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See a sample rate comparisonCPT 67221 Fee Schedule
Last Verified: October 2026
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.
Treat Abnormal Eye Tissue, Treatment In One Or More Sessions In One Or Both Eyes Of Abnormal Tissue Beneath The Retina. The Procedure May Include Stopping Or Stabilizing Leaking Fluid.
| 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 |
| Medicare Fee Schedule | View Medicare rates for 67221 |
| Medicaid Fee Schedule | View Medicaid rates for 67221 |
National average reimbursement for CPT 67221 by major payers:
$321.70
$372.58
$382.08
$355.32
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CPT 67221
5 of 25 sample ratesHigher to lower in this preview
Denton Surgicare Partners Ltd, Baylor Scott & White Surgicare - Denton
Denton Surgicare Partners Ltd
$2,172.00Published rateSanta Barbara Surgery Center Lp
$1,158.00Published rateMacon Outpatient Surgery, LLC
$614.00Published rateKirurgs, LLC, Surgeons' Surgical Center
Surgeons Surgical Center, LLC
$374.00Published rateWestern Maryland Surgicenter LLP
$221.00Published rate
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See a sample payer proposalCPT 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-CPT | Moderate | Treat Abnormal Eye Tissue, Treatment In One Or More Sessions In One Or Both Eyes Of Abnormal Tissue Beneath The Retina. The Procedure May Include Stopping Or Stabilizing Leaking Fluid. |
| 67221-CPT | Moderate | Treat Abnormal Eye Tissue, Treatment In One Or More Sessions In One Or Both Eyes Of Abnormal Tissue Beneath The Retina. The Procedure May Include Stopping Or Stabilizing Leaking Fluid. |
| 67225-CPT | Low | Eye Photodynamic Ther Add On, 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-CPT | Moderate | Treat Blood Vessels In The Eye, Laser Or Other Treatment To Destroy Abnormal Growths Of Blood Vessels On The Retina (Layer Of Tissue At The Back Of The Eye). |
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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