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 | $1633.00 | 1871557652 - PORT ST LUCIE SURGERY CENTER LTD | 621600419 - (FL) PORT ST LUCIE SURGERY CENTER LTD | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 67042 | $1857.00 | 1770645905 - SILVER SPRING MD ENDOSCOPY ASC LLC, ENDOSCOPIC SURGICAL CENTRE OF MARYLAND | 205988845 - (MD) SILVER SPRING MD ENDOSCOPY ASC LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 67042 | $3150.00 | 1285630160 - NOVAMED EYE SURGERY CENTER OF NORTH COUNTY, LLC, WOODCREST SURGERY CENTER | 364111316 - (MO) NOVAMED EYE SURGERY CENTER OF NORTH COUNTY LLC | MO | 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 | $1037.00 | 1265465025 - GEORGIA SURGICAL CENTERS INC | 43650858 | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 67042 | $2052.00 | 1164764577 - MARCELLE STUCKY | 350593390 - DEACONESS HOSPITAL INC | IN | Cardiovascular Disease Physician (207RC0000X) |
United | 67042 | $6506.00 | 1104974310 - NORTHWEST SURGERY CENTER, LLP, NORTHWEST SURGERY CENTER | 205537270 - (TX) NORTHWEST SURGERY CENTER LLP | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 67042 | $5433.00 | 1770929044 - SURGCENTER OF PALM BEACH GARDENS, SURGCENTER OF PALM BEACH GARDENS, LLC | 462315994 - (FL) SURGCENTER OF PALM BEACH GARDENS, LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 67042 | $2731.00 | 1427690775 - CARDIAC AND VASCULAR INSTITUTE AMBULATORY SURGERY CENTER, LLC | 851809741 - (FL) CARDIAC AND VASCULAR INSTITUTE AMBULATORY SURGERY CENTER LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 67042 | $2935.00 | 1891184826 - SURGICAL CENTER OF NORTH FLORIDA, LLC, SURGICAL CENTER OF NORTH FLORIDA | 463936705 - (FL) SURGICAL CENTER OF NORTH FLORIDA, LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 67042 | $1500.00 | 1164495198 - SARASOTA OPHTHALMOLOGY ASC LLC, CENTER FOR ADVANCED EYE SURGERY | 621825704 - (FL) SARASOTA OPHTHALMOLOGY ASC LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 67042 | $2000.00 | 1508528910 - CHEROKEE FARM ORTHOPEDIC SURGERY CENTER, LLC | 850654744 - (TN) CHEROKEE FARM ORTHOPEDIC SURGERY CENTER LLC | TN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 67042 | $2809.00 | 1740231489 - STONEGATE SURGERY CENTER LP | 201211544 - (TX) STONEGATE SURGERY CENTER LP | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 67042 | $673.00 | 1528134293 - MARYLAND AESTHETIC AND RECONSTRUCTIVE AMBULATORY SURGICAL CENTER LLC | 522277480 - (MD) MARYLAND AESTHETIC AND RECONSTRUCTIVE AMBULATORY SURGICAL CENTER LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 67042 | $5820.00 | 1649655515 - PARKWAY SURGERY CENTER, LLC, PARKWAY SURGERY CENTER AT HORIZON RIDGE | 880403777 | NV | 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 | High | Vitrect. W Focal Endolaser Photocoag. |
| 67040 | High | Vitrec,Mech;Endolasr Panretin.Photo |
| 67041 | High | Vit For Macular Pucker |
| 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) |
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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