CPT code 67221: Photodynamic therapy, choroidal lesion2026 Medicare rate & RVUs in California
Reports photodynamic treatment of a selected choroidal lesion, including the photosensitizing drug infusion and laser activation, when Medicare coverage criteria are met.
Medicare pays $297.80–$364.75 for 67221 in the office in California, from Chico, CA to San Benito County, CA. Which amount applies depends on the service address.
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
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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.
Where 67221 pays more and less in California
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
29 payment localities
$297.80 to $364.75
29 of 29 payment localities
| Payment locality | Office | Facility |
|---|---|---|
| Bakersfield, CA | $298.66 | $171.63 |
| Chico, CA | $297.80 | $170.77 |
| El Centro, CA | $297.84 | $170.82 |
| Fresno, CA | $297.80 | $170.77 |
| Hanford, CA | $297.80 | $170.77 |
| Los Angeles, CA | $315.81 | $178.70 |
| Madera, CA | $297.80 | $170.77 |
| Marin County, CA | $357.17 | $193.75 |
| Merced, CA | $297.80 | $170.77 |
| Modesto, CA | $297.80 | $170.77 |
| Napa, CA | $338.98 | $186.22 |
| Oxnard, CA | $313.84 | $176.84 |
| Redding, CA | $297.80 | $170.77 |
| Rest of California | $297.80 | $170.77 |
| Riverside, CA | $300.66 | $173.64 |
| Sacramento, CA | $310.88 | $176.08 |
| Salinas, CA | $309.66 | $175.33 |
| San Benito County, CA | $364.75 | $197.62 |
| San Diego, CA | $315.64 | $177.03 |
| San Francisco, CA | $356.88 | $193.45 |
| San Luis Obispo, CA | $304.82 | $172.81 |
| Santa Clara County, CA | $363.54 | $196.41 |
| Santa Cruz, CA | $317.68 | $176.87 |
| Santa Maria, CA | $310.47 | $175.33 |
| Santa Rosa, CA | $320.82 | $178.49 |
| Stockton, CA | $297.80 | $170.77 |
| Vallejo, CA | $338.55 | $185.80 |
| Visalia, CA | $297.80 | $170.77 |
| Yuba City, CA | $297.80 | $170.77 |
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
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.
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
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 000 | Same-day global: pre- and post-op care on the day of the procedure is included. |
| Multiple procedures | 2 | Standard reduction: highest-valued procedure at 100%, others at 50%. |
| Bilateral (modifier 50) | 0 | The 150% bilateral adjustment doesn’t apply. |
| Assistant at surgery (80/81/82/AS) | 1 | Not paid (statutory restriction). |
| Co-surgeons (62) | 0 | Not permitted. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 0 | Physician 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%).
67221 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 67225Photodynamic therapySecond eye, same session
- 67225 is an add-on for photodynamic treatment of the second eye at the same session; 67221 reports the primary-eye treatment.
- 67220Choroidal lesion treatmentLaser photocoagulation
- Both address choroidal lesions, but 67220 uses photocoagulation, while 67221 uses a photosensitizing drug infusion and light activation.
- 67210Retinal laserLocalized lesion photocoagulation
- 67210 treats a localized retinal lesion by photocoagulation. Code 67221 is for photodynamic treatment of a choroidal lesion.
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
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