No office rate
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.
On this page
CMS RVU26D · Effective 2026-10-01
67028 Intravitreal injection Medicare reimbursement rates in Wisconsin
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. Compare 67028 office and facility rates across CMS payment localities in Wisconsin.
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 67028 in Wisconsin?
Wisconsin 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
$109.01
1 of 1 localities have a supported rate.
Payment area: Wisconsin
One mapped payment locality.
Facility setting
$71.89
1 of 1 localities have a supported rate.
Payment area: Wisconsin
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 67028: Intravitreal injection of medication
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.
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.
CMS billing rules for 67028
- 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 RVU1.40 · 41%
- Practice expense (office) RVU1.91 · 56%
- Malpractice RVU0.11 · 3%
3.6M
Medicare services in 2024 · #53 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.
67028 compared with similar codes
Office rates for Wisconsin, from the same CMS release.
$708.95
67025 addresses injection of a vitreous substitute, such as gas or fluid, to replace vitreous; 67028 applies to medication injected into the vitreous cavity.
$169.10
66030 delivers medication into the anterior chamber; 67028 delivers it into the vitreous cavity.
$49.32
67515 injects medication into Tenon's capsule outside the globe, such as a sub-Tenon steroid; 67028 delivers medication into the vitreous cavity.
Compare 67028 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
Wisconsin →
Office / nonfacility
$109.01
Facility
$71.89
Need rates for a whole code list?
Fee-sheet and API access are in early access. Tell us which codes and locations your team needs.
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 67028 in Wisconsin.
PPRRVU2026_Oct_nonQPP.csv
7,421
- Code
- 67028
- Physician work
- 1.40
- Practice expense
- 1.91
- Malpractice
- 0.11
GPCI2026.csv
111
- Locality
- Wisconsin
- Physician work
- 1.000
- Practice expense
- 0.958
- Malpractice
- 0.308
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 1.40 | × 1.000 | 1.4000 |
| Practice expense | 1.91 | × 0.958 | 1.8298 |
| Malpractice | 0.11 | × 0.308 | 0.0339 |
| Total RVUs | 3.2637 | ||
| Conversion factor | × 33.4009 | ||
Office / nonfacility rate, Wisconsin$109.01
Explore RVUs, geographic factors and the full formula
Office / nonfacility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 1.4 | 1 |
| Practice expense | 1.91 | 0.958 |
| Malpractice | 0.11 | 0.308 |
(1.4 × 1 + 1.91 × 0.958 + 0.11 × 0.308) × $33.4009 = $109.01
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 1.4 | 1 |
| Practice expense | 0.75 | 0.958 |
| Malpractice | 0.11 | 0.308 |
(1.4 × 1 + 0.75 × 0.958 + 0.11 × 0.308) × $33.4009 = $71.89
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.
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 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.
7,41867015,,Release of eye fluid,A,,6.96,8.19,NA,8.19,,0.55,15.70,15.70,0,090,0.10,0.70,0.20,2,1,1,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,41967025,,Replace eye fluid,A,,7.91,13.70,,7.64,,0.62,22.23,16.17,0,090,0.10,0.70,0.20,2,1,1,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,42067027,,Implant eye drug system,A,,11.33,9.17,NA,9.17,,0.91,21.41,21.41,0,090,0.10,0.70,0.20,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,42167028,,Injection eye drug,A,,1.40,1.91,,0.75,,0.11,3.42,2.26,0,000,0.00,0.00,0.00,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,42267030,,Incise inner eye strands,A,,5.96,8.27,NA,8.27,,0.47,14.70,14.70,0,090,0.10,0.70,0.20,2,1,1,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,42367031,,Laser surgery eye strands,A,,4.36,6.96,,4.44,,0.35,11.67,9.15,0,090,0.10,0.70,0.20,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,42467036,,Removal of inner eye fluid,A,,11.83,9.95,NA,9.95,,0.95,22.73,22.73,0,090,0.10,0.70,0.20,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
10802402,WA,02,SEATTLE (KING CNTY),1.050,1.227,0.817
10902402,WA,99,REST OF WASHINGTON,1.013,1.053,0.761
11011402,WV,16,WEST VIRGINIA,1.000,0.869,1.431
11106302,WI,00,WISCONSIN,1.000,0.958,0.308
11203602,WY,21,WYOMING**,1.000,1.000,0.740
113"MAC Assignments as of November 22, 2023",,,,,,
114,,,,,,