CENTER LLC | 770324855 - (CA) MONTEREY BAY ENDOSCOPY CENTER LLC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 67042 | $3450.00 | 1164584066 - NAPERVILLE SURGICAL CENTRE LLC | 200433367 - (IL) NAPERVILLE SURGICAL CENTRE, LLC | IL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 67042 | $3429.00 | 1881375319 - MIDWEST SURGERY CENTER, LLC, MIDWEST SURGERY CENTER - EAGAN | 411537436 - (MN) MIDWEST SURGERY CENTER | MN | 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 67042 vs. Other Surgical Procedures on the Eye and Ocular Adnexa Codes
The CPT 67042 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 67042 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 | Vitrect. W Focal Endolaser Photocoag. |
| 67040-CPT | High | Vitrec,Mech;Endolasr Panretin.Photo |
| 67041-CPT | High | Vit For Macular Pucker |
| 67042-CPT | 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) |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 67042. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 67042 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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