67221
No office rateOcular photodynamic ther
67221 reports the primary photodynamic therapy procedure. Use 67225 only for the second eye treated during that same session, in addition to 67221.
On this page
CMS RVU26D · Effective 2026-10-01
67225 Photodynamic therapy Medicare reimbursement rates in Rhode Island
Reports photodynamic treatment of the fellow eye during the same session as primary-eye therapy for a choroidal lesion, billed as an add-on. Compare 67225 office and facility rates across CMS payment localities in Rhode Island.
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 67225 in Rhode Island?
Rhode Island 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
$29.61
1 of 1 localities have a supported rate.
Payment area: Rhode Island
One mapped payment locality.
Facility setting
$22.37
1 of 1 localities have a supported rate.
Payment area: Rhode Island
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 procedure
About 67225: Second-eye ocular photodynamic therapy
Reports photodynamic treatment of the fellow eye during the same session as primary-eye therapy for a choroidal lesion, billed as an add-on.
This add-on represents photodynamic therapy to the second eye during the same session as treatment of the first eye. An ophthalmologist, often a retina specialist, uses an intravenous photosensitizing drug followed by laser activation to treat a targeted choroidal lesion, such as choroidal neovascularization. Treatment may occur in an ophthalmology office or an outpatient facility, depending on the practice and setting.
Report this code only with the primary photodynamic therapy procedure when both eyes are treated in the same session. Documentation should identify both treated eyes, the choroidal condition, and the treatment performed in each eye. CMS classifies the code as an add-on: it is billed only with a primary procedure, and payment is included within that procedure's global period. It does not represent a separate session for later treatment of the other eye.
CMS billing rules for 67225
- Global period
- Add-on code: billed only together with a primary procedure and paid within that procedure's global period.
Where the value comes from
- Work RVU0.46 · 53%
- Practice expense (office) RVU0.37 · 43%
- Malpractice RVU0.04 · 5%
56
Medicare services in 2024 · #5288 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.
67225 compared with similar codes
Office rates for Rhode Island, from the same CMS release.
$544.48
67220 describes photocoagulation of a choroidal lesion. This add-on is for second-eye photodynamic therapy, not laser photocoagulation.
$529.25
67210 concerns photocoagulation of a retinal lesion. This code is an add-on for same-session photodynamic treatment of the second eye for a choroidal lesion.
Compare 67225 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
Rhode Island →
Office / nonfacility
$29.61
Facility
$22.37
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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 67225 in Rhode Island.
PPRRVU2026_Oct_nonQPP.csv
7,446
- Code
- 67225
- Physician work
- 0.46
- Practice expense
- 0.37
- Malpractice
- 0.04
GPCI2026.csv
92
- Locality
- Rhode Island
- Physician work
- 1.019
- Practice expense
- 1.033
- Malpractice
- 0.892
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 0.46 | × 1.019 | 0.4687 |
| Practice expense | 0.37 | × 1.033 | 0.3822 |
| Malpractice | 0.04 | × 0.892 | 0.0357 |
| Total RVUs | 0.8866 | ||
| Conversion factor | × 33.4009 | ||
Office / nonfacility rate, Rhode Island$29.61
Explore RVUs, geographic factors and the full formula
Office / nonfacility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 0.46 | 1.019 |
| Practice expense | 0.37 | 1.033 |
| Malpractice | 0.04 | 0.892 |
(0.46 × 1.019 + 0.37 × 1.033 + 0.04 × 0.892) × $33.4009 = $29.61
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 0.46 | 1.019 |
| Practice expense | 0.16 | 1.033 |
| Malpractice | 0.04 | 0.892 |
(0.46 × 1.019 + 0.16 × 1.033 + 0.04 × 0.892) × $33.4009 = $22.37
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.
67225 billing questions
Which primary code must accompany this add-on?
Report it with 67221 when photodynamic therapy is performed on the second eye in the same session as primary-eye treatment.
Can this code be reported for treatment on a later date?
No. It represents treatment of the second eye during the same session as the primary procedure, not a later visit.
What documentation supports reporting the second-eye service?
Document the choroidal condition and the treatment performed in each eye, including which eye received the primary procedure and which received the add-on service.
How does CMS treat payment for this code?
CMS identifies it as an add-on that must be billed with a primary procedure; payment is within that procedure's global period.
Is treatment of the second eye reported as another primary procedure?
For same-session treatment of the second eye, report this add-on with the primary photodynamic therapy code rather than reporting a separate primary procedure.
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.
7,44367218,,Treatment of retinal lesion,A,,19.85,13.15,NA,13.15,,1.58,34.58,34.58,0,090,0.10,0.70,0.20,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,44467220,,Treatment of choroid lesion,A,,6.20,9.25,,6.13,,0.48,15.93,12.81,0,090,0.10,0.70,0.20,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,44567221,,Ocular photodynamic ther,R,,3.36,4.89,,1.42,,0.26,8.51,5.04,0,000,0.00,0.00,0.00,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,44667225,,Eye photodynamic ther add-on,A,,0.46,0.37,,0.16,,0.04,0.87,0.66,0,ZZZ,0.00,0.00,0.00,0,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,44767227,,Dstrj extensive retinopathy,A,,3.41,5.21,,2.77,,0.26,8.88,6.44,0,010,0.10,0.80,0.10,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,44867228,,Treatment x10sv retinopathy,A,,4.28,5.58,,2.97,,0.35,10.21,7.60,0,010,0.10,0.80,0.10,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,44967229,,Tr retinal les preterm inf,A,,15.89,11.88,NA,11.88,,1.27,29.04,29.04,0,090,0.10,0.70,0.20,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
8912502,PA,01,METROPOLITAN PHILADELPHIA,1.018,1.041,1.193
9012502,PA,99,REST OF PENNSYLVANIA,1.000,0.918,0.945
9109202,PR,20,PUERTO RICO,1.000,1.011,0.985
9214412,RI,01,RHODE ISLAND,1.019,1.033,0.892
9311202,SC,01,SOUTH CAROLINA,1.000,0.924,0.850
9403402,SD,02,SOUTH DAKOTA**,1.000,1.000,0.336
9510312,TN,35,TENNESSEE,1.000,0.909,0.537