What Is CPT Code 67228?
CPT code 67228 is a retinal laser procedure code that reports panretinal photocoagulation, the scatter laser treatment for extensive or progressive retinopathy such as proliferative diabetic retinopathy. Each session is reported per eye. In 2026, Medicare’s national rate is $341.02 in the office and $253.85 in a facility setting, and the code carries a 10-day global period.
Repeat sessions: A session on the same eye after the 10-day global ends bills as a new 67228, while some Medicaid and commercial plans still apply a 90-day global.
Eye modifiers: Every line needs RT or LT, or modifier 50 for both eyes in one session, and a fellow-eye session inside the first eye’s 10-day window adds modifier 79.
67228 vs 67210: 67228 covers scatter treatment of extensive disease, while 67210 covers focal laser of a localized lesion such as macular edema and carries a 90-day global.
What CPT 67228 Covers
The AMA’s CPT descriptor for 67228 reads “Treatment of extensive or progressive retinopathy (eg, diabetic retinopathy), photocoagulation.” In practice, that is panretinal photocoagulation (PRP): hundreds to thousands of laser burns placed across the peripheral retina to reduce the ischemic drive behind neovascularization. Proliferative diabetic retinopathy is the most common indication, followed by retinal vein occlusion with neovascularization, proliferative sickle cell retinopathy, and severe nonproliferative disease when the retina specialist judges early treatment worthwhile.
The code changed shape in 2016. CPT dropped the phrase “1 or more sessions,” and CMS cut the global period from 90 days to 10, turning PRP into a minor procedure billed per session. Retinal Physician reported that the national allowable fell from $1,016.20 to $345.15 that year, a 66% drop, and that the ABLE Act phase-in for large cuts did not apply because the code’s definition had changed. The 2026 rate of $341.02 is still slightly below that 2016 figure.
Setting changes the payment. The office (non-facility) rate of $341.02 includes the practice’s laser and supply costs, while the $253.85 facility rate applies when PRP is performed in a hospital outpatient department or ambulatory surgery center, where the facility bills its own fee. PRP is commonly performed in the office and is often staged across two or more sessions per eye, which is why the session-based global rules carry so much weight. Laser platforms range from single-spot lasers to pattern-scanning systems that place burns in arrays, but the code is the same regardless of the device. Each session note should record the eye, the number of burns, spot size, duration, and power.
What Is the Difference Between 67228 and 67210?
67228 reports scatter photocoagulation for extensive or progressive retinopathy across the retina, while 67210 reports photocoagulation of a localized retinal lesion, such as macular edema or a tumor. The two also differ in global period: Medicare assigns 67228 a 10-day global and 67210 a 90-day global, which changes how follow-up care and repeat sessions are billed.
One question we hear constantly from practice managers is whether a focal treatment after PRP counts as another 67228. It does not. Focal or grid laser for macular edema reports with 67210, and because 67210 opens a 90-day global, a PRP session on that eye during those 90 days needs modifier 58 or 79, depending on whether it was planned as part of the same treatment course.
Two neighboring codes cover the same disease with a different method or patient. 67227 reports cryotherapy for extensive or progressive retinopathy and shares the 10-day global, while 67229 covers treatment of retinopathy in a preterm infant up to one year of age, by photocoagulation or cryotherapy, with a 90-day global.
Here is how the four retinal treatment codes compare:
| Code | What it reports | Medicare global | 2026 national rate (office) |
|---|---|---|---|
| 67228 | Scatter laser (PRP) for extensive or progressive retinopathy | 10 days | $341.02 |
| 67227 | Cryotherapy for extensive or progressive retinopathy | 10 days | $296.60 |
| 67210 | Photocoagulation of a localized retinal lesion | 90 days | $517.38 |
| 67229 | Retinopathy treatment in a preterm infant | 90 days | $969.96 |
Rates are national non-facility amounts from the CMS 2026 Physician Fee Schedule relative value file (October release) at the $33.4009 conversion factor, before geographic adjustment.
What Is the Global Period for CPT 67228?
Medicare assigns CPT 67228 a 10-day global period, which makes PRP a minor procedure. The payment covers the procedure day and related follow-up for the next 10 days, so another session on the same eye after day 10 bills as a new 67228. Some Medicaid and commercial plans still apply a 90-day global, so check each payer.
Inside the window, the global surgery package controls. A related post-procedure visit is included and not billed. A visit for an unrelated problem, such as new symptoms in the fellow eye, takes modifier 24. A planned additional session on the same eye inside the 10 days is a staged procedure, which modifier 58 describes, but payers differ on paying a repeat 67228 that soon, so scheduling sessions after day 10 avoids the question.
Because PRP is a minor procedure, the decision to treat is part of the procedure payment. A same-day exam is billable only when it is significant and separately identifiable, with modifier 25 rather than modifier 57, which applies to major surgery. That pairing is the target of CMS’s CY2027 proposed rule (CMS-1848-P): when a modifier 25 visit falls on the same day as a procedure with a 0-, 10-, or 90-day global, the highest-valued service would pay at 100% and the other at 50%. At 2026 national rates, a 99214-25 billed with 67228 would drop from $135.61 to $67.81. The AMA and more than 140 medical organizations urged CMS not to finalize the cut, and the final rule is expected in November 2026. Our breakdown of 2027 ophthalmology Medicare payment changes covers the full proposal.
In our experience matching providers with billing partners, retina practices feel global-period mistakes fastest, because PRP is so often staged across sessions and eyes.
Want billing help from a team that tracks every PRP session against its global period? Billing Service Quotes connects ophthalmology practices with medical billing companies within 30 minutes of a request, at no cost.
How Do Modifiers Work on a 67228 Claim?
Every 67228 line needs an eye modifier, RT or LT, or modifier 50 when both eyes are treated in one session. Global-period modifiers come first and the eye modifier last: 79 for a fellow-eye session inside the first eye’s 10-day window, 58 for a planned staged session, and 25 on a significant same-day exam.
Here is how each modifier behaves on a PRP claim:
- RT or LT: Identifies the treated eye on every 67228 line and should match the eye in the diagnosis code.
- 50: Reports both eyes treated in one session, which Medicare pays at 150% of the single-eye rate, or $511.53 nationally in the office.
- 79: Flags a fellow-eye session inside the first eye’s 10-day window as unrelated, starting a new global period at full payment.
- 58: Marks a planned, staged session on the same eye inside the window; confirm the payer pays it before scheduling.
- 24: Allows payment for an unrelated exam during the 10-day window, such as new symptoms in the fellow eye.
- 25: Supports a significant, separately identifiable exam on the day of PRP, and it goes on the E/M code, not on 67228.
Formats for bilateral claims vary. Medicare accepts a single line with modifier 50, while some commercial payers want separate RT and LT lines; never combine 50 with RT or LT on the same line. When several modifiers apply, list the eye modifier last, the order AAO coding staff recommend for retina claims. Payers also check the modifiers against the dates: a 79 on a session that falls outside every open global period is unnecessary and can trigger review.
ICD-10 Codes That Support 67228
Providers often come to us after a run of 67228 denials that traced back to laterality, not the laser. For diabetic retinopathy, the diagnosis comes from E10.35 (type 1), E11.35 (type 2), or E13.35 (other specified diabetes), and each code needs a seventh character for the eye: 1 for right, 2 for left, 3 for bilateral, and 9 for unspecified.
The sixth character describes the retinopathy. Within E11.35, a 1 indicates macular edema, 2 through 4 indicate traction or combined retinal detachment, 5 indicates stable proliferative disease, and 9 indicates no macular edema. A right eye with active proliferative disease and no macular edema is E11.3591; the same finding in both eyes is E11.3593.
The FY2027 ICD-10-CM Official Guidelines address staged treatment directly. Under Section I.B.13, when a bilateral condition is treated in separate encounters, the bilateral code applies to the first side and remains appropriate if that treatment did not completely resolve the condition. PRP does not cure diabetic retinopathy, so E11.3593 often supports both sessions. If the provider later documents the treated eye as stable, code each eye as documented, such as E11.3551 with E11.3592.
Other indications carry their own codes: central retinal vein occlusion with neovascularization (H34.8111 for the right eye), branch retinal vein occlusion with neovascularization (H34.8311), and proliferative sickle cell retinopathy (H36.821), sequenced after the sickle cell disease code. None of these codes changed in the FY2027 update that took effect October 1, 2026. Code to the highest specificity the exam supports, because an unspecified-eye code (seventh character 9) on a laterality-driven procedure is an easy target for payer edits.
Why Do 67228 Claims Get Denied?
67228 claims often deny over modifiers and timing rather than medical necessity. Common causes include a missing or mismatched eye modifier, a session billed inside a global period without modifier 58 or 79, a same-day exam without a supported modifier 25, and a diagnosis code whose laterality does not match the treated eye.
Check these six points before a PRP claim goes out:
- Match the eye modifier to the diagnosis. A 67228-RT line pointed to a left-eye code invites a denial.
- Check the global calendar. Confirm whether either eye is still inside a 10-day or 90-day window, and add 58 or 79 when it is.
- Confirm the payer’s global period. Medicaid and commercial plans that still apply 90 days can bundle sessions Medicare would pay.
- Separate the exam from the decision to treat. Modifier 25 needs a significant, separately documented problem, not just the PRP evaluation.
- Justify same-day imaging separately. Retinal OCT (92134) and fundus photography (92250) carry a same-day bundling edit, which our CPT 92134 guide explains.
- Document the visual field when it matters. Extensive PRP can constrict the peripheral field, and an extended field (92083) is billable only when the record supports it; see our 92083 billing guide.
The most common issue we see providers run into is a fellow-eye session booked inside the first eye’s window without modifier 79. Consider a practice that performs 30 PRP sessions a month, with six falling in a fellow eye’s 10-day window. If those six go out without 79, the practice loses $2,046.12 a month at the 2026 national office rate, or $24,553.44 a year, before rework time.
Frequently Asked Questions
Yes. 67228 is reported per eye, per session, with RT or LT. When both eyes are treated in the same session, report modifier 50 for Medicare, which pays 150% of the single-eye amount. Each eye’s session opens its own 10-day global, so a fellow-eye session inside that window needs modifier 79.
The 2026 national Medicare rate for 67228 is $341.02 in the office and $253.85 in a facility, based on 10.21 and 7.60 total RVUs at the $33.4009 conversion factor. Local rates vary with geographic adjustments, and a same-session bilateral claim pays 150% of the single-eye amount.
Not when it is related and falls inside the global period. Routine follow-up within 10 days of a Medicare PRP session is included in the 67228 payment. After day 10, follow-up exams are billable, and an unrelated problem inside the window, such as a new complaint in the fellow eye, takes modifier 24.
Yes, when both are medically necessary. Report 67228 and 67028 with the correct eye modifiers plus the drug code. Both carry Medicare’s standard multiple procedure indicator, so the lower-valued procedure pays at 50%, and same-eye pairs should be checked against current NCCI edits before billing.
Use the E10.35, E11.35, or E13.35 code that matches the diabetes type, retinopathy status, and eye. For example, E11.3591 reports type 2 diabetes with proliferative diabetic retinopathy without macular edema in the right eye, and E11.3593 reports the same finding in both eyes.
Yes. CMS lists 67228 as payable in an ambulatory surgery center, and the physician is then paid the facility rate of $253.85 nationally while the center bills its own facility fee. PRP is also commonly performed in the office, where the higher non-facility rate covers the practice’s laser costs.
Next Steps
- Budgeting for 2027? Review the 2027 ophthalmology Medicare payment changes, including the proposed same-day cut.
- Billing OCT before or after PRP? See our CPT 92134 billing guide.
- Documenting peripheral field changes? Read the 92083 visual field billing guide.
Keep every PRP session paid. Billing Service Quotes has matched about 2,000 providers with medical billing companies, with rates starting as low as 2.95%, and matching is 100% free.
