CPT 67221 Fee Schedule
Healthcare providers use this code to document and receive reimbursement for visits that address moderate-level medical decision-making, often including multiple diagnoses or prescription management.
| Key Fact | Detail |
|---|---|
| Service Type | • Surgery • Surgical Procedures on the Eye and Ocular Adnexa |
| Common Place of Service | • 11 - Office • 22 - On Campus Outpatient Hospital |
| Common Modifiers | • None • RT - Right side of body • LT - Left side of body |
| Complexity Level | Moderate |
National average reimbursement for CPT 67221 by major payers:
$321.70
$372.58
$382.08
$462.73
| Payer | Code | Rate | NPI | Tax ID | State | Specialty |
|---|---|---|---|---|---|---|
Select a payer to view fee schedule data Choose a payer from the options above to see rates for CPT 67221 | ||||||
United | 67221 | $1963.00 | 1801309612 - TEXAS HEALTH SURGERY CENTER ROCKWALL, LLC | 474425996 - (TX) TEXAS HEALTH SURGERY CENTER ROCKWALL LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 67221 | $367.00 | 1700828423 - SOUTHWESTERN EYE CENTER LTD, SOUTHWESTERN EYE CENTER | 860423068 - SOUTHWESTERN EYE CENTER, LTD. | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 67221 | $617.00 | 1477089126 - BISMARCK SINUS CENTER | 821303553 - (ND) BISMARCK SINUS CENTER | ND | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 67221 | $298.00 | 1629409578 - PAIN CENTER OF WYOMING VALLEY, LLC | 462023592 - (PA) PAIN CENTER OF WYOMING VALLEY LLC | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 67221 | $315.00 | 1376580498 - SAME DAY SURGERY CENTERS OF FLORIDA LLC, SAME DAY SURGERY CENTER | 201804147 - (FL) SAME DAY SURGERY CENTERS OF FLORIDA LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 67221 | $618.00 | 1144200163 - ABILENE ASC LP, ABILENE ENDOSCOPY CENTER | 621562008 - (TX) ABILENE ASC LP | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 67221 | $750.00 | 1700546629 - STONE OAK SURGICENTER, LLC | 873925488 | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 67221 | $1575.00 | 1013493824 - ANN & ROBERT H. LURIE CHILDREN'S HOSPITAL OF CHICAGO, LURIE CHILDREN'S SURGERY CENTER IN NORTHBROOK | 362170833 - ANN & ROBERT H LURIE CHILDRENS HOSPITAL OF CHICAGO | IL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 67221 | $2350.00 | 1033586136 - PHYSICIANS WEST HOUSTON SURGICAL CENTER, LLC, MEMORIAL HERMANN SURGERY CENTER PARK TEN | 371789833 | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 67221 | $305.00 | 1588152920 - SPECIALTY SURGICAL CENTER, LLC | 352617906 - (MS) SPECIALTY SURGICAL CENTER LLC | MS | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 67221 | $664.00 | 1427028919 - CASCADE ENDOSCOPY CENTER, LLC, CASCADE ENDOSCOPY CENTER | 931331197 - (OR) CASCADE ENDOSCOPY CENTER, LLC | OR | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 67221 | $555.00 | 1629173075 - THE DIGESTIVE ENDOSCOPY CENTER OF MICHIGAN, PLLC, CROWNE POINT ENDOSCOPY & SURGERY CENTER | 352227535 - (MI) THE DIGESTIVE ENDOSCOPY CENTER OF MICHIGAN PLLC | MI | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 67221 | $953.00 | 1942715826 - SAFETY HARBOR ASC COMPANY LLC, SAFETY HARBOR SURGERY CENTER | 320547161 | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 67221 | $3000.00 | 1023159860 - THOUSAND OAKS SURGERY CENTER, LLC | 272867027 - (CA) THOUSAND OAKS SURGERY CENTER LLC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 67221 | $287.00 | 1396192241 - ANDERSON ENDOSCOPY CENTER LLC | 811947476 - (OH) ANDERSON ENDOSCOPY CENTER LLC | OH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
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CPT 67221 vs. Other Surgical Procedures on the Eye and Ocular Adnexa Codes
The CPT 67221 code is part of the Surgery services used for Surgical Procedures on the Eye and Ocular Adnexa. It represents a moderate-complexity encounter and is one of several codes that vary based on time spent, level of medical decision-making, and documentation requirements.
The CPT 67221 code involves more provider time and moderate medical decision-making, unlike lower-level codes that require less time and simpler assessments. It typically includes multiple diagnoses, medication management, or test interpretation, leading to higher reimbursement and more detailed documentation requirements.
| Code | Complexity | Description |
|---|---|---|
| 67220 | Moderate | Destruction Of Localized Lesion Of Choroid (Eg, Choroidal Neovascularization); Photocoagulation (Eg, Laser), 1 Or More Sessions |
| 67221 | Moderate | Destruction Of Localized Lesion Of Choroid (Eg, Choroidal Neovascularization); Photodynamic Therapy (Includes Intravenous Infusion) |
| 67225 | Low | Destruction Of Localized Lesion Of Choroid (Eg, Choroidal Neovascularization); Photodynamic Therapy, Second Eye, At Single Session (List Separately In Addition To Code For Primary Eye Treatment) |
| 67227 | Moderate | Destruction Of Extensive Or Progressive Retinopathy (Eg Diabetic Retinopathy) Cryotherapy Diathermy Revised 01/01/2016 |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 67221. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 67221 fee schedule helps patients estimate costs and providers optimize billing for accurate reimbursements.
Factors that affect fee schedules
Medicare & Medicaid Rates
Government-set reimbursement amounts
Private Insurance Rates
Negotiated rates between providers and insurance companies
Geographic Location
Costs may be higher in urban areas.
Provider Type
Hospital providers may have different rates than private practice.
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