CPT 67043 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 67043 by major payers:
$1,684.79
$1,698.68
$1,767.23
$2,102.03
| 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 67043 | ||||||
United | 67043 | $1590.00 | 1043612534 - HHC ASC, LLC | 824195385 | MO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 67043 | $2600.00 | 1720129893 - PACIFIC GASTROENTEROLOGY ENDOSCOPY CENTER | 330898866 | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 67043 | $701.00 | 1700876703 - RIVERSIDE SURGERY CENTER INC | 593599967 - (FL) RIVERSIDE SURGERY CENTER INC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 67043 | $4800.00 | 1316462377 - UCSD SURGICAL CENTER OF SAN DIEGO, LLC | 822218664 | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 67043 | $4143.00 | 1265487474 - HORSESHOE SURGERY CENTER, LLC, LAKEWOOD SURGERY CENTER | 202137172 - (MN) LAKEWOOD SURGERY CENTER | MN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 67043 | $1061.00 | 1801196050 - AGCNY EAST LLC, ENDOSCOPY CENTER OF CENTRAL NEW YORK | 270546550 - (NY) AGCNY EAST LLC | NY | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 67043 | $1467.00 | 1457898215 - PROSPECT BLACKSTONE VALLEY SURGICARE, LLC, BLACKSTONE VALLEY SURGICARE | 814871794 - (RI) PROSPECT BLACKSTONE VALLEY SURGICARE LLC | RI | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 67043 | $5020.00 | 1720085277 - ROSWELL SURGERY CENTER LLC, ROSWELL SURGERY CENTER | 582577112 - (GA) ROSWELL SURGERY CENTER LLC | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 67043 | $1316.75 | 1093595696 - NEW LEXINGTON CLINIC PSC, DERMATOLOGY ASSOCIATES OF KENTUCKY PSC | 610701663 - (KY) DERMATOLOGY ASSOCIATES OF KENTUCKY, P.S.C. | KY | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 67043 | $2707.00 | 1124396544 - VALLEY PLASTIC SURGERY LLC, VALLEY PLASTIC SURGERY | 454030103 - (OR) VALLEY PLASTIC SURGERY LLC | OR | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 67043 | $774.00 | 1194999359 - JEFFREY L BOBER DPM PA, JEFFREY L BOBER DPM PA ASC | 521706931 - (MD) JEFFREY L BOBER DPM PA | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 67043 | $8532.00 | 1538245717 - LUBBOCK COUNTY HOSPITAL DISTRICT, UNIVERSITY MEDICAL CENTER | 751301362 - LUBBOCK COUNTY HOSPITAL DISTRICT | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 67043 | $2700.00 | 1972232981 - SOUTHPOINT SURGERY CENTER LLC | 841989776 - (NC) SOUTHPOINT SURGERY CENTER LLC | NC | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 67043 | $4370.00 | 1639195217 - CY FAIR SURGERY CENTER | 760386971 - (TX) CY FAIR SURGERY CENTER | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 67043 | $3252.00 | 1639701980 - ORTHOPAEDIC SURGERY CENTER OF PANTHER CREEK LLC | 843730735 - (NC) ORTHOPAEDIC SURGERY CENTER OF PANTHER CREEK LLC | NC | 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 67043 vs. Other Surgical Procedures on the Eye and Ocular Adnexa Codes
The CPT 67043 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 67043 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 |
| 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 67043. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 67043 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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