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

In Virginia, Medicare pays $935.66 for 67042 in a facility. There’s no office rate.

Check a contract rate as a % of Medicare · 67042 nationwide

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

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.

How Virginia compares for 67042

Across 109 of 109 payment localities, the facility rate for 67042 runs from $880.38 in Arkansas to $1,226.15 in Alaska. Virginia pays $935.66. The RVUs are the same everywhere; the geographic indexes change the dollars.

Every other payment area

67042 rates by state

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

See 67042 in every payment locality

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.

Payment rules and modifiers for 67042

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

What modifiers do to the payment

When to use modifier 50

Codes related to 67042

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

How 67042 has changed in Virginia

Price 67042 for an earlier date of service

Where the Virginia rate applies

Virginia is a Medicare payment area, not a city. Our Census mapping connects it to 628 cities and communities in Virginia. Some span more than one payment area; confirm with the service ZIP.

• Abbs Valley
• Abingdon
• Accomac
• Adwolf
• Afton
• Alberta
• Aldie
• Allison Gap

Browse all communities in Virginia

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

Open CMS sourceHow we calculate rates