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HCPCS code J3396: Verteporfin injection, per 0.1 mg2026 Medicare rate & RVUs

Verteporfin is an intravenous photosensitizing drug used with ocular photodynamic therapy, reported in 0.1 mg units for the amount administered.

CMS RVU26DEffective Oct 1, 2026109 payment localities

Medicare rate · J3396

Verteporfin injection, per 0.1 mg

Office or facility?

Work RVUs
0
Total RVUs
0.00
Global days
XXX

National rate · 2026

—

Not priced in the facility setting.

See every locality for J3396 →Billed by an NP, PA or therapist? →

Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.

Your location

Medicare pays by the payment locality where the service is performed.

On this page 10 sections
  1. Medicare rate
  2. What J3396 covers
  3. By payment locality
  4. Rate map
  5. How it’s calculated
  6. Payment rules
  7. Similar codes
  8. Related codes
  9. Billing questions
  10. Sources

What J3396 covers

Verteporfin is infused intravenously for photodynamic treatment of selected retinal or choroidal vascular disorders, including some cases of age-related macular degeneration. An ophthalmologist or retina specialist then applies light to the targeted area. J3396 identifies the verteporfin quantity; the applicable ophthalmic procedure code identifies the treatment performed.

Each J3396 unit represents 0.1 mg, so 1 mg equals 10 units. Report units based on the amount administered. CMS assigns physician fee schedule status E, excluding the code from the physician fee schedule by regulation. When Medicare covers the item or service, payment is under another method. For a covered Part B drug, CMS generally uses its quarterly Average Sales Price drug pricing files. The HCPCS coverage designation indicates that special Medicare coverage instructions apply.

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 J3396 pays more and less

The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.

109 of 109 payment localities

J3396 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailableUnavailable
AlaskaUnavailableUnavailable
ArizonaUnavailableUnavailable
ArkansasUnavailableUnavailable
Atlanta, GAUnavailableUnavailable
Austin, TXUnavailableUnavailable
Bakersfield, CAUnavailableUnavailable
Baltimore area, MDUnavailableUnavailable
Beaumont, TXUnavailableUnavailable
Brazoria, TXUnavailableUnavailable

J3396 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.

View every state and territory as a table
J3396 office rate range by state
State / territoryOffice rate rangeLocalities
AKNo published base rate1
ALNo published base rate1
ARNo published base rate1
AZNo published base rate1
CANo published base rate29
CONo published base rate1
CTNo published base rate1
DCNo published base rate1
DENo published base rate1
FLNo published base rate3
GANo published base rate2
GUNo published base rate1
HINo published base rate1
IANo published base rate1
IDNo published base rate1
ILNo published base rate4
INNo published base rate1
KSNo published base rate1
KYNo published base rate1
LANo published base rate2
MANo published base rate2
MDNo published base rate3
MENo published base rate2
MINo published base rate2
MNNo published base rate1
MONo published base rate3
MSNo published base rate1
MTNo published base rate1
NCNo published base rate1
NDNo published base rate1
NENo published base rate1
NHNo published base rate1
NJNo published base rate2
NMNo published base rate1
NVNo published base rate1
NYNo published base rate5
OHNo published base rate1
OKNo published base rate1
ORNo published base rate2
PANo published base rate2
PRNo published base rate1
RINo published base rate1
SCNo published base rate1
SDNo published base rate1
TNNo published base rate1
TXNo published base rate8
UTNo published base rate1
VANo published base rate2
VINo published base rate1
VTNo published base rate1
WANo published base rate2
WINo published base rate1
WVNo published base rate1
WYNo published base rate1

How the J3396 rate is calculated

Each of J3396’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 · J3396

RVUs × geographic indexes × conversion factor

Office or facility?

Work0.00

0.00 RVUs× 1.000 GPCI

Practice expense0.00

0.00 RVUs× 1.000 GPCI

Malpractice0.00

0.00 RVUs× 1.000 GPCI

Adjusted RVUs

0.0000

Conversion factor

$33.4009

Medicare rate

$0.00

Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.

Payment rules and modifiers for J3396

J3396 has no global surgery period, no multiple-procedure, bilateral or assistant-at-surgery adjustment, and no professional/technical split. What changes the payment is where the service happens: the place of service on the claim decides whether Medicare pays the office or the facility rate.

Place of service · J3396

Which rate does Medicare pay?

The POS code on the claim line (CMS-1500 box 24B).

POS 11 · non-facility rate · national

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J3396 isn’t priced in this setting.

J3396 compared with similar codes

Compare codes · National

4 codes, side by side

Office or facility?

  • J3396

    Verteporfin injection, per 0.1 mg0 wRVU

    Not priced

  • 67221

    Photodynamic therapy, choroidal lesion3.36 wRVU

    $284.24

  • 67225

    Photodynamic therapy, second eye, same session0.46 wRVU

    $29.06

  • 67220

    Choroidal lesion treatment, laser photocoagulation6.2 wRVU

    $532.08

How to choose

67221Photodynamic therapyChoroidal lesion
CPT 67221 identifies one-eye photodynamic treatment, including the intravenous infusion service; J3396 identifies the verteporfin drug quantity.
67225Photodynamic therapySecond eye, same session
CPT 67225 describes photodynamic treatment of the second eye in the same session. J3396 reports the verteporfin administered, not the eye or procedure treated.
67220Choroidal lesion treatmentLaser photocoagulation
CPT 67220 describes laser photocoagulation of a localized choroidal lesion, rather than verteporfin-based photodynamic treatment.

Codes related to J3396

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

Codes related to J3396
CodeHow it relatesNational office range
Often billed with
67221Photodynamic therapy, choroidal lesionIdentifies one-eye photodynamic treatment performed with verteporfin.$257.00–$364.75
67225Photodynamic therapy, second eye, same sessionIdentifies second-eye photodynamic treatment when performed in the same session.$26.67–$36.94
Used instead
67220Choroidal lesion treatment, laser photocoagulationIdentifies laser photocoagulation, a different treatment approach for selected choroidal lesions.$480.74–$683.98

J3396 billing questions

How many units represent 1 mg of verteporfin?

Each unit represents 0.1 mg, so 1 mg corresponds to 10 units. Report units based on the amount administered.

Is J3396 the code for the eye procedure?

No. J3396 identifies the verteporfin drug quantity; the ophthalmic procedure code identifies the photodynamic treatment performed.

What code identifies ocular photodynamic treatment with verteporfin?

CPT 67221 identifies photodynamic treatment of one eye. J3396 identifies the verteporfin quantity.

Does Medicare pay J3396 under the physician fee schedule?

CMS assigns status E, excluding J3396 from the physician fee schedule by regulation. When Medicare covers the item or service, payment is handled under another method.

What should the record support for the drug line?

Document the amount of verteporfin administered so the reported units reflect the 0.1 mg billing increment.

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

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