Reimbursement
$157.31
Threshold
N/A
2026 Status
Active
What is CPT Code 67028?
CPT 67028 is defined as: The injection of a pharmacologic agent (such as anti-VEGF medications, steroids, or antibiotics) into the vitreous body of the eye. This procedure is commonly used to treat retinal diseases including age-related macular degeneration (AMD), diabetic retinopathy, and retinal vein occlusion. It is a 'separate procedure' when performed as the only surgical service, but it is often billed with a separate J-code for the medication.
This code is primarily used for Specialist services. It falls under the category of Surgery / Eye and Ocular Adnexa and is valid for the 2026 calendar year according to the CMS Physician Fee Schedule.
2026 RVU Components
Relative Value Units (Non-Facility)
Work RVU
1.46
Physician Effort
PE (Non-Fac)
3.1
Practice Expense
Malpractice
0.15
Risk Factor
Total RVU
4.71
Note: [(Work RVU * Work GPCI) + (PE RVU * PE GPCI) + (MP RVU * MP GPCI)] * Conversion Factor
2026 CMS Policy Intelligence
efficiency adjustment
Subject to -2.5% Efficiency Adjustment. CMS assumes that the standardization of injection protocols and the high volume of these procedures in specialized clinics have reduced the average physician work time per injection.
conversion factor
Utilizes the 2026 Non-QP baseline of $33.40.
drug payment reform
Monitor CMS 'Part B Drug' policy changes in 2026, as reimbursement for the high-cost medications used with 67028 may be subject to separate inflationary caps.
Administrative Framework
Global Period
000 (0 Days)
Place of Service
NCCI Exclusions
Key Modifiers
Operational Requirements
drug j codes
The cost of the medication (e.g., Eylea, Lucentis, Avastin) is NOT included in 67028 and must be billed using the specific J-code (e.g., J0178, J2778) and appropriate dosage units.
site documentation
The procedure note must specify the site (intravitreal) and the lateralization (Right, Left, or Both).
waste documentation
If a single-use vial is used and there is leftover medication, use Modifier JW (Waste) on a separate line to bill for the discarded amount, as required by CMS.
supply billing
Most supplies used (needles, syringes, drapes) are included in the PE portion of 67028 and cannot be billed separately.
Compliance Checklist
Audit Defense
No specific audit defense elements defined.
2026 Update
Work RVU reduced by 2.5% efficiency adjustment. National payment for the professional service is ~$117.57.
Common Clinical Scenarios
No clinical examples provided.
Target Specialties & Utilization
Typical Clinical Indications (ICD-10)
Frequently Asked Questions
Maximize Revenue with AI Confidence
Stop leaving earned revenue on the table. CPT Copilot (Coming Soon) automatically handles the complexity of 2026 CMS policies, identifying every opportunity while ensuring 100% compliance.