CPT code 67516: Eye injection, suprachoroidal route2026 Medicare rate & RVUs in Missouri
Report this service when an ophthalmologist delivers a therapeutic agent into the suprachoroidal space, such as for uveitic macular edema.
Medicare pays $111.83–$118.01 for 67516 in the office in Missouri, from Rest of Missouri to Metropolitan St. Louis, MO. 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 67516 covers
An ophthalmologist, often a retina specialist, uses a specialized injection technique to deliver medication into the space between the choroid and sclera. A typical clinical use is treatment of macular edema associated with uveitis. The code identifies the suprachoroidal route; injections into the vitreous, subconjunctival tissue, or orbit are different services.
Document the treated eye, medication, route, and clinical indication, including that the injection entered the suprachoroidal space. The drug may be reported separately when appropriate. This is a minor procedure with a 0-day global period, so same-day preoperative and postoperative care is included. With multiple procedures in one session, Medicare pays the highest-valued procedure in full and reduces others to 50%. For bilateral treatment, modifier 50 is paid at 150%. Assistant-at-surgery services are not paid; co-surgeons and team surgery 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 67516 pays more and less in Missouri
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
3 payment localities
$111.83 to $118.01
| Payment locality | Office | Facility |
|---|---|---|
| Metropolitan Kansas City, MO | $117.04 | $78.15 |
| Metropolitan St. Louis, MO | $118.01 | $78.59 |
| Rest of Missouri | $111.83 | $76.13 |
How the 67516 rate is calculated
Each of 67516’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 · 67516
RVUs × geographic indexes × conversion factor
Work1.49
1.49 RVUs× 1.000 GPCI
Practice expense2.02
2.02 RVUs× 1.000 GPCI
Malpractice0.12
0.12 RVUs× 1.000 GPCI
Adjusted RVUs
3.6300
Conversion factor
$33.4009
Medicare rate
$121.25
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 67516
The CMS indicators that decide how 67516 is paid alongside other services.
CMS payment indicators · 67516
Eye injection, suprachoroidal route
| 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) | 1 | Bilateral with modifier 50 pays 150% of the fee schedule amount. |
| 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 50 · payment effect
With and without the modifier
67516 without 50 · national office
$121.25
Eye injection, suprachoroidal route
67516-50 · Bilateral: 150%
$181.88
Both sides on one line with modifier 50 are paid at 150% of the fee schedule amount (subject to multiple-procedure rules with other procedures).
67516 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 67028Intravitreal injectionMedication delivered into vitreous cavity
- Choose 67028 for delivery into the vitreous; choose 67516 when the documented injection is into the suprachoroidal space.
- 67515Eye injectionTenon's capsule
- 67515 identifies a subconjunctival injection. The injection site for 67516 is the suprachoroidal space.
- 67500Eye injectionRetrobulbar medication
- 67500 describes a retrobulbar injection, commonly used for medication delivery or anesthesia in the orbit; it is not a suprachoroidal injection.
67516 billing questions
How is this different from an intravitreal injection?
This service delivers medication into the suprachoroidal space. Use the intravitreal injection code when the medication is delivered into the vitreous.
Is the medication included in this code?
The code describes the injection procedure, not the drug itself. Report the administered drug separately when appropriate and supported by the drug’s coding requirements.
How should bilateral treatment be reported?
For treatment of both eyes, report modifier 50. CMS pays bilateral procedures at 150%.
What documentation supports reporting this code?
Record the indication, treated eye, medication, and the suprachoroidal route. The documentation should distinguish this injection from delivery into another ocular compartment.
Can an assistant surgeon or co-surgeon be reported?
Medicare does not pay an assistant-at-surgery service for this procedure. Co-surgeons and team surgery are not permitted.
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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