How much does Medicare pay for CPT 67228?

Medicare allowed an average of $328.65 per service and paid $256.24 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $1807.97, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 67228?

Destruction of leaking blood vessels of retina using laser. It was billed 19,251 times to 11,505 Medicare beneficiaries by 581 providers in 2024.

Does 67228 pay differently in an office than a hospital?

Yes. The allowed amount averaged $344.78 in an office setting and $244.17 in a facility. The office rate is generally higher because the practice supplies the room, staff and equipment out of that single payment; in a hospital those are billed separately by the facility.

Which specialty bills 67228 most?

Ophthalmology, with 17,861 services from 553 clinicians. Next are Ambulatory Surgical Center.

CPT 67228

Destruction of leaking blood vessels of retina using laser

$328.65Medicare-allowed amount per service, averaged across 19,251 services

Providers submitted

$1807.97

Asking price, not received

Medicare allowed

$328.65

The fee schedule figure

Medicare paid

$256.24

Balance is patient coinsurance

Providers submitted an average of $1807.97 for this code and Medicare allowed $328.65 — 5.5× less. That gap is normal and means nothing on its own: Medicare pays its fee schedule regardless of what is billed, so the submitted figure describes a hospital chargemaster, not a price anyone paid. Of the allowed amount Medicare paid $256.24 (78%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $344.78
Hospital / facility: $244.17

The office rate is higher because the practice supplies the room, staff and equipment out of that payment. In a hospital the facility bills those separately, so the clinician's share is smaller — the total cost to Medicare is usually higher, not lower. 16,165 services were billed in an office setting and 3,086 in a facility.

Services: 19,251
Beneficiaries: 11,505
Providers billing it: 581
Total allowed: $6,326,841

What Medicare pays for CPT 67228

Across 19,251 services billed by 581 providers to 11,505 beneficiaries, Medicare allowed an average of $328.65 per service. That is 1.7 services per beneficiary, so this is a code patients typically receive more than once. The allowed amount is the figure that matters: it is what Medicare and the patient together owe, set by the fee schedule and adjusted for local practice costs. What a provider chose to submit has no bearing on it.

Who bills 67228

Specialty	Services	Beneficiaries	Avg allowed	Providers
Ophthalmology	17,861	10,699	$340.64	553
Ambulatory Surgical Center	1,390	806	$174.54	28

67228 reimbursement by state

Two different numbers. Allowed is what Medicare actually allowed in that state, which includes the local practice-cost adjustment. Standardized strips that geographic adjustment out of the payment, so it is the column to use when comparing states — a difference there reflects how the code was billed, not what it costs to run a practice locally.

State	Services	Allowed	Standardized pmt	Providers
California	3,828	$350.02	$245.40	110
New York	1,775	$376.17	$257.14	49
Texas	1,644	$300.67	$237.22	41
Illinois	1,517	$316.39	$238.76	38
Indiana	897	$310.82	$246.25	19
Florida	866	$353.74	$279.35	18
Maryland	713	$346.37	$262.98	22
Oklahoma	641	$311.53	$258.61	15
Virginia	608	$302.28	$228.99	21
Michigan	564	$318.97	$247.71	18
Ohio	484	$317.81	$247.40	19
Louisiana	421	$319.57	$261.26	11
New Jersey	417	$368.85	$257.80	15
Pennsylvania	377	$302.37	$235.28	20
North Carolina	369	$288.83	$232.36	12
Missouri	301	$299.88	$237.07	14
Arkansas	292	$289.33	$257.33	8
Washington	253	$311.17	$227.22	9
Georgia	248	$318.67	$253.13	10
West Virginia	224	$281.41	$229.98	7
Kentucky	210	$320.20	$257.47	6
Massachusetts	204	$325.76	$239.97	9
Wisconsin	194	$320.82	$248.19	7
Kansas	192	$317.07	$253.20	9
Alabama	180	$324.89	$266.93	3
Arizona	155	$343.95	$255.57	4
Nebraska	149	$289.82	$247.20	5
Maine	146	$241.81	$188.22	5
Colorado	137	$286.21	$219.67	4
South Carolina	128	$327.86	$253.14	5
Connecticut	123	$358.07	$268.20	5
Tennessee	103	$320.02	$261.08	6
New Mexico	101	$316.17	$269.81	4
Nevada	96	$327.23	$255.98	1
North Dakota	87	$340.70	$256.37	3
Utah	81	$307.37	$250.17	3
Minnesota	75	$339.97	$252.11	5
Mississippi	68	$294.45	$249.62	3
Iowa	64	$325.99	$259.03	4
Idaho	62	$285.52	$255.25	1
Hawaii	57	$329.78	$252.00	2
Oregon	34	$343.89	$251.76	2
Rhode Island	28	$331.70	$283.16	1
Puerto Rico	28	$347.41	$256.81	1
New Hampshire	26	$316.98	$232.57	2
South Dakota	19	$365.27	$296.72	1
Vermont	18	$323.44	$252.44	1
Northern Mariana Islands	17	$351.31	$263.08	1
District of Columbia	16	$374.64	$251.00	1
Alaska	14	$108.51	$80.08	1

Related codes

67210Destruction of growth of retina$529.88

Billing this code is not the same as earning it

An allowed amount is revenue to a practice, not income to a clinician. It funds staff, premises, equipment and supplies before anyone is paid. What clinicians actually earn is published separately by the Department of Labor, and what industry pays them is published separately again by CMS — this site carries both.

What doctors are paid →·Look up a clinician →·All procedure codes →

Where this comes from. CMS Medicare Physician & Other Practitioners, by Provider and Service, 2024. It covers fee-for-service Original Medicare Part B only — not Medicare Advantage, not Medicaid, and not commercial insurance, which typically pays more for the same code.

How it is averaged. CMS publishes one average per provider per code. Every figure here is re-weighted by the number of services, so a clinician who billed the code 4,000 times counts 4,000 times more than one who billed it twice. CMS also suppresses any provider-code pair with fewer than 11 beneficiaries, so low-volume practice is missing from these totals by design.