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CPT 67028: Intravitreal Injection into Vitreous Chamber
CPT code 67028 denotes an intravitreal injection: a targeted procedure in which medication is delivered directly into the vitreous chamber of the eye as an isolated or separate service. This procedure is central to modern ophthalmic care for posterior segment conditions because it enables high local drug concentrations while minimizing systemic exposure. Nationally, intravitreal injections are a common outpatient procedure with significant utilization and payer interest due to drug costs and frequency of administration.
Key payers examined in this publication include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. The analysis covers coverage considerations, coding context, and clinical scenarios associated with the code.
Readers will find a concise explanation of what 67028 represents, typical sites of service and clinical indications, how it relates to related procedural codes, and the set of primary payers included in the review. The publication also outlines common billing modifiers and linked ICD-10 diagnoses used in practice, plus operational notes relevant to coding and claims submission. Data not available in the input is explicitly noted where applicable.
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Billing Code Overview
CPT code 67028 describes an intravitreal injection procedure in which a clinician injects medication directly into the vitreous chamber of the eye as an isolated or separate procedure. The service is performed when an intravitreal route is required to deliver pharmacologic therapy to the posterior segment of the eye.
Service type: In-office or ambulatory procedural injection of intravitreal medication
Typical site of service: Ophthalmology clinic, outpatient surgical center, or other ambulatory care setting where procedures on the eye are performed
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.