No office rate
Choose 67041 when the preretinal membrane is removed without internal limiting membrane removal. Choose 67043 when both membrane layers are removed.
On this page
CMS RVU26D · Effective 2026-10-01
67043 Vitrectomy Medicare reimbursement rates in Pennsylvania
Reports pars plana vitrectomy to remove a preretinal membrane and the internal limiting membrane, commonly for a macular pucker requiring both membrane procedures. Compare 67043 office and facility rates across CMS payment localities in Pennsylvania.
Amounts below use the non-QP conversion factor for participating physicians. These are base physician payments before claim-level adjustments, not patient costs or total hospital charges.
What does Medicare pay for 67043 in Pennsylvania?
Pennsylvania has 2 payment localities in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the 2 payment areas shown below, using the same CMS release.
Office / nonfacility
No supported rate
Facility setting
$970.00–$1039.66
2 of 2 localities have a supported rate.
These are locality ranges, not averages or address-specific quotes. A facility-setting amount covers the physician service; it does not include a hospital’s separate bill. Choose a locality below to inspect its calculation, compare other payment areas, or price a percentage of Medicare.
Vitreoretinal surgery
About 67043: Vitrectomy with dual membrane removal
Reports pars plana vitrectomy to remove a preretinal membrane and the internal limiting membrane, commonly for a macular pucker requiring both membrane procedures.
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.
CMS billing rules for 67043
- Global period
- Major surgery with a 90-day global period: the day-before preoperative visit and 90 days of related postoperative care are included.
- Multiple procedures
- Standard multiple procedure reduction: the highest-valued procedure is paid in full and others at 50% when performed in the same session.
- Bilateral procedures
- Bilateral procedure with modifier 50 is paid at 150%.
- Assistant at surgery
- Assistant at surgery may be paid.
- Co-surgeons
- Co-surgeons paid only with supporting documentation.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU16.97 · 56%
- Practice expense (office) RVU11.77 · 39%
- Malpractice RVU1.34 · 4%
352
Medicare services in 2024 · #3855 by national volume
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.
67043 compared with similar codes
Office rates for Pennsylvania, from the same CMS release.
No office rate
67042 describes internal limiting membrane removal without the combined preretinal membrane work; 67043 represents removal of both.
No office rate
67036 is mechanical pars plana vitrectomy without the membrane-removal work that distinguishes 67043.
Compare 67043 by payment locality
Find the payment area for your service address, then open its rate page for calculation inputs, release history and the percentage-of-Medicare tool. A city may cross payment-area boundaries; the ZIP lookup above helps resolve the location.
2 of 2 payment localities
Metropolitan Philadelphia →
Office / nonfacility
Unavailable
Facility
$1039.66
Rest Of Pennsylvania →
Office / nonfacility
Unavailable
Facility
$970.00
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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 indices and the applicable conversion factor. Unavailable or separately priced services are labeled rather than assigned a made-up amount.
Source: RVU26D. Effective 2026-10-01 through the day before 2027-01-01.
7,42667040,,Laser treatment of retina,A,,14.14,10.77,NA,10.77,,1.13,26.04,26.04,0,090,0.10,0.70,0.20,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,42767041,,Vit for macular pucker,A,,15.92,11.40,NA,11.40,,1.27,28.59,28.59,0,090,0.10,0.70,0.20,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,42867042,,Vit for macular hole,A,,15.92,11.39,NA,11.39,,1.27,28.58,28.58,0,090,0.10,0.70,0.20,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,42967043,,Vit for membrane dissect,A,,16.97,11.77,NA,11.77,,1.34,30.08,30.08,0,090,0.10,0.70,0.20,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,43067101,,Repair detached retina crtx,A,,3.41,6.37,,3.69,,0.26,10.04,7.36,0,010,0.10,0.80,0.10,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,43167105,,Repair detached retina pc,A,,3.31,5.38,,3.54,,0.25,8.94,7.10,0,010,0.10,0.80,0.10,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,43267107,,Repair detached retina,A,,15.60,11.28,NA,11.28,,1.25,28.13,28.13,0,090,0.10,0.70,0.20,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00