$106.84
Choose 67028 for delivery into the vitreous; choose 67516 when the documented injection is into the suprachoroidal space.
On this page
CMS RVU26D · Effective 2026-10-01
67516 Eye injection Medicare reimbursement rates in Kentucky
Report this service when an ophthalmologist delivers a therapeutic agent into the suprachoroidal space, such as for uveitic macular edema. Compare 67516 office and facility rates across CMS payment localities in Kentucky.
Amounts below use the non-QP conversion factor for participating physicians. These are base physician payments before claim-level adjustments, not patient costs or total hospital charges.
What does Medicare pay for 67516 in Kentucky?
Kentucky has 1 payment locality in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the payment area shown below, using the same CMS release.
Office / nonfacility
$113.42
1 of 1 localities have a supported rate.
Payment area: Kentucky
One mapped payment locality.
Facility setting
$76.60
1 of 1 localities have a supported rate.
Payment area: Kentucky
One mapped payment locality.
These are locality ranges, not averages or address-specific quotes. A facility-setting amount covers the physician service; it does not include a hospital’s separate bill. Choose a locality below to inspect its calculation, compare other payment areas, or price a percentage of Medicare.
Ophthalmology
About 67516: Suprachoroidal therapeutic agent injection
Report this service when an ophthalmologist delivers a therapeutic agent into the suprachoroidal space, such as for uveitic macular edema.
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.
CMS billing rules for 67516
- Global period
- Minor procedure with a 0-day global period: same-day preoperative and postoperative care is included.
- Multiple procedures
- Standard multiple procedure reduction: the highest-valued procedure is paid in full and others at 50% when performed in the same session.
- Bilateral procedures
- Bilateral procedure with modifier 50 is paid at 150%.
- Assistant at surgery
- Statutory restriction: assistant at surgery is not paid.
- Co-surgeons
- Co-surgeons not permitted.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU1.49 · 41%
- Practice expense (office) RVU2.02 · 56%
- Malpractice RVU0.12 · 3%
2.2K
Medicare services in 2024 · #2404 by national volume
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.
67516 compared with similar codes
Office rates for Kentucky, from the same CMS release.
$48.78
67515 identifies a subconjunctival injection. The injection site for 67516 is the suprachoroidal space.
$74.41
67500 describes a retrobulbar injection, commonly used for medication delivery or anesthesia in the orbit; it is not a suprachoroidal injection.
Compare 67516 by payment locality
Find the payment area for your service address, then open its rate page for calculation inputs, release history and the percentage-of-Medicare tool. A city may cross payment-area boundaries; the ZIP lookup above helps resolve the location.
1 of 1 payment localities
Kentucky →
Office / nonfacility
$113.42
Facility
$76.60
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How this local rate is calculated
Each RVU component is multiplied by its own geographic practice cost index (GPCI). The three adjusted components are added, then multiplied by the conversion factor. These are the inputs used for 67516 in Kentucky.
PPRRVU2026_Oct_nonQPP.csv
7,482
- Code
- 67516
- Physician work
- 1.49
- Practice expense
- 2.02
- Malpractice
- 0.12
GPCI2026.csv
55
- Locality
- Kentucky
- Physician work
- 1.000
- Practice expense
- 0.889
- Malpractice
- 0.915
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 1.49 | × 1.000 | 1.4900 |
| Practice expense | 2.02 | × 0.889 | 1.7958 |
| Malpractice | 0.12 | × 0.915 | 0.1098 |
| Total RVUs | 3.3956 | ||
| Conversion factor | × 33.4009 | ||
Office / nonfacility rate, Kentucky$113.42
Explore RVUs, geographic factors and the full formula
Office / nonfacility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 1.49 | 1 |
| Practice expense | 2.02 | 0.889 |
| Malpractice | 0.12 | 0.915 |
(1.49 × 1 + 2.02 × 0.889 + 0.12 × 0.915) × $33.4009 = $113.42
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 1.49 | 1 |
| Practice expense | 0.78 | 0.889 |
| Malpractice | 0.12 | 0.915 |
(1.49 × 1 + 0.78 × 0.889 + 0.12 × 0.915) × $33.4009 = $76.60
The office and facility calculations use their respective practice-expense RVUs. The facility amount here is the physician fee, not a separate hospital or facility bill.
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% under the supplied fee schedule rule.
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 indices and the applicable conversion factor. Unavailable or separately priced services are labeled rather than assigned a made-up amount.
Source: RVU26D. Effective 2026-10-01 through the day before 2027-01-01.
7,47967500,,Inject/treat eye socket,A,,1.15,1.13,,0.42,,0.08,2.36,1.65,0,000,0.00,0.00,0.00,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,48067505,,Inject/treat eye socket,A,,1.15,1.31,,0.51,,0.08,2.54,1.74,0,000,0.00,0.00,0.00,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,48167515,,Inject/treat eye socket,A,,0.73,0.76,,0.36,,0.06,1.55,1.15,0,000,0.00,0.00,0.00,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,48267516,,Sprchoroidal spc njx rx agt,A,,1.49,2.02,,0.78,,0.12,3.63,2.39,0,000,0.00,0.00,0.00,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,48367550,,Insert eye socket implant,A,,11.48,16.16,NA,16.16,,0.98,28.62,28.62,0,090,0.10,0.70,0.20,2,1,1,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,48467560,,Revise eye socket implant,A,,11.88,16.27,NA,16.27,,1.06,29.21,29.21,0,090,0.10,0.70,0.20,2,1,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,48567570,,Decompress optic nerve,A,,14.04,18.02,NA,18.02,,1.12,33.18,33.18,0,090,0.10,0.70,0.20,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5208102,IN,00,INDIANA,1.000,0.927,0.486
5305102,IA,00,IOWA,1.000,0.915,0.397
5405202,KS,00,KANSAS,1.000,0.904,0.504
5515102,KY,00,KENTUCKY,1.000,0.889,0.915
5607202,LA,01,NEW ORLEANS,1.000,0.941,1.136
5707202,LA,99,REST OF LOUISIANA,1.000,0.885,0.958
5814112,ME,03,SOUTHERN MAINE,1.000,0.991,0.631