CPT code 67043: Vitrectomy, preretinal and internal limiting membranes2026 Medicare rate & RVUs in Missouri
Reports pars plana vitrectomy to remove a preretinal membrane and the internal limiting membrane, commonly for a macular pucker requiring both membrane procedures.
CMS doesn’t publish an office rate for 67043 in Missouri.
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
On this page 9 sections
What 67043 covers
A vitreoretinal surgeon performs this pars plana vitrectomy to remove a preretinal cellular membrane and the retina’s internal limiting membrane. A common setting is surgery for a macular pucker when the surgeon also peels the internal limiting membrane. The work takes place in an operating room, usually in a facility setting, and may include other operative steps needed to complete the retinal procedure.
Report this code when the operative documentation supports removal of both membrane layers; removal of only the preretinal membrane or only the internal limiting membrane points to a different code. The 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 other procedures 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 67043 pays more and less in Missouri
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
| Payment locality | Office | Facility |
|---|---|---|
| Metropolitan Kansas City, MO | Unavailable | $979.69 |
| Metropolitan St. Louis, MO | Unavailable | $985.92 |
| Rest of Missouri | Unavailable | $949.28 |
How the 67043 rate is calculated
Each of 67043’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 · 67043
RVUs × geographic indexes × conversion factor
Work16.97
16.97 RVUs× 1.000 GPCI
Practice expense11.77
11.77 RVUs× 1.000 GPCI
Malpractice1.34
1.34 RVUs× 1.000 GPCI
Adjusted RVUs
30.0800
Conversion factor
$33.4009
Medicare rate
$1,004.70
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 67043
67043 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 67043
Vitrectomy, preretinal and internal limiting membranes
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 090 | Major surgery: the day before, the day of, and 90 days after are included. |
| Multiple procedures | 2 | Standard reduction: highest-valued procedure at 100%, others at 50%. |
| Bilateral (modifier 50) | 1 | Bilateral with modifier 50 pays 150% of the fee schedule amount. |
| Assistant at surgery (80/81/82/AS) | 2 | Paid. |
| Co-surgeons (62) | 1 | Permitted with supporting documentation. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 0 | Physician service: no professional/technical split. |
| Split (54/55/56) | 0.10/0.70/0.20 | Share of the payment for pre-op, the procedure itself, and post-op care. |
Global surgery period · 67043
Vitrectomy, preretinal and internal limiting membranes
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.
Pre-op dayGlobal period
What modifiers do to the payment
Modifier 50 · payment effect
With and without the modifier
67043 without 50 · national facility
$1,004.70
Vitrectomy, preretinal and internal limiting membranes
67043-50 · Bilateral: 150%
$1,507.05
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).
67043 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 67041VitrectomyPreretinal membrane removal
- Choose 67041 when the preretinal membrane is removed without internal limiting membrane removal. Choose 67043 when both membrane layers are removed.
- 67042Retinal surgeryInternal limiting membrane peel
- 67042 describes internal limiting membrane removal without the combined preretinal membrane work; 67043 represents removal of both.
- 67036VitrectomyPars plana approach
- 67036 is mechanical pars plana vitrectomy without the membrane-removal work that distinguishes 67043.
67043 billing questions
When should 67043 be selected instead of 67041?
Use 67043 when the surgeon removes both the preretinal membrane and the internal limiting membrane. Removal of the preretinal membrane without the internal limiting membrane is represented by 67041.
How does 67043 differ from 67042?
67043 covers removal of both membrane layers. 67042 is for internal limiting membrane removal without the paired preretinal membrane removal described by 67043.
Is internal limiting membrane peeling included?
Yes, when performed as part of the membrane-removal service. The operative report should identify the membranes removed.
How is bilateral surgery reported?
For bilateral procedures, modifier 50 is associated with payment at 150% under the CMS rule for this code.
What postoperative care is included?
The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care.
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
Fee sheets · Coming soon
Put 67043 and the rest of your codes on one sheet
Your codes at your locality, with payer contracts beside Medicare.
Join the waitlist