CPT 67218
Global 090 ActiveTreatment of retinal lesion
CPT 67218 Billing & Documentation Guide
CPT code 67218 (Treatment of retinal lesion) is classified under Surgery (Endocrine/Nervous/Eye/Ear) with a global period indicator of 090. The 2026 Medicare Physician Fee Schedule assigns a work RVU of 19.85, a non-facility practice expense RVU of 13.15, and a malpractice RVU of 1.58, a total non-facility RVU of 34.58 and facility RVU of 34.58. With the current conversion factor of $33.4009, the national average non-facility reimbursement is approximately $1180.12, though rates vary from $1067.48 to $1491.36 based on MAC locality and Geographic Practice Cost Indices (GPCIs).
When billing 67218, ensure documentation supports medical necessity and the specific components required for the code's level of service. For E/M codes, document MDM (medical decision-making) elements: problems addressed, data reviewed, and risk. For procedural codes, document the indication, technique, and any complications. Always verify NCCI edits before bundling 67218 with related codes; this code has 10 PTP bundling relationships on file (see table below).
Payment Status & Global Period
Active code (paid under MPFS)
90-day global period (major surgery: 1 day pre-op + procedure + 90 days post-op)
MUE Limit (Medically Unlikely Edits)
Submitting more than 1 units of 67218 for the same patient on the same date triggers automatic line denial unless an appropriate modifier and supporting documentation justify the higher quantity.
RVU Breakdown, CPT 67218
| Component | Non-Facility | Facility |
|---|---|---|
| Work RVU | 19.85 | 19.85 |
| Practice Expense RVU | 13.15 | 13.15 |
| Malpractice RVU | 1.58 | 1.58 |
| Total RVU | 34.58 | 34.58 |
| Conversion Factor | $33.4009 | |
2026 Medicare Reimbursement by State, CPT 67218
State-level averages across all MAC localities. Non-facility rates typically apply to office-based services; facility rates apply to hospital outpatient / inpatient.
| State | Non-Facility | Facility | Range (Non-Fac) | Localities |
|---|---|---|---|---|
| California | $1235.1 | $1235.1 | $1183.95 - $1397.58 | 29 |
| Florida | $1206.42 | $1206.42 | $1162.22 - $1253.7 | 3 |
| Georgia | $1146.17 | $1146.17 | $1117.7 - $1174.63 | 2 |
| Illinois | $1190.58 | $1190.58 | $1146.5 - $1230.18 | 4 |
| Michigan | $1149.72 | $1149.72 | $1123.6 - $1175.83 | 2 |
| North Carolina | $1106.52 | $1106.52 | $1106.52 - $1106.52 | 1 |
| New York | $1256.18 | $1256.18 | $1117.37 - $1325.68 | 5 |
| Ohio | $1117.21 | $1117.21 | $1117.21 - $1117.21 | 1 |
| Pennsylvania | $1155.61 | $1155.61 | $1116.08 - $1195.13 | 2 |
| Texas | $1148.09 | $1148.09 | $1111.73 - $1177.08 | 8 |
Source: CMS PFSRVU 2026 · Updated 2026-04-01. Full locality-level detail available for all 53 states, contact us for custom reports.
NCCI Bundling Edits, CPT 67218
Procedure-to-procedure (PTP) edits. If you bill any of these codes with 67218 on the same date of service, review the modifier indicator and payer policy before submission.
| Partner Code | Relationship | Modifier Allowed | Rationale |
|---|---|---|---|
| 0124T | Column 1 (primary), can be billed with modifier | Yes | Anesthesia service included in surgical procedure |
| 0186T | Column 1 (primary), can be billed with modifier | Yes | Anesthesia service included in surgical procedure |
| 0213T | Column 1 (primary), can be billed with modifier | No | Misuse of Column Two code with Column One code |
| 0216T | Column 1 (primary), can be billed with modifier | No | Misuse of Column Two code with Column One code |
| 0228T | Column 1 (primary), can be billed with modifier | No | Standards of medical/surgical practice |
| 0230T | Column 1 (primary), can be billed with modifier | No | Standards of medical/surgical practice |
| 0465T | Column 1 (primary), can be billed with modifier | Yes | Standards of medical/surgical practice |
| 0596T | Column 1 (primary), can be billed with modifier | Yes | Standards of medical/surgical practice |
| 0597T | Column 1 (primary), can be billed with modifier | Yes | Standards of medical/surgical practice |
| 0708T | Column 1 (primary), can be billed with modifier | Yes | Standards of medical/surgical practice |
Frequently Asked Questions, CPT 67218
What does CPT code 67218 mean? +
CPT code 67218 represents: Treatment of retinal lesion. It's in the Surgery (Endocrine/Nervous/Eye/Ear) category with a global period of 090.
What is the Medicare reimbursement for CPT 67218? +
The 2026 Medicare national average non-facility payment for CPT 67218 is $1180.12. Rates range from $1067.48 to $1491.36 across 53 states depending on MAC locality and GPCIs.
What modifiers can I use with CPT 67218? +
Surgery codes commonly use modifier 22 (increased procedural services), 50 (bilateral), 51 (multiple procedures), 52 (reduced services), 58/78/79 (staged, unplanned return, unrelated within global), 62 (co-surgeons), 80/82 (assistant surgeon), and 59 or the X{EPSU} subset for distinct procedural service.
What bundling edits apply to CPT 67218? +
This code has 10 NCCI PTP bundling relationships. See the NCCI Bundling section below for full list.
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Reviewed by the PayerReady Medical Coding Team
Verified against the CMS 2026 code set on May 31, 2026.
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