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

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 Houston, TX, Medicare pays $287.26 for 67221 in the office and $172.17 when it’s performed in a hospital or facility.

$287.26Office (non-facility)
$172.17Hospital or facility
+1.1%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 Houston, TX
  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 Houston, TX 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. Houston, TX pays $287.26. The RVUs are the same everywhere; the geographic indexes change the dollars.

67221 in Houston, TX vs other payment areas
  1. Houston, TX · this page$287.26
  2. Austin, TX · Texas$292.95+$5.69
  3. Beaumont, TX · Texas$268.93−$18.33
  4. Brazoria, TX · Texas$281.76−$5.50
  5. Dallas, TX · Texas$283.37−$3.89
  6. Fort Worth, TX · Texas$281.84−$5.42
  7. Galveston, TX · Texas$282.50−$4.76

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

Every other payment area

67221 in every other Medicare payment locality
Payment localityOfficeFacility
Rest of TexasTexas$275.07$165.08
Los Angeles, CACalifornia$315.81$178.70
Washington, DC areaDistrict of Columbia$320.36$183.82
Miami, FLFlorida$304.22$183.56
Chicago, ILIllinois$297.09$180.61
Manhattan, NYNew York$322.97$188.30
AlaskaAlaska$347.07$223.64
AlabamaAlabama$260.06$158.64

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 Houston, TX 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

102

Locality
Houston, TX
Physician work
1.008
Practice expense
0.993
Malpractice
1.376
Office calculation for 67221 in Houston, TX
ComponentRVULocality factorAdjusted
Physician work3.36× 1.0083.3869
Practice expense4.89× 0.9934.8558
Malpractice0.26× 1.3760.3578
Total RVUs8.6004
Conversion factor× 33.4009

Office rate, Houston, TX$287.26

Office: (3.36 × 1.008 + 4.89 × 0.993 + 0.26 × 1.376) × $33.4009 = $287.26

Facility: (3.36 × 1.008 + 1.42 × 0.993 + 0.26 × 1.376) × $33.4009 = $172.17

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, Houston, TX
Add-on codes
67225Photodynamic therapy, second eye, same sessionAdd-on for photodynamic treatment of the second eye during the same session.$29.60
Used instead
67220Choroidal lesion treatment, laser photocoagulationTreats a choroidal lesion by photocoagulation rather than photodynamic therapy.$537.60
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 Houston, TX

67221 · Office / nonfacility

$287.26

Effective 2026-10-01

The base rate is $10.61 higher than on 2025-10-01, moving from $276.65 to $287.26 (3.8%).

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

    $276.65changed to$287.26

    • 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
    • Work GPCI 1.014 changed to 1.008
    • Practice expense GPCI 1.003 changed to 0.993
    • Malpractice GPCI 1.409 changed to 1.376

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    $274.55changed to$276.65

    • 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

    $270.07changed to$274.55

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $279.19changed to$270.07

    • Conversion factor 33.8872 changed to 32.7442
    • Practice expense RVU 4.34 changed to 4.37
    • Work GPCI 1.023 changed to 1.014
    • Practice expense GPCI 1.016 changed to 1.003
    • Malpractice GPCI 1.154 changed to 1.409

  5. January 1, 2023

    RVU23A

    $281.98changed to$279.19

    • 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
    • Work GPCI 1.032 changed to 1.023
    • Practice expense GPCI 1.029 changed to 1.016
    • Malpractice GPCI 0.900 changed to 1.154

    Held through RVU23B, RVU23C, RVU23D.

  6. January 1, 2022

    RVU22A

    $288.59changed to$281.98

    • 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

    $292.77changed to$288.59

    • 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
    • Work GPCI 1.026 changed to 1.032
    • Practice expense GPCI 1.020 changed to 1.029
    • Malpractice GPCI 0.918 changed to 0.900

    Held through RVU21B, RVU21C, RVU21D.

  8. January 1, 2020

    RVU20A

    $294.64changed to$292.77

    • 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
    • Work GPCI 1.020 changed to 1.026
    • Practice expense GPCI 1.012 changed to 1.020
    • Malpractice GPCI 0.936 changed to 0.918

    Held through RVU20B, RVU20C, RVU20D.

  9. January 1, 2019

    RVU19A

    $297.96changed to$294.64

    • 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

    $294.84changed to$297.96

    • Conversion factor 35.8887 changed to 35.9996
    • Practice expense RVU 4.42 changed to 4.47
    • Practice expense GPCI 1.009 changed to 1.012
    • Malpractice GPCI 0.946 changed to 0.936

    Held through RVU18B, RVU18C, RVU18D.

  11. January 1, 2017

    RVU17A

    $293.26changed to$294.84

    • Conversion factor 35.8043 changed to 35.8887
    • Practice expense RVU 4.41 changed to 4.42
    • Work GPCI 1.019 changed to 1.020
    • Practice expense GPCI 1.006 changed to 1.009
    • Malpractice GPCI 0.955 changed to 0.946

    Held through RVU17B, RVU17C, RVU17D.

  12. January 1, 2016

    RVU16A

    $294.30changed to$293.26

    • 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

    $292.84changed to$294.30

    • Conversion factor 35.7547 changed to 35.9335

    Held through RVU15D.

  14. January 1, 2015

    RVU15A

    $299.40changed to$292.84

    • 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
    • Work GPCI 1.014 changed to 1.019
    • Practice expense GPCI 1.004 changed to 1.006
    • Malpractice GPCI 0.939 changed to 0.955

    Held through RVU15B.

  15. January 1, 2014

    RVU14A

    $297.49changed to$299.40

    • 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
    • Work GPCI 1.009 changed to 1.014
    • Practice expense GPCI 1.002 changed to 1.004
    • Malpractice GPCI 0.923 changed to 0.939

    Held through RVU14B, RVU14C, RVU14D.

  16. January 1, 2013

    RVU13AR

    Earliest loaded release: $297.49

    Held through RVU13B, RVU13C, RVU13D.

Rates in every CMS release
Effective fromOfficeFacilityCMS release
2026-10-01$287.26$172.17RVU26D
2026-07-01$287.26$172.17RVU26C
2026-04-01$287.26$172.17RVU26B
2026-01-01$287.26$172.17RVU26A
2025-10-01$276.65$204.95RVU25D
2025-07-01$276.65$204.95RVU25C
2025-04-01$276.65$204.95RVU25B
2025-01-01$276.65$204.95RVU25A
2024-10-01$274.55$209.78RVU24D
2024-07-01$274.55$209.78RVU24C
2024-04-01$274.55$209.78RVU24B
2024-03-09$274.55$209.78RVU24AR
2024-01-01$270.07$206.35RVU24A
2023-10-01$279.19$212.40RVU23D
2023-07-01$279.19$212.40RVU23C
2023-04-01$279.19$212.40RVU23B
2023-01-01$279.19$212.40RVU23A
2022-10-01$281.98$213.61RVU22D
2022-07-01$281.98$213.61RVU22C
2022-04-01$281.98$213.61RVU22B
2022-01-01$281.98$213.61RVU22A
2021-10-01$288.59$215.70RVU21D
2021-07-01$288.59$215.70RVU21C
2021-04-01$288.59$215.70RVU21B
2021-01-01$288.59$215.70RVU21A
2020-10-01$292.77$221.36RVU20D
2020-07-01$292.77$221.36RVU20C
2020-04-01$292.77$221.36RVU20B
2020-01-01$292.77$221.36RVU20A
2019-10-01$294.64$220.96RVU19D
2019-07-01$294.64$220.96RVU19C
2019-04-01$294.64$220.96RVU19B
2019-01-01$294.64$220.96RVU19A
2018-10-01$297.96$222.18RVU18D
2018-07-01$297.96$222.18RVU18C
2018-04-01$297.96$222.18RVU18B
2018-01-01$297.96$222.18RVU18AR1
2017-10-01$294.84$220.60RVU17D
2017-07-01$294.84$220.60RVU17C
2017-04-01$294.84$220.60RVU17B
2017-01-01$294.84$220.60RVU17A
2016-10-01$293.26$219.43RVU16D
2016-07-01$293.26$219.43RVU16C
2016-04-01$293.26$219.43RVU16B
2016-01-01$293.26$219.43RVU16A
2015-10-01$294.30$220.56RVU15D
2015-07-01$294.30$220.56RVU15C
2015-04-01$292.84$219.46RVU15B
2015-01-01$292.84$219.46RVU15A
2014-10-01$299.40$226.39RVU14D
2014-07-01$299.40$226.39RVU14C
2014-04-01$299.40$226.39RVU14B
2014-01-01$299.40$226.39RVU14A
2013-10-01$297.49$220.10RVU13D
2013-07-01$297.49$220.10RVU13C
2013-04-01$297.49$220.10RVU13B
2013-01-01$297.49$220.10RVU13AR

Price 67221 for an earlier date of service

Where the Houston, TX rate applies

Houston, TX is a Medicare payment area, not a city. Our Census mapping connects it to 46 cities and communities in Texas. Some span more than one payment area; confirm with the service ZIP.

Browse all communities in Texas

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 Houston, TXGPCI2026.csv, line 102 (RVU26D)

Open CMS sourceHow we calculate rates

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