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

In South Dakota, Medicare pays $278.48 for 67221 in the office and $162.57 when it’s performed in a hospital or facility.

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.

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 South Dakota 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. South Dakota pays $278.48. The RVUs are the same everywhere; the geographic indexes change the dollars.

Every other payment area

67221 rates by state

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

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.

Payment rules and modifiers for 67221

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

What modifiers do to the payment

When to use modifier 51

Codes related to 67221

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

How 67221 has changed in South Dakota

Price 67221 for an earlier date of service

Where the South Dakota rate applies

South Dakota is a Medicare payment area, not a city. Our Census mapping connects it to 485 cities and communities in South Dakota. Some span more than one payment area; confirm with the service ZIP.

• Aberdeen
• Agar
• Agency Village
• Akaska
• Albee
• Alcester
• Alexandria
• Allen

Browse all communities in South Dakota

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

Open CMS sourceHow we calculate rates