CPT 67225
Global ZZZ ActiveEye photodynamic ther add-on
CPT 67225 Billing & Documentation Guide
CPT code 67225 (Eye photodynamic ther add-on) is classified under Surgery (Endocrine/Nervous/Eye/Ear) with a global period indicator of ZZZ. The 2026 Medicare Physician Fee Schedule assigns a work RVU of 0.46, a non-facility practice expense RVU of 0.37, and a malpractice RVU of 0.04, a total non-facility RVU of 0.87 and facility RVU of 0.66. With the current conversion factor of $33.4009, the national average non-facility reimbursement is approximately $29.72, though rates vary from $26.67 to $36.94 based on MAC locality and Geographic Practice Cost Indices (GPCIs).
When billing 67225, 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 67225 with related codes; this code has 10 PTP bundling relationships on file (see table below).
Payment Status & Global Period
Active code (paid under MPFS)
Add-on code (global concept does not apply)
MUE Limit (Medically Unlikely Edits)
Submitting more than 1 units of 67225 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 67225
| Component | Non-Facility | Facility |
|---|---|---|
| Work RVU | 0.46 | 0.46 |
| Practice Expense RVU | 0.37 | 0.16 |
| Malpractice RVU | 0.04 | 0.04 |
| Total RVU | 0.87 | 0.66 |
| Conversion Factor | $33.4009 | |
2026 Medicare Reimbursement by State, CPT 67225
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 | $31.26 | $22.96 | $29.89 - $35.59 | 29 |
| Florida | $30.37 | $23.33 | $29.19 - $31.61 | 3 |
| Georgia | $28.78 | $22.08 | $27.98 - $29.57 | 2 |
| Illinois | $29.91 | $23.13 | $28.74 - $30.96 | 4 |
| Michigan | $28.85 | $22.26 | $28.16 - $29.54 | 2 |
| North Carolina | $27.75 | $21.2 | $27.75 - $27.75 | 1 |
| New York | $31.69 | $23.87 | $28.04 - $33.52 | 5 |
| Ohio | $27.99 | $21.59 | $27.99 - $27.99 | 1 |
| Pennsylvania | $29.04 | $22.17 | $27.97 - $30.1 | 2 |
| Texas | $28.86 | $21.95 | $27.85 - $29.65 | 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 67225
Procedure-to-procedure (PTP) edits. If you bill any of these codes with 67225 on the same date of service, review the modifier indicator and payer policy before submission.
| Partner Code | Relationship | Modifier Allowed | Rationale |
|---|---|---|---|
| 0213T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 0216T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 36000 | Column 1 (primary), can be billed with modifier | Yes | Standards of medical/surgical practice |
| 36400 | Column 1 (primary), can be billed with modifier | Yes | Standards of medical/surgical practice |
| 36410 | Column 1 (primary), can be billed with modifier | Yes | Standards of medical/surgical practice |
| 36425 | Column 1 (primary), can be billed with modifier | Yes | Standards of medical/surgical practice |
| 36591 | Column 1 (primary), can be billed with modifier | No | CPT Manual or CMS manual coding instruction |
| 36592 | Column 1 (primary), can be billed with modifier | No | CPT Manual or CMS manual coding instruction |
| 37202 | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 61650 | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
Frequently Asked Questions, CPT 67225
What does CPT code 67225 mean? +
CPT code 67225 represents: Eye photodynamic ther add-on. It's in the Surgery (Endocrine/Nervous/Eye/Ear) category with a global period of ZZZ.
What is the Medicare reimbursement for CPT 67225? +
The 2026 Medicare national average non-facility payment for CPT 67225 is $29.72. Rates range from $26.67 to $36.94 across 53 states depending on MAC locality and GPCIs.
What modifiers can I use with CPT 67225? +
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 67225? +
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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