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CPT code 67042: Retinal surgery, internal limiting membrane peel2026 Medicare rate & RVUs

Reports pars plana vitrectomy with retinal internal limiting membrane removal, most often to repair a macular hole, with tamponade or focal laser when performed.

CMS RVU26DEffective Oct 1, 2026109 payment localities38.9K Medicare services in 2024

Medicare pays $954.60 for 67042 nationally in a facility.

Medicare rate · 67042

Retinal surgery, internal limiting membrane peel

Office or facility?

Work RVUs
15.92
Total RVUs
28.58
Global days
090

National rate · 2026

$954.60

Facility setting, before claim adjustments.

See every locality for 67042 →Billed by an NP, PA or therapist? →

Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.

Your location

Medicare pays by the payment locality where the service is performed.

On this page 10 sections
  1. Medicare rate
  2. What 67042 covers
  3. By payment locality
  4. Rate map
  5. How it’s calculated
  6. Payment rules
  7. Similar codes
  8. Related codes
  9. Billing questions
  10. Sources

What 67042 covers

A retinal surgeon removes vitreous gel through a pars plana approach to reach the retina, then peels the internal limiting membrane when treating a macular hole. The procedure is commonly performed in an operating room or ambulatory surgery setting. Air or gas tamponade and focal endolaser may be part of the service when performed. The code is also used for selected retinal conditions requiring this membrane peel, such as diabetic macular edema.

Report this code when the operative documentation supports vitrectomy and removal of the internal limiting membrane; distinguish it from membrane peeling without ILM removal or vitrectomy without a peel. Document the indication, operative approach, and structures treated. A 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care. For multiple procedures in one session, the highest-valued procedure is paid in full and others at 50%. Bilateral reporting with modifier 50 is paid at 150%. Assistant-at-surgery payment may be available; co-surgeon payment requires supporting documentation, and team surgery is not permitted.

This summary was written with AI assistance from CMS physician fee schedule data and checked against the CMS billing rules shown here. Rates on this page come directly from CMS files.

Where 67042 pays more and less

The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.

109 of 109 payment localities

67042 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$888.63
AlaskaUnavailable$1,226.15
ArizonaUnavailable$936.70
ArkansasUnavailable$880.38
Atlanta, GAUnavailable$970.81
Austin, TXUnavailable$972.89
Bakersfield, CAUnavailable$984.64
Baltimore area, MDUnavailable$1,000.93
Beaumont, TXUnavailable$917.35
Brazoria, TXUnavailable$946.10

67042 rates by state

Office rate range in each state. Select a state to see its payment localities.

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Local rates. Clear comparisons.

Hover or focus a tile to see its rate range. Select it to open the state’s fee schedule.

View every state and territory as a table
67042 office rate range by state
State / territoryOffice rate rangeLocalities
AKNo published base rate1
ALNo published base rate1
ARNo published base rate1
AZNo published base rate1
CANo published base rate29
CONo published base rate1
CTNo published base rate1
DCNo published base rate1
DENo published base rate1
FLNo published base rate3
GANo published base rate2
GUNo published base rate1
HINo published base rate1
IANo published base rate1
IDNo published base rate1
ILNo published base rate4
INNo published base rate1
KSNo published base rate1
KYNo published base rate1
LANo published base rate2
MANo published base rate2
MDNo published base rate3
MENo published base rate2
MINo published base rate2
MNNo published base rate1
MONo published base rate3
MSNo published base rate1
MTNo published base rate1
NCNo published base rate1
NDNo published base rate1
NENo published base rate1
NHNo published base rate1
NJNo published base rate2
NMNo published base rate1
NVNo published base rate1
NYNo published base rate5
OHNo published base rate1
OKNo published base rate1
ORNo published base rate2
PANo published base rate2
PRNo published base rate1
RINo published base rate1
SCNo published base rate1
SDNo published base rate1
TNNo published base rate1
TXNo published base rate8
UTNo published base rate1
VANo published base rate2
VINo published base rate1
VTNo published base rate1
WANo published base rate2
WINo published base rate1
WVNo published base rate1
WYNo published base rate1

How the 67042 rate is calculated

Each of 67042’s three RVUs is multiplied by a geographic index (GPCI) for the payment locality, added up, and multiplied by the conversion factor. Drag the indexes or enter a ZIP to see what moves the rate.

How the rate is built · 67042

RVUs × geographic indexes × conversion factor

Office or facility?

Work15.92

15.92 RVUs× 1.000 GPCI

Practice expense11.39

11.39 RVUs× 1.000 GPCI

Malpractice1.27

1.27 RVUs× 1.000 GPCI

Adjusted RVUs

28.5800

Conversion factor

$33.4009

Medicare rate

$954.60

Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.

Payment rules and modifiers for 67042

67042 has a 90-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 67042

Retinal surgery, internal limiting membrane peel

RuleCMS valueWhat it means
Global period090Major surgery: the day before, the day of, and 90 days after are included.
Multiple procedures2Standard reduction: highest-valued procedure at 100%, others at 50%.
Bilateral (modifier 50)1Bilateral with modifier 50 pays 150% of the fee schedule amount.
Assistant at surgery (80/81/82/AS)2Paid.
Co-surgeons (62)1Permitted with supporting documentation.
Team surgery (66)0Not permitted.
Professional/technical0Physician service: no professional/technical split.
Split (54/55/56)0.10/0.70/0.20Share of the payment for pre-op, the procedure itself, and post-op care.

Global surgery period · 67042

Retinal surgery, internal limiting membrane peel

90-day global period ends

Dec 30, 2026

Covers Sep 30, 2026 through Dec 30, 2026 (92 days, including the day before surgery).

Visit on Oct 31, 2026

Day 30 of the 90-day post-op period: related follow-up care is included in the surgical payment.

  • 24Unrelated E/M visit by the same physician
  • 79Unrelated procedure (starts its own global period)
  • 58Staged, more extensive, or therapy procedure that was planned
  • 78Unplanned return to the operating room for a related complication
SurgeryVisit
Sep 23, 2026Jan 10, 2027

Pre-op dayGlobal period

What modifiers do to the payment

Modifier 50 · payment effect

With and without the modifier

67042 without 50 · national facility

$954.60

Retinal surgery, internal limiting membrane peel

67042-50 · Bilateral: 150%

$1,431.90

Both sides on one line with modifier 50 are paid at 150% of the fee schedule amount (subject to multiple-procedure rules with other procedures).

When to use modifier 50

67042 compared with similar codes

Compare codes · National

4 codes, side by side

Office or facility?

  • 67042

    Retinal surgery, internal limiting membrane peel15.92 wRVU

    Not priced

  • 67041

    Vitrectomy, preretinal membrane removal15.92 wRVU

    Not priced

  • 67043

    Vitrectomy, preretinal and internal limiting membranes16.97 wRVU

    Not priced

  • 67036

    Vitrectomy, pars plana approach11.83 wRVU

    Not priced

How to choose

67041VitrectomyPreretinal membrane removal
Choose 67041 for vitrectomy with preretinal cellular membrane removal, such as a macular pucker, when the documented work does not include ILM removal.
67043VitrectomyPreretinal and internal limiting membranes
Choose 67043 when the surgeon removes both a preretinal cellular membrane and the internal limiting membrane; 67042 represents the ILM peel without that combined membrane removal.
67036VitrectomyPars plana approach
Choose 67036 for pars plana vitrectomy without the ILM removal represented by 67042.

Codes related to 67042

Related codes aren’t interchangeable: bill the code that matches the service performed.

Codes related to 67042
CodeHow it relatesNational office range
Used instead
67036Vitrectomy, pars plana approachFor pars plana vitrectomy when the ILM-peel work represented by 67042 is not performed.No office rate
Same family
67041Vitrectomy, preretinal membrane removalRelated vitrectomy code for removal of a preretinal cellular membrane, such as a macular pucker.No office rate
67043Vitrectomy, preretinal and internal limiting membranesRelated vitrectomy code when both preretinal cellular membrane and internal limiting membrane are removed.No office rate
67039Vitrectomy, focal endolaserVitrectomy variant that includes focal endolaser rather than the ILM peel defining 67042.No office rate

67042 billing questions

How does this differ from 67041?

67042 represents an internal limiting membrane peel, typically for macular-hole repair. 67041 is for peeling a preretinal cellular membrane, such as a macular pucker, without the ILM removal represented by 67042.

Can air or gas tamponade and focal endolaser be reported separately?

When performed as part of this vitrectomy, air or gas tamponade and focal endolaser are included in the service.

How is bilateral surgery reported?

Use modifier 50 for a bilateral procedure; CMS pays the bilateral service at 150%.

What happens when another procedure is performed in the same session?

Under the standard multiple-procedure reduction, the highest-valued procedure is paid in full and the other procedure or procedures are paid at 50%.

What documentation supports reporting 67042 rather than 67036?

The operative note should document the vitrectomy and removal of the internal limiting membrane. 67036 represents vitrectomy without the ILM-peel work described by 67042.

Where these rates come from

FeeBase calculates base physician payments from CMS work, practice-expense and malpractice RVUs, adjusted by each locality’s geographic indexes and the conversion factor. Services without a published rate are labeled, never given a made-up amount. Amounts are Medicare allowed amounts before claim adjustments: not a patient’s bill or a commercial rate.

CMS RVU26D · effective Oct 1, 2026 through the day before Jan 1, 2027

Show the CMS file lines behind this rate
RVUs for 67042PPRRVU2026_Oct_nonQPP.csv, line 7,428 (RVU26D)

Open CMS sourceHow we calculate rates

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