{
    "code": "67042",
    "coding_system": "CPT",
    "canonical_url": "https://localishealth.com/cpt/67042/2021/A",
    "release_specific_url": "https://localishealth.com/cpt/67042/2021/D",
    "description": "Vitrectomy combined with peeling away the internal limiting membrane, the glass-clear innermost layer covering the surface of the retina. Once the vitreous gel is out, the surgeon stains that microscopically thin layer with dye and lifts it off the macula with fine forceps, releasing the pull that is distorting central vision, then often leaves a gas bubble in the eye to hold things in place while healing occurs. What separates this from its close sibling is which layer comes off: the retina's own surface membrane here, rather than a scar membrane growing on top of the retina.",
    "answer": {
        "question": "How much did Medicare pay for CPT 67042 in Q4 2021?",
        "text": "Medicare paid $1,151.82 for CPT 67042 in the office (non-facility) setting and $1,151.82 in a facility under the Q4 2021 Physician Fee Schedule, effective October 2021. These are the national allowed amounts before the ~2% sequestration cut and before locality (GPCI) adjustment. This price has been unchanged since Q1 2021, when it decreased 1.9%."
    },
    "release": {
        "schedule": "pfs",
        "year": 2021,
        "quarter": "D",
        "label": "Q4 2021",
        "effective": "October 1 – December 31, 2021",
        "revision": 1
    },
    "status": {
        "code": "A",
        "non_facility_payable": true,
        "facility_payable": true
    },
    "national_rates_usd": {
        "office_non_facility": 1151.82,
        "facility": 1151.82,
        "sequestration_applied": false,
        "gpci": 1
    },
    "rvus": {
        "work": 16.33,
        "practice_expense_non_facility": 15.44,
        "practice_expense_facility": 15.44,
        "malpractice": 1.24
    },
    "formula": "(work_rvu × work_gpci + pe_rvu × pe_gpci + mp_rvu × mp_gpci) × conversion_factor",
    "conversion_factor": 34.8931,
    "source": {
        "label": "Physician relative value file (Q4 2021)",
        "cms_url": "https://www.cms.gov/files/zip/rvu21d.zip",
        "local_source_url": "https://localishealth.com/sources/physician-fee-schedule/2021/D",
        "file": "PPRRVU21_OCT.csv",
        "row": 11864,
        "sha256": "f1972bd23bdc51795ceba7d536bb413a0ba0b47fad8c2ed594e7ee7799877297"
    },
    "modified_at": "2026-08-04T03:10:59+00:00"
}