Table 1. Medicare Allowable Costs For Panretinal Photocoagulation/Intravitreal Ranibizumab And Associated Treatments.
| Procedure | CPT Code | Facility | Nonfacility | ||||||
|---|---|---|---|---|---|---|---|---|---|
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| Professional Fee | Facility Fee | Anesthesia | Total | Professional Fee | Facility Fee | Anesthesia | Total | ||
| PRP | 67228 | $354 | $440 | $0 | $794 | $393 | $0 | $0 | $393 |
| Intravitreal injection | 67028 | $116 | $280 | $0 | $396 | $117 | $0 | $0 | $117 |
| OCT | 92134 | $51 | $56 | $0 | $107 | $51 | $0 | $0 | $51 |
| Fundus photography | 92250 | $91 | $91 | $0 | $182 | $91 | $0 | $0 | $91 |
| Focal laser | 67210 | $578 | $440 | $0 | $1018 | $598 | $0 | $0 | $598 |
| PPV with PRP | 67040 | $1203 | $3381 | $250 | $4834 | $1204 | $1711 | $250 | $3165 |
| New comprehensive eye examination | 92004 | $111 | $102 | $0 | $213 | $168 | $0 | $0 | $168 |
| Intermediate follow-up examination | 92012 | $59 | $102 | $0 | $162 | $97 | $0 | $0 | $97 |
CPT = Current Procedural Terminology; OCT = optical coherence tomography; PPV = pars plana vitrectomy; PRP = panretinal photocoagulation.