CPT code 67225: Photodynamic therapy, second eye, same session2026 Medicare rate & RVUs in Texas
Reports photodynamic treatment of the fellow eye during the same session as primary-eye therapy for a choroidal lesion, billed as an add-on.
Medicare pays $27.85–$29.65 for 67225 in the office in Texas, from Beaumont, TX to Austin, TX. 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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On this page 9 sections
What 67225 covers
This add-on represents photodynamic therapy to the second eye during the same session as treatment of the first eye. An ophthalmologist, often a retina specialist, uses an intravenous photosensitizing drug followed by laser activation to treat a targeted choroidal lesion, such as choroidal neovascularization. Treatment may occur in an ophthalmology office or an outpatient facility, depending on the practice and setting.
Report this code only with the primary photodynamic therapy procedure when both eyes are treated in the same session. Documentation should identify both treated eyes, the choroidal condition, and the treatment performed in each eye. CMS classifies the code as an add-on: it is billed only with a primary procedure, and payment is included within that procedure's global period. It does not represent a separate session for later treatment of the other eye.
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 67225 pays more and less in Texas
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
8 payment localities
$27.85 to $29.65
8 of 8 payment localities
| Payment locality | Office | Facility |
|---|---|---|
| Austin, TX | $29.65 | $22.23 |
| Beaumont, TX | $27.85 | $21.47 |
| Brazoria, TX | $28.78 | $21.83 |
| Dallas, TX | $28.96 | $21.97 |
| Fort Worth, TX | $28.85 | $21.94 |
| Galveston, TX | $28.87 | $21.90 |
| Houston, TX | $29.60 | $22.63 |
| Rest of Texas | $28.30 | $21.64 |
How the 67225 rate is calculated
Each of 67225’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 · 67225
RVUs × geographic indexes × conversion factor
Work0.46
0.46 RVUs× 1.000 GPCI
Practice expense0.37
0.37 RVUs× 1.000 GPCI
Malpractice0.04
0.04 RVUs× 1.000 GPCI
Adjusted RVUs
0.8700
Conversion factor
$33.4009
Medicare rate
$29.06
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 67225
The CMS indicators that decide how 67225 is paid alongside other services.
CMS payment indicators · 67225
Photodynamic therapy, second eye, same session
| Rule | CMS value | What it means |
|---|---|---|
| Global period | ZZZ | Add-on code: falls within the primary procedure’s global period. |
| Multiple procedures | 0 | No multiple-procedure reduction. |
| 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. |
67225 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 67221Photodynamic therapyChoroidal lesion
- 67221 reports the primary photodynamic therapy procedure. Use 67225 only for the second eye treated during that same session, in addition to 67221.
- 67220Choroidal lesion treatmentLaser photocoagulation
- 67220 describes photocoagulation of a choroidal lesion. This add-on is for second-eye photodynamic therapy, not laser photocoagulation.
- 67210Retinal laserLocalized lesion photocoagulation
- 67210 concerns photocoagulation of a retinal lesion. This code is an add-on for same-session photodynamic treatment of the second eye for a choroidal lesion.
67225 billing questions
Which primary code must accompany this add-on?
Report it with 67221 when photodynamic therapy is performed on the second eye in the same session as primary-eye treatment.
Can this code be reported for treatment on a later date?
No. It represents treatment of the second eye during the same session as the primary procedure, not a later visit.
What documentation supports reporting the second-eye service?
Document the choroidal condition and the treatment performed in each eye, including which eye received the primary procedure and which received the add-on service.
How does CMS treat payment for this code?
CMS identifies it as an add-on that must be billed with a primary procedure; payment is within that procedure's global period.
Is treatment of the second eye reported as another primary procedure?
For same-session treatment of the second eye, report this add-on with the primary photodynamic therapy code rather than reporting a separate primary procedure.
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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