Billing code 67113: Retinal repairMedicare rate & RVUs in Washington
Reports vitrectomy-based repair of a complex retinal detachment, such as one involving proliferative vitreoretinopathy or diabetic traction.
CMS doesn’t publish an office rate for 67113 in Washington.
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
On this page 9 sections
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 in Washington
| Payment locality | Office | Facility |
|---|---|---|
| Rest Of Washington | Unavailable | $1,130.00 |
| Seattle (King Cnty) | Unavailable | $1,232.59 |
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.
How the rate is built · 67113
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 18.53Practice expense 13.24Malpractice 1.47
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 67113
67113 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 67113
Retinal repair
| 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 · 67113
Retinal repair
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
67113 without 50 · national facility
$1,110.25
Retinal repair
67113-50 · Bilateral: 150%
$1,665.38
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).
67113 compared with similar codes
Compare codes
67113 vs 67108 vs 67107 vs 67101 vs 67105: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 67108Retinal detachment 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 repair
- 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 repair
- 67101 is a cryotherapy-based repair for a less complex detachment situation; 67113 is for complex repair requiring vitrectomy and membrane peeling.
- 67105Retinal detachment repair
- 67105 is a photocoagulation-based repair for a less complex detachment situation; 67113 reports complex vitrectomy-based repair.
67113 billing questions
When should 67113 be chosen over 67108?
Use 67113 when the detachment is complex and the operative work supports vitrectomy with membrane peeling. Use 67108 for a detachment repair with vitrectomy when the case does not meet the complex-repair criteria.
What operative details support 67113?
Document the pathology establishing complexity, such as proliferative vitreoretinopathy or diabetic traction, and the vitrectomy and membrane work performed. Include other repair steps, such as drainage, laser, buckle, or tamponade, when performed.
Are gas or oil tamponade and laser separately reported as part of the repair?
These may be steps in the retinal repair represented by 67113. The operative report should describe the steps performed as part of the complex repair.
How does the 90-day global period affect postoperative billing?
The day-before preoperative visit and 90 days of related postoperative care are included in the global period for 67113.
How are bilateral repairs and multiple same-session procedures handled?
Bilateral reporting with modifier 50 is paid at 150%. When multiple procedures are performed in the same session, the highest-valued procedure is paid in full and the others are paid at 50%.
Can an assistant or co-surgeon be reported for 67113?
Assistant-at-surgery payment may be made. Co-surgeons are paid only with supporting documentation; team surgery is not permitted.
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
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