CPT 67228 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 • 24 - Ambulatory Surgical Center |
| Common Modifiers | • None • LT - Left side of body • RT - Right side of body |
| Complexity Level | Moderate |
National average reimbursement for CPT 67228 by major payers:
$681.33
$772.49
$791.26
$827.93
| 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 67228 | ||||||
United | 67228 | $750.00 | 1740230523 - SARASOTA AMBULATORY SURGERY CENTER LTD, SARASOTA AMBULATORY SURGERY CENTER | 203686491 - (FL) SARASOTA AMBULATORY SURGERY CENTER LTD | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 67228 | $649.00 | 1689986879 - DEER POINTE SURGICAL CENTER, LLC, POA SURGERY CENTER | 272384315 - (MD) DEER POINTE SURGICAL CENTER, LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 67228 | $608.34 | 1003892035 - SRIDHAR BHASKARA | 350593390 - DEACONESS HOSPITAL INC | IN | Anesthesiology Physician (207L00000X) |
United | 67228 | $200.00 | 1275642480 - EGNM LLC, LEWES SURGERY CENTER | 510411737 - (DE) EGNM, LLC DBA LEWES SURGERY CENTER | DE | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 67228 | $720.00 | 1184897472 - LAKE COUNTRY ENDOSCOPY CENTER, LLC | 261572986 - (WI) LAKE COUNTRY ENDOSCOPY CENTER LLC | WI | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 67228 | $859.00 | 1356903967 - UNITY LINDEN OAKS SURGERY CENTER | 800798208 | NY | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 67228 | $1783.00 | 1649827973 - PARK NICOLLET METHODIST HOSPITAL, PARK NICOLLET SAME DAY SURGERY CENTER | 410132080 - (MN) PARK NICOLLET HEALTH SERVICES | MN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 67228 | $608.34 | 1255473625 - HILARY NWOSU | 350593390 - DEACONESS HOSPITAL INC | CA | Emergency Medicine Physician (207P00000X) |
United | 67228 | $380.00 | 1891728382 - MISSISSIPPI COAST ENDOSCOPY & AMBULATORY CENTER LLC, MISSISSIPPI COAST ENDOSCOPY & AMBULATORY SURGICAL | 640927074 - (MS) MISSISSIPPI COAST ENDOSCOPY AND AMBULATORY CENTER, LLC | MS | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 67228 | $608.34 | 1649547712 - OMAR RIVERA-RIVERA | 350593390 - DEACONESS HOSPITAL INC | PR | Family Medicine Physician (207Q00000X) |
United | 67228 | $279.51 | 1477112357 - TAYLOR COULSON | 350593390 - DEACONESS HOSPITAL INC | IN | Nurse Practitioner (363L00000X) |
United | 67228 | $900.00 | 1003116823 - NORTHERN N.J. ENDOSCOPY CENTER, L.L.C. | 640955113 - (NJ) NORTHERN NJ ENDOSCOPY CENTER LLC | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 67228 | $445.00 | 1760423180 - CENTRAL COAST ENDOSCOPY CENTER INC | 770456846 - (CA) CENTRAL COAST ENDOSCOPY CENTER INC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 67228 | $445.00 | 1821074485 - SURGERY CENTER OF FARMINGTON, L.L.C. | 431811835 - (MO) SURGERY CENTER OF FARMINGTON | MO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 67228 | $410.00 | 1871593269 - ACADIANA SURGERY CENTER, INC. | 721235496 - (LA) ACADIANA SURGERY CENTER INC | LA | 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 67228 vs. Other Surgical Procedures on the Eye and Ocular Adnexa Codes
The CPT 67228 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 67228 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 |
|---|---|---|
| 67221-CPT | Moderate | Destruction Of Localized Lesion Of Choroid (Eg, Choroidal Neovascularization); Photodynamic Therapy (Includes Intravenous Infusion) |
| 67227-CPT | Moderate | Destruction Of Extensive Or Progressive Retinopathy (Eg Diabetic Retinopathy) Cryotherapy Diathermy Revised 01/01/2016 |
| 67228-CPT | Moderate | Treatment Of Extensive Or Progressive Retinopathy, One Or More Sessions (Eg Diabetic Retinopathy), Photocoagulation |
| 67229-CPT | High | Treatment Of Extensive Or Progressive Retinopathy One Or More Sessions; Preterm Infant (Less Than 37 Weeks Gestation At Birth) Performed From Birth Up To 1 Year Of Age (Eg Retinopathy Of Prematurity) Photocoagulationor Cryotherapy |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 67228. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 67228 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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