FeeBase
Log inGet started
Menu

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

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 North Carolina, Medicare pays $270.16 for 67221 in the office and $162.03 when it’s performed in a hospital or facility.

$270.16Office (non-facility)
$162.03Hospital or facility
−5.0%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 North Carolina
  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 North Carolina 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. North Carolina pays $270.16. The RVUs are the same everywhere; the geographic indexes change the dollars.

67221 in North Carolina vs other payment areas
  1. North Carolina · this page$270.16
  2. Los Angeles, CA · California$315.81+$45.65
  3. Washington, DC area · District of Columbia$320.36+$50.20
  4. Miami, FL · Florida$304.22+$34.06
  5. Chicago, IL · Illinois$297.09+$26.93
  6. Manhattan, NY · New York$322.97+$52.81
  7. Alaska · Alaska$347.07+$76.91

Other areas in North Carolina 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
ArkansasArkansas$257.00$157.44
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

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 North Carolina 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

83

Locality
North Carolina
Physician work
1.000
Practice expense
0.933
Malpractice
0.639
Office calculation for 67221 in North Carolina
ComponentRVULocality factorAdjusted
Physician work3.36× 1.0003.3600
Practice expense4.89× 0.9334.5624
Malpractice0.26× 0.6390.1661
Total RVUs8.0885
Conversion factor× 33.4009

Office rate, North Carolina$270.16

Office: (3.36 × 1 + 4.89 × 0.933 + 0.26 × 0.639) × $33.4009 = $270.16

Facility: (3.36 × 1 + 1.42 × 0.933 + 0.26 × 0.639) × $33.4009 = $162.03

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, North Carolina
Add-on codes
67225Photodynamic therapy, second eye, same sessionAdd-on for photodynamic treatment of the second eye during the same session.$27.75
Used instead
67220Choroidal lesion treatment, laser photocoagulationTreats a choroidal lesion by photocoagulation rather than photodynamic therapy.$505.59
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 North Carolina

67221 · Office / nonfacility

$270.16

Effective 2026-10-01

The base rate is $13.18 higher than on 2025-10-01, moving from $256.98 to $270.16 (5.1%).

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

    $256.98changed to$270.16

    • 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 0.926 changed to 0.933
    • Malpractice GPCI 0.665 changed to 0.639

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    $255.30changed to$256.98

    • 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

    $251.13changed to$255.30

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $259.78changed to$251.13

    • Conversion factor 33.8872 changed to 32.7442
    • Practice expense RVU 4.34 changed to 4.37
    • Practice expense GPCI 0.927 changed to 0.926
    • Malpractice GPCI 0.742 changed to 0.665

  5. January 1, 2023

    RVU23A

    $262.64changed to$259.78

    • 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 0.928 changed to 0.927
    • Malpractice GPCI 0.819 changed to 0.742

    Held through RVU23B, RVU23C, RVU23D.

  6. January 1, 2022

    RVU22A

    $268.67changed to$262.64

    • 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

    $274.19changed to$268.67

    • 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 0.930 changed to 0.928
    • Malpractice GPCI 0.757 changed to 0.819

    Held through RVU21B, RVU21C, RVU21D.

  8. January 1, 2020

    RVU20A

    $277.22changed to$274.19

    • 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 0.931 changed to 0.930
    • Malpractice GPCI 0.695 changed to 0.757

    Held through RVU20B, RVU20C, RVU20D.

  9. January 1, 2019

    RVU19A

    $280.27changed to$277.22

    • 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

    $278.07changed to$280.27

    • Conversion factor 35.8887 changed to 35.9996
    • Practice expense RVU 4.42 changed to 4.47
    • Malpractice GPCI 0.732 changed to 0.695

    Held through RVU18B, RVU18C, RVU18D.

  11. January 1, 2017

    RVU17A

    $277.24changed to$278.07

    • Conversion factor 35.8043 changed to 35.8887
    • Practice expense RVU 4.41 changed to 4.42
    • Practice expense GPCI 0.930 changed to 0.931
    • Malpractice GPCI 0.768 changed to 0.732

    Held through RVU17B, RVU17C, RVU17D.

  12. January 1, 2016

    RVU16A

    $278.19changed to$277.24

    • 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

    $276.80changed to$278.19

    • Conversion factor 35.7547 changed to 35.9335

    Held through RVU15D.

  14. January 1, 2015

    RVU15A

    $282.41changed to$276.80

    • 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 0.929 changed to 0.930
    • Malpractice GPCI 0.732 changed to 0.768

    Held through RVU15B.

  15. January 1, 2014

    RVU14A

    $280.43changed to$282.41

    • 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 0.927 changed to 0.929
    • Malpractice GPCI 0.695 changed to 0.732

    Held through RVU14B, RVU14C, RVU14D.

  16. January 1, 2013

    RVU13AR

    Earliest loaded release: $280.43

    Held through RVU13B, RVU13C, RVU13D.

Rates in every CMS release
Effective fromOfficeFacilityCMS release
2026-10-01$270.16$162.03RVU26D
2026-07-01$270.16$162.03RVU26C
2026-04-01$270.16$162.03RVU26B
2026-01-01$270.16$162.03RVU26A
2025-10-01$256.98$190.79RVU25D
2025-07-01$256.98$190.79RVU25C
2025-04-01$256.98$190.79RVU25B
2025-01-01$256.98$190.79RVU25A
2024-10-01$255.30$195.50RVU24D
2024-07-01$255.30$195.50RVU24C
2024-04-01$255.30$195.50RVU24B
2024-03-09$255.30$195.50RVU24AR
2024-01-01$251.13$192.31RVU24A
2023-10-01$259.78$198.84RVU23D
2023-07-01$259.78$198.84RVU23C
2023-04-01$259.78$198.84RVU23B
2023-01-01$259.78$198.84RVU23A
2022-10-01$262.64$200.98RVU22D
2022-07-01$262.64$200.98RVU22C
2022-04-01$262.64$200.98RVU22B
2022-01-01$262.64$200.98RVU22A
2021-10-01$268.67$202.93RVU21D
2021-07-01$268.67$202.93RVU21C
2021-04-01$268.67$202.93RVU21B
2021-01-01$268.67$202.93RVU21A
2020-10-01$274.19$209.08RVU20D
2020-07-01$274.19$209.08RVU20C
2020-04-01$274.19$209.08RVU20B
2020-01-01$274.19$209.08RVU20A
2019-10-01$277.22$209.44RVU19D
2019-07-01$277.22$209.44RVU19C
2019-04-01$277.22$209.44RVU19B
2019-01-01$277.22$209.44RVU19A
2018-10-01$280.27$210.56RVU18D
2018-07-01$280.27$210.56RVU18C
2018-04-01$280.27$210.56RVU18B
2018-01-01$280.27$210.56RVU18AR1
2017-10-01$278.07$209.57RVU17D
2017-07-01$278.07$209.57RVU17C
2017-04-01$278.07$209.57RVU17B
2017-01-01$278.07$209.57RVU17A
2016-10-01$277.24$208.98RVU16D
2016-07-01$277.24$208.98RVU16C
2016-04-01$277.24$208.98RVU16B
2016-01-01$277.24$208.98RVU16A
2015-10-01$278.19$210.01RVU15D
2015-07-01$278.19$210.01RVU15C
2015-04-01$276.80$208.97RVU15B
2015-01-01$276.80$208.97RVU15A
2014-10-01$282.41$214.86RVU14D
2014-07-01$282.41$214.86RVU14C
2014-04-01$282.41$214.86RVU14B
2014-01-01$282.41$214.86RVU14A
2013-10-01$280.43$208.84RVU13D
2013-07-01$280.43$208.84RVU13C
2013-04-01$280.43$208.84RVU13B
2013-01-01$280.43$208.84RVU13AR

Price 67221 for an earlier date of service

Where the North Carolina rate applies

North Carolina is a Medicare payment area, not a city. Our Census mapping connects it to 785 cities and communities in North Carolina. Some span more than one payment area; confirm with the service ZIP.

  • Aberdeen
  • Advance
  • Ahoskie
  • Alamance
  • Albemarle
  • Alexis
  • Alliance
  • Altamahaw

Browse all communities in North Carolina

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 North CarolinaGPCI2026.csv, line 83 (RVU26D)

Open CMS sourceHow we calculate rates

Did this answer your question about what 67221 pays in North Carolina?

Tell us what you were actually trying to work out. We’ll answer you directly, or build the page that does.

Fee sheets

Put 67221 and the rest of your codes on one sheet

Your codes at your locality, with payer contracts beside Medicare.

Build my fee sheet