CPT code 67113: Retinal repair, complex detachment2026 Medicare rate & RVUs

Medicare pays $1,110.25 for 67113 nationally in a facility.

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

What 67113 covers

A vitreoretinal surgeon uses this code for complex retinal detachment repair involving vitrectomy and membrane peeling. Cases may involve proliferative vitreoretinopathy or traction from diabetic retinopathy. Depending on the operative findings, repair may also include draining subretinal fluid, laser or cryotherapy, a scleral buckle, and gas or oil tamponade. These procedures are typically performed in an operating room, most often in a facility setting.

Choose this code when the documented detachment and operative work support a complex repair, rather than a less complex detachment procedure. The operative report should establish the retinal pathology and describe the vitrectomy, membrane work, and other repair steps performed. The day-before preoperative visit and 90 days of related postoperative care are included in the global period. For multiple procedures in one session, the highest-valued procedure is paid in full and other procedures are subject to a 50% reduction. Bilateral reporting with modifier 50 is paid at 150%. Assistant-at-surgery payment may be made; co-surgeons require 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 67113 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

67113 rates by state

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

How the 67113 rate is calculated

Each of 67113’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 67113

67113 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

67113 compared with similar codes

How to choose

67108Retinal detachment repairVitrectomy-based repair

67108 reports retinal detachment repair with vitrectomy when the case is not complex. 67113 is for complex repair involving vitrectomy and membrane peeling.

67107Retinal detachment repairScleral buckle without vitrectomy

67107 describes detachment repair by an approach distinct from the complex vitrectomy-based repair reported with 67113. Select based on the operative method and case complexity.

67101Retinal repairCryotherapy

67101 is a cryotherapy-based repair for a less complex detachment situation; 67113 is for complex repair requiring vitrectomy and membrane peeling.

67105Retinal detachment repairPhotocoagulation method

67105 is a photocoagulation-based repair for a less complex detachment situation; 67113 reports complex vitrectomy-based repair.

Codes related to 67113

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

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