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CPT code 67221: Photodynamic therapy, choroidal lesion2026 Medicare rate & RVUs in Arkansas

Reports photodynamic treatment of a selected choroidal lesion, including the photosensitizing drug infusion and laser activation, when Medicare coverage criteria are met.

CMS RVU26DEffective Oct 1, 2026One payment locality1K Medicare services in 2024

In Arkansas, Medicare pays $257.00 for 67221 in the office and $157.44 when it’s performed in a hospital or facility.

$257.00Office (non-facility)
$157.44Hospital or facility
−9.6%vs the national office rate ($284.24)

Check a contract rate as a % of Medicare · 67221 nationwide

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

We’ll open 67221 for the payment locality that covers the ZIP.

On this page 11 sections
  1. Rate in Arkansas
  2. What 67221 covers
  3. Compared with other areas
  4. Rate map
  5. How it’s calculated
  6. Payment rules
  7. Related codes
  8. Rate history
  9. Where it applies
  10. Billing questions
  11. Sources

What 67221 covers

A retina specialist uses this service to treat a selected choroidal lesion, commonly choroidal neovascularization affecting the macula. Treatment involves an intravenous photosensitizing drug followed by targeted light activation at the lesion. It is performed in an ophthalmology setting equipped for the infusion and ocular laser treatment, including an office or hospital outpatient department.

Report the service for the treated eye when the clinical indication meets applicable Medicare coverage criteria; document the lesion, diagnosis, treatment plan, eye, and procedure performed. The infusion service is included, but the drug product may be reported separately. The procedure has a 0-day global period, so same-day preoperative and postoperative care is included. Do not use modifier 50; an additional eye treated in the same session may be reported with add-on code 67225 when appropriate. For other procedures subject to the multiple procedure reduction in the same session, Medicare pays the highest-valued procedure in full and reduces the others to 50%. Assistant-at-surgery payment is not payable; co-surgeon and team-surgery billing are 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.

How Arkansas compares for 67221

Across 109 of 109 payment localities, the office rate for 67221 runs from $257.00 in Arkansas to $364.75 in San Benito County, CA. Arkansas pays $257.00. The RVUs are the same everywhere; the geographic indexes change the dollars.

67221 in Arkansas vs other payment areas
  1. Arkansas · this page$257.00
  2. Los Angeles, CA · California$315.81+$58.81
  3. Washington, DC area · District of Columbia$320.36+$63.36
  4. Miami, FL · Florida$304.22+$47.22
  5. Chicago, IL · Illinois$297.09+$40.09
  6. Manhattan, NY · New York$322.97+$65.97
  7. Alaska · Alaska$347.07+$90.07

Other areas in Arkansas first, then benchmark localities. Bars start at $0.

Every other payment area

67221 in every other Medicare payment locality
Payment localityOfficeFacility
AlabamaAlabama$260.06$158.64
ArizonaArizona$277.93$165.62
Bakersfield, CACalifornia$298.66$171.63
Chico, CACalifornia$297.80$170.77
El Centro, CACalifornia$297.84$170.82
Fresno, CACalifornia$297.80$170.77
Hanford, CACalifornia$297.80$170.77
Madera, CACalifornia$297.80$170.77

67221 rates by state

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

MEWIVTNHMTNDMNMINYMARIWAIDWYSDIAILINOHPANJCTORNVUTCONEMOKYWVVAMDDECAAZNMKSOKARTNNCSCDCTXLAMSALGAFLAKHI

Explore a state

Local rates. Clear comparisons.

Hover or focus a tile to see its rate range. Select it to open the state’s fee schedule.

$257.00

$347.07

Color shows the midpoint of each state’s locality range.

View every state and territory as a table
67221 office rate range by state
State / territoryOffice rate rangeLocalities
AK$347.071
AL$260.061
AR$257.001
AZ$277.931
CA$297.80–$364.7529
CO$294.141
CT$300.891
DC$320.361
DE$281.971
FL$281.42–$304.223
GA$268.27–$288.942
GU$302.961
HI$302.961
IA$265.121
ID$266.601
IL$274.92–$297.094
IN$267.851
KS$264.251
KY$265.371
LA$265.09–$275.792
MA$292.93–$319.572
MD$286.61–$320.363
ME$267.89–$279.572
MI$271.15–$284.482
MN$282.861
MO$261.48–$276.423
MS$259.271
MT$284.221
NC$270.161
ND$279.081
NE$266.261
NH$289.851
NJ$304.60–$318.042
NM$272.431
NV$282.951
NY$273.50–$329.745
OH$270.101
OK$264.831
OR$281.01–$301.942
PA$270.37–$294.632
PR$285.911
RI$290.831
SC$270.531
SD$278.481
TN$265.361
TX$268.93–$292.958
UT$273.561
VA$278.91–$320.362
VI$285.911
VT$278.321
WA$292.28–$325.342
WI$271.371
WV$266.591
WY$281.981

See 67221 in every payment locality

How the 67221 rate is calculated

Each of 67221’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 · 67221

RVUs × geographic indexes × conversion factor

Office or facility?

Work3.36

3.36 RVUs× 1.000 GPCI

Practice expense4.89

4.89 RVUs× 1.000 GPCI

Malpractice0.26

0.26 RVUs× 1.000 GPCI

Adjusted RVUs

8.5100

Conversion factor

$33.4009

Medicare rate

$284.24

Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.

The exact Arkansas inputs and CMS source lines

PPRRVU2026_Oct_nonQPP.csv

7,445

Code
67221
Physician work
3.36
Practice expense
4.89
Malpractice
0.26

GPCI2026.csv

7

Locality
Arkansas
Physician work
1.000
Practice expense
0.859
Malpractice
0.515
Office calculation for 67221 in Arkansas
ComponentRVULocality factorAdjusted
Physician work3.36× 1.0003.3600
Practice expense4.89× 0.8594.2005
Malpractice0.26× 0.5150.1339
Total RVUs7.6944
Conversion factor× 33.4009

Office rate, Arkansas$257.00

Office: (3.36 × 1 + 4.89 × 0.859 + 0.26 × 0.515) × $33.4009 = $257.00

Facility: (3.36 × 1 + 1.42 × 0.859 + 0.26 × 0.515) × $33.4009 = $157.44

Open 67221 in the RVU calculator

Payment rules and modifiers for 67221

The CMS indicators that decide how 67221 is paid alongside other services.

CMS payment indicators · 67221

Photodynamic therapy, choroidal lesion

RuleCMS valueWhat it means
Global period000Same-day global: pre- and post-op care on the day of the procedure is included.
Multiple procedures2Standard reduction: highest-valued procedure at 100%, others at 50%.
Bilateral (modifier 50)0The 150% bilateral adjustment doesn’t apply.
Assistant at surgery (80/81/82/AS)1Not paid (statutory restriction).
Co-surgeons (62)0Not permitted.
Team surgery (66)0Not permitted.
Professional/technical0Physician service: no professional/technical split.

What modifiers do to the payment

Modifier 51 · payment effect

With and without the modifier

67221 without 51 · national office

$284.24

Photodynamic therapy, choroidal lesion

67221-51 · Second procedure: 50%

$142.12

When this isn’t the highest-valued procedure in the session, Medicare pays 50% of its fee schedule amount (the highest is paid at 100%).

When to use modifier 51

Codes related to 67221

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

Codes related to 67221
CodeHow it relatesOffice range, Arkansas
Add-on codes
67225Photodynamic therapy, second eye, same sessionAdd-on for photodynamic treatment of the second eye during the same session.$26.67
Used instead
67220Choroidal lesion treatment, laser photocoagulationTreats a choroidal lesion by photocoagulation rather than photodynamic therapy.$480.74
Often billed with
J3396Verteporfin injection, per 0.1 mgIdentifies verteporfin, the drug product used for photodynamic treatment.No office rate

How 67221 has changed in Arkansas

67221 · Office / nonfacility

$257.00

Effective 2026-10-01

The base rate is $11.25 higher than on 2025-10-01, moving from $245.75 to $257.00 (4.6%).

It is unchanged from the immediately preceding available release, effective 2026-07-01.

Base rate by release · bars start at $0 · select a bar to compare

One bar per available release, ordered by effective date. Missing rates remain gaps. These comparisons hold the code, setting and locality identifiers constant; they do not isolate which policy or input caused a change.

What changed, release by release

  1. January 1, 2026

    RVU26A

    $245.75changed to$257.00

    • Conversion factor 32.3465 changed to 33.4009
    • Work RVU 3.45 changed to 3.36
    • Practice expense RVU 4.66 changed to 4.89
    • Malpractice RVU 0.27 changed to 0.26
    • Practice expense GPCI 0.860 changed to 0.859
    • Malpractice GPCI 0.518 changed to 0.515

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    $244.43changed to$245.75

    • Conversion factor 33.2875 changed to 32.3465
    • Practice expense RVU 4.37 changed to 4.66
    • Malpractice RVU 0.26 changed to 0.27

    Held through RVU25B, RVU25C, RVU25D.

  3. March 9, 2024

    RVU24AR

    $240.44changed to$244.43

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $246.70changed to$240.44

    • Conversion factor 33.8872 changed to 32.7442
    • Practice expense RVU 4.34 changed to 4.37
    • Practice expense GPCI 0.853 changed to 0.860
    • Malpractice GPCI 0.492 changed to 0.518

  5. January 1, 2023

    RVU23A

    $247.69changed to$246.70

    • Conversion factor 34.6062 changed to 33.8872
    • Practice expense RVU 4.24 changed to 4.34
    • Malpractice RVU 0.25 changed to 0.26
    • Practice expense GPCI 0.847 changed to 0.853
    • Malpractice GPCI 0.465 changed to 0.492

    Held through RVU23B, RVU23C, RVU23D.

  6. January 1, 2022

    RVU22A

    $253.16changed to$247.69

    • Conversion factor 34.8931 changed to 34.6062
    • Practice expense RVU 4.35 changed to 4.24
    • Malpractice RVU 0.26 changed to 0.25

    Held through RVU22B, RVU22C, RVU22D.

  7. January 1, 2021

    RVU21A

    $261.03changed to$253.16

    • Conversion factor 36.0896 changed to 34.8931
    • Practice expense RVU 4.24 changed to 4.35
    • Malpractice RVU 0.27 changed to 0.26
    • Practice expense GPCI 0.859 changed to 0.847
    • Malpractice GPCI 0.521 changed to 0.465

    Held through RVU21B, RVU21C, RVU21D.

  8. January 1, 2020

    RVU20A

    $266.86changed to$261.03

    • Conversion factor 36.0391 changed to 36.0896
    • Practice expense RVU 4.37 changed to 4.24
    • Malpractice RVU 0.25 changed to 0.27
    • Practice expense GPCI 0.872 changed to 0.859
    • Malpractice GPCI 0.576 changed to 0.521

    Held through RVU20B, RVU20C, RVU20D.

  9. January 1, 2019

    RVU19A

    $269.70changed to$266.86

    • Conversion factor 35.9996 changed to 36.0391
    • Practice expense RVU 4.47 changed to 4.37

    Held through RVU19B, RVU19C, RVU19D.

  10. January 1, 2018

    RVU18AR1

    $266.80changed to$269.70

    • Conversion factor 35.8887 changed to 35.9996
    • Practice expense RVU 4.42 changed to 4.47
    • Practice expense GPCI 0.870 changed to 0.872
    • Malpractice GPCI 0.555 changed to 0.576

    Held through RVU18B, RVU18C, RVU18D.

  11. January 1, 2017

    RVU17A

    $265.20changed to$266.80

    • Conversion factor 35.8043 changed to 35.8887
    • Practice expense RVU 4.41 changed to 4.42
    • Practice expense GPCI 0.867 changed to 0.870
    • Malpractice GPCI 0.534 changed to 0.555

    Held through RVU17B, RVU17C, RVU17D.

  12. January 1, 2016

    RVU16A

    $266.04changed to$265.20

    • Conversion factor 35.9335 changed to 35.8043
    • Practice expense RVU 4.40 changed to 4.41
    • Malpractice RVU 0.26 changed to 0.25

    Held through RVU16B, RVU16C, RVU16D.

  13. July 1, 2015

    RVU15C

    $264.71changed to$266.04

    • Conversion factor 35.7547 changed to 35.9335

    Held through RVU15D.

  14. January 1, 2015

    RVU15A

    $268.51changed to$264.71

    • Conversion factor 35.8228 changed to 35.7547
    • Practice expense RVU 4.41 changed to 4.40
    • Malpractice RVU 0.46 changed to 0.26
    • Practice expense GPCI 0.866 changed to 0.867
    • Malpractice GPCI 0.492 changed to 0.534

    Held through RVU15B.

  15. January 1, 2014

    RVU14A

    $266.29changed to$268.51

    • Conversion factor 34.0230 changed to 35.8228
    • Practice expense RVU 4.81 changed to 4.41
    • Malpractice RVU 0.48 changed to 0.46
    • Practice expense GPCI 0.865 changed to 0.866
    • Malpractice GPCI 0.450 changed to 0.492

    Held through RVU14B, RVU14C, RVU14D.

  16. January 1, 2013

    RVU13AR

    Earliest loaded release: $266.29

    Held through RVU13B, RVU13C, RVU13D.

Rates in every CMS release
Effective fromOfficeFacilityCMS release
2026-10-01$257.00$157.44RVU26D
2026-07-01$257.00$157.44RVU26C
2026-04-01$257.00$157.44RVU26B
2026-01-01$257.00$157.44RVU26A
2025-10-01$245.75$184.27RVU25D
2025-07-01$245.75$184.27RVU25C
2025-04-01$245.75$184.27RVU25B
2025-01-01$245.75$184.27RVU25A
2024-10-01$244.43$188.89RVU24D
2024-07-01$244.43$188.89RVU24C
2024-04-01$244.43$188.89RVU24B
2024-03-09$244.43$188.89RVU24AR
2024-01-01$240.44$185.81RVU24A
2023-10-01$246.70$190.62RVU23D
2023-07-01$246.70$190.62RVU23C
2023-04-01$246.70$190.62RVU23B
2023-01-01$246.70$190.62RVU23A
2022-10-01$247.69$191.42RVU22D
2022-07-01$247.69$191.42RVU22C
2022-04-01$247.69$191.42RVU22B
2022-01-01$247.69$191.42RVU22A
2021-10-01$253.16$193.17RVU21D
2021-07-01$253.16$193.17RVU21C
2021-04-01$253.16$193.17RVU21B
2021-01-01$253.16$193.17RVU21A
2020-10-01$261.03$200.89RVU20D
2020-07-01$261.03$200.89RVU20C
2020-04-01$261.03$200.89RVU20B
2020-01-01$261.03$200.89RVU20A
2019-10-01$266.86$203.38RVU19D
2019-07-01$266.86$203.38RVU19C
2019-04-01$266.86$203.38RVU19B
2019-01-01$266.86$203.38RVU19A
2018-10-01$269.70$204.41RVU18D
2018-07-01$269.70$204.41RVU18C
2018-04-01$269.70$204.41RVU18B
2018-01-01$269.70$204.41RVU18AR1
2017-10-01$266.80$202.79RVU17D
2017-07-01$266.80$202.79RVU17C
2017-04-01$266.80$202.79RVU17B
2017-01-01$266.80$202.79RVU17A
2016-10-01$265.20$201.56RVU16D
2016-07-01$265.20$201.56RVU16C
2016-04-01$265.20$201.56RVU16B
2016-01-01$265.20$201.56RVU16A
2015-10-01$266.04$202.48RVU15D
2015-07-01$266.04$202.48RVU15C
2015-04-01$264.71$201.48RVU15B
2015-01-01$264.71$201.48RVU15A
2014-10-01$268.51$205.53RVU14D
2014-07-01$268.51$205.53RVU14C
2014-04-01$268.51$205.53RVU14B
2014-01-01$268.51$205.53RVU14A
2013-10-01$266.29$199.48RVU13D
2013-07-01$266.29$199.48RVU13C
2013-04-01$266.29$199.48RVU13B
2013-01-01$266.29$199.48RVU13AR

Price 67221 for an earlier date of service

Where the Arkansas rate applies

Arkansas is a Medicare payment area, not a city. Our Census mapping connects it to 626 cities and communities in Arkansas. Some span more than one payment area; confirm with the service ZIP.

  • Acorn
  • Adona
  • Alexander
  • Alicia
  • Alix
  • Alleene
  • Allport
  • Alma

Browse all communities in Arkansas

67221 billing questions

How is 67221 different from 67220?

67221 uses a photosensitizing drug infusion followed by light activation for a choroidal lesion. Code 67220 describes choroidal lesion treatment by photocoagulation.

Can 67225 be reported with 67221?

67225 is the add-on code for photodynamic treatment of the second eye during the same session. Report it with 67221 when that additional-eye service is performed and its requirements are met.

Is the drug infusion separately reported?

The infusion service is included in 67221 and is not separately reported as a distinct procedure. The verteporfin drug product may be reported separately when supplied.

Should modifier 50 be used for treatment of both eyes?

No. Modifier 50 is not appropriate for 67221. For a second eye treated during the same session, consider add-on code 67225 instead.

What documentation supports 67221?

Document the choroidal lesion and diagnosis, the clinical indication supporting treatment under applicable Medicare coverage criteria, the eye treated, and the photodynamic treatment performed.

How does the 0-day global period affect same-day care?

Same-day preoperative and postoperative care is included in the procedure. The global period does not extend beyond the day of treatment.

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
RVUs for 67221PPRRVU2026_Oct_nonQPP.csv, line 7,445 (RVU26D)
Geographic factors for ArkansasGPCI2026.csv, line 7 (RVU26D)

Open CMS sourceHow we calculate rates

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