Billing code 67028: Intravitreal injectionMedicare rate & RVUs in Guam
Intravitreal medication injection through the pars plana is reported for a treated eye, commonly for neovascular macular degeneration, diabetic macular edema, or retinal vein occlusion.
Medicare pays $121.42 for 67028 in the office in Guam (Hawaii, Guam). 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.
On this page 9 sections
What 67028 covers
A retina specialist or ophthalmologist injects medication through the pars plana into the vitreous cavity after ocular anesthesia and antiseptic preparation, often using a lid speculum. Intravitreal anti-VEGF treatment is common for neovascular age-related macular degeneration, diabetic macular edema, and macular edema from retinal vein occlusion; steroids and antibiotics are other possible agents. Injections occur primarily in the office but may also take place in an outpatient facility. The procedure code captures the injection; the medication supplied is reported separately under its applicable HCPCS drug code.
Document laterality, medication and dose, indication, and injection technique. For one treated eye, report one unit with RT or LT; for both eyes in the same session, report one unit with modifier 50, paid at 150% of the unilateral amount. CMS assigns a 0-day global period, including same-day preoperative and postoperative care; a separately identifiable E/M requires modifier 25. When multiple procedures are performed in the same session, the highest-valued is paid in full and others at 50%. 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.
67028 in Hawaii, Guam
| Payment locality | Office | Facility |
|---|---|---|
| Hawaii, Guam | $121.42 | $77.37 |
How the 67028 rate is calculated
Each of 67028’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 · 67028
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 1.40Practice expense 1.91Malpractice 0.11
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 67028
The CMS indicators that decide how 67028 is paid alongside other services.
CMS payment indicators · 67028
Intravitreal injection
| 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
67028 without 50 · national office
$114.23
Intravitreal injection
67028-50 · Bilateral: 150%
$171.35
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).
67028 compared with similar codes
Compare codes
67028 vs 67027 vs 67025 vs 66030 vs 67515: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 67027Drug implant
- 67027 is surgical implantation of a drug delivery system that releases medication over time; 67028 is a needle injection of medication into the vitreous cavity.
- 67025Vitreous exchange
- 67025 addresses injection of a vitreous substitute, such as gas or fluid, to replace vitreous; 67028 applies to medication injected into the vitreous cavity.
- 66030Eye injection
- 66030 delivers medication into the anterior chamber; 67028 delivers it into the vitreous cavity.
- 67515Eye injection
- 67515 injects medication into Tenon's capsule outside the globe, such as a sub-Tenon steroid; 67028 delivers medication into the vitreous cavity.
67028 billing questions
Is the drug included in this code?
No. The code covers the injection procedure. Bill the medication separately using its applicable HCPCS code, such as J0178 for aflibercept or J2778 for ranibizumab, with units based on the dose supplied.
How are injections in both eyes in the same session billed to Medicare?
Report one procedure unit with modifier 50, which CMS pays at 150% of the unilateral amount. Report drug units based on the dose supplied for both eyes.
Can an office visit be billed on the injection day?
Yes, if the documentation supports a significant, separately identifiable E/M service beyond routine injection-related assessment and care; append modifier 25 to the E/M code. A planned injection visit with only brief pre-injection assessment is included in the 0-day global period.
Can retinal OCT be billed on an injection day?
Retinal OCT (92134) may be reported on the same date when it is medically necessary to assess the retina and its interpretation is documented.
Should this code be reported for a drug injected during vitrectomy?
An injection integral to a vitrectomy in the same eye is not reported separately as 67028. Use 67028 for a distinct intravitreal injection service.
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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