HCPCS code J3396: Verteporfin injection, per 0.1 mg2026 Medicare rate & RVUs in Michigan
Verteporfin is an intravenous photosensitizing drug used with ocular photodynamic therapy, reported in 0.1 mg units for the amount administered.
CMS doesn’t publish an office rate for J3396 in Michigan.
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 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 in Michigan
| Payment locality | Office | Facility |
|---|---|---|
| Detroit, MI | Unavailable | Unavailable |
| Rest of Michigan | Unavailable | Unavailable |
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
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
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.
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
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