CPT 67028: Intravitreal Injection, Isolated Procedure
Medicare pays $118 and commercial payers pay $394 on average nationally for this procedure.
CPT code 67028 describes an intravitreal injection where the provider injects medication directly into the vitreous chamber of the eye as an isolated or separate procedure, typically classified as an ophthalmic injection service provided in an ambulatory surgical center or office-based ophthalmology setting for treatment of retinal conditions.
For related coverage guidance, see recent payer policy updates: Evaluation of Dry Eyes, Evaluation of Dry Eyes, Ophthalmic Prostaglandin Analog Prior Authorization Criteria.
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National Reimbursement Benchmarks
Medicare’s mean rate sits at $118, well below BUCA’s average commercial mean of $393.6, indicating a sizable gap between government and commercial reimbursements for CPT 67028. That divergence highlights how commercial payers on average pay roughly three times Medicare for this code, with BUCA positioned substantially above the Medicare baseline.
Dispersion (P75–P25) varies across payers: Blue Cross Blue Shield shows the widest interquartile spread at $213.0 (P75 $680.7 minus P25 $466.7), followed by Aetna at $107.0, Cigna at $137.7, UnitedHealth Group at $114.4, and BUCA at $179.0 (P75 $480.7 minus P25 $308.6). Aetna has the tightest IQR relative to the others in this list, while Blue Cross Blue Shield is the most dispersed.