Intravitreal Injection (Drug Injection into the Eye)
CPT 67028 is an intravitreal injection, a procedure where medication is injected directly into the eye. It is performed over 650,000 times per year on Medicare beneficiaries for conditions like macular degeneration, diabetic macular edema, and retinal vein occlusion. Providers charge an average of $562.06 for the injection procedure alone (4.9x markup over Medicare's $114.23 office rate). The drug itself is billed separately and can cost $50 to $1,800 per dose. Patients who need Avastin ($50 to $80) instead of Eylea ($1,800) can save over $1,000 per injection with similar clinical outcomes.
CPT 67028 at a Glance
- Average provider charge (injection): $562.06
- Medicare rate (office): $114.23
- Medicare rate (hospital, physician only): ~$56.07
- Typical markup: 4.9x over Medicare office rate
- Drug cost (billed separately): $50 to $1,800
- Frequency: Monthly or every 6 to 8 weeks
- Annual injection cost: ~$6,744 (procedure only)
- Beneficiaries (2023): 653,581
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How the Medicare Rate Is Calculated
Medicare values every procedure using Relative Value Units (RVUs) across three components, then multiplies by the national conversion factor of $33.4009 (2026). For an intravitreal injection, the work RVU reflects the physician skill required to inject medication into the eye safely. The practice expense includes the sterile supplies and clinical staff time needed for the procedure.
| Component | What It Covers | Office (Non-Facility) | Hospital (Facility) |
|---|---|---|---|
| Work RVU | Physician skill and time for the injection | 1.44 | 1.44 |
| Practice Expense RVU | Sterile supplies, clinical staff, exam room | 1.74 | 0.12 |
| Malpractice RVU | Professional liability (eye procedures carry higher risk) | 0.12 | 0.12 |
| Total RVU | 3.30 | 1.68 | |
| x $33.4009 | 2026 conversion factor | $114.23 | $56.07 |
Medicare Rate by State
Medicare adjusts the national rate based on your location using Geographic Practice Cost Indices (GPCIs). The same intravitreal injection pays differently in each state, from $81.92 in Arkansas to $113.02 in Alaska.
Medicare Rate by State (2026)
Medicare adjusts payments by location using Geographic Practice Cost Indices (GPCIs). Select your state to see the adjusted rate.
Sample State Rates (Office Setting)
| State | Medicare Pays | Avg. Charge | Markup |
|---|---|---|---|
| Texas (Austin) | $93.30 | $562.06 | 6.0x |
| California (Los Angeles) | $99.37 | $562.06 | 5.7x |
| New York (Manhattan) | $100.36 | $562.06 | 5.6x |
| Florida (Fort Lauderdale) | $94.22 | $562.06 | 6.0x |
| Ohio | $86.39 | $562.06 | 6.5x |
| Mississippi | $82.77 | $562.06 | 6.8x |
| Arkansas | $81.92 | $562.06 | 6.9x |
| Alaska | $113.02 | $562.06 | 5.0x |
Rates shown are for the non-facility (office) setting using 2026 GPCIs and the $33.4009 conversion factor. The average provider charge of $562.06 is the 2023 national average from CMS utilization data. Drug costs are billed separately and not included in these figures.
What Insured Patients Actually Pay for Eye Injections
Your cost for intravitreal injections has two components: the injection procedure and the drug. Both are billed to insurance separately. The total depends on which drug your doctor uses and your plan design:
| Your Situation | Injection + Drug (per visit) | How It Works |
|---|---|---|
| Medicare Part B (Avastin) | $23 + $10 to $16 = ~$35 | 20% of approved amounts for injection + drug |
| Medicare Part B (Eylea) | $23 + $360 = ~$383 | 20% of approved amounts for injection + drug |
| Commercial insurance (deductible met, Avastin) | $40 to $80 | 20% coinsurance on injection + low-cost drug |
| Commercial insurance (deductible met, Eylea) | $200 to $500 | 20% coinsurance on injection + expensive drug |
| High-deductible plan (not met, Eylea) | $800 to $2,400 | Full negotiated rate for injection + drug |
Should You Use Insurance or Pay Cash?
For intravitreal injections, using insurance almost always makes sense because of the recurring nature of the treatment. Patients typically need injections monthly or every 6 to 8 weeks indefinitely, meaning you will likely meet your deductible early in the year and then pay only coinsurance for the remaining treatments.
Why Insurance Almost Always Wins Here
- Recurring monthly treatments mean you hit your deductible quickly
- Once at out-of-pocket maximum, all subsequent injections are covered at 100%
- Drug costs (especially Eylea/Lucentis) are prohibitive without insurance
- Many retina specialists participate in manufacturer copay assistance programs
Cost Reduction Strategies
- Ask about Avastin instead of Eylea/Lucentis (saves $1,000+ per injection)
- Apply for manufacturer patient assistance programs (Regeneron, Genentech)
- Ask about "treat-and-extend" protocols to reduce injection frequency
- Confirm your retina specialist is in-network before starting treatment
Common Billing Problems with Intravitreal Injections
Billing the office visit separately on injection days
Some practices bill a separate office visit (99213 or 99214) on the same day as the injection. While this is sometimes legitimate if a distinct evaluation is performed, it is not appropriate when the visit is solely to administer the scheduled injection. If you see both an E/M code (99213/99214) and 67028 on the same date of service, ask whether a separate and distinct evaluation was documented. The injection code (67028) already includes a brief assessment of the eye.
Drug wastage charges
Avastin is purchased in larger vials and divided among multiple patients. Some practices charge for "drug wastage" if the vial is not fully used. Medicare allows billing for discarded drug using modifier JW, but the patient should not be paying for an entire vial when only a small portion is used. Review your EOB for unusually high Avastin charges. If you are being charged more than $80 to $100 for the Avastin dose, the billing may include inappropriate wastage fees.
Using Eylea/Lucentis without discussing Avastin
Some retina practices default to Eylea or Lucentis without discussing Avastin as an option. While there are clinical scenarios where Eylea may be preferred (certain cases of diabetic macular edema respond slightly better), for wet AMD the evidence shows comparable outcomes. If your doctor starts you on Eylea or Lucentis without discussion, ask: "Would Avastin be appropriate for my condition?" The answer may save you over $1,000 per injection in cost-sharing.
Bilateral injection billing
If both eyes are injected on the same day, the second injection should be billed with modifier -50 (bilateral) or with modifier -RT/-LT (right/left). Some practices incorrectly bill both injections at the full rate without modifiers, or fail to apply bilateral surgery rules that reduce the second side's payment. Check that bilateral injections are not being billed as two completely separate full-price procedures.
Related Eye Procedure Codes
| Code | Description | Medicare (Office) | Avg. Charge |
|---|---|---|---|
| 67028 | Intravitreal injection of drug | $114.23 | $562.06 |
| 92134 | OCT scan of retina (diagnostic imaging) | $42.00 | $150.00 |
| 92250 | Fundus photography | $34.00 | $120.00 |
| 92235 | Fluorescein angiography | $85.00 | $350.00 |
| 67210 | Retinal laser treatment (focal) | $210.00 | $850.00 |
Frequently Asked Questions
How much does an intravitreal injection cost without insurance?
The injection procedure (CPT 67028) averages $562 without insurance. However, the drug is billed separately and can cost $50 to $1,800 per dose depending on the medication used. Avastin costs $50 to $80, Lucentis approximately $1,100, and Eylea approximately $1,800. The total cost per treatment ranges from $600 to $2,400 without insurance. For Medicare patients, the out-of-pocket for injection plus drug ranges from approximately $35 (with Avastin) to $383 (with Eylea) after the Part B deductible.
Is Avastin as effective as Eylea or Lucentis for macular degeneration?
Multiple clinical studies, including the landmark CATT trial sponsored by the National Eye Institute, have shown that Avastin (bevacizumab) has similar efficacy to Lucentis and Eylea for treating wet age-related macular degeneration. Avastin costs $50 to $80 per dose versus $1,100 to $1,800 for the alternatives. The main difference is that Avastin is used "off-label" for eye injections (it is FDA-approved for cancer), while Lucentis and Eylea are specifically approved for eye conditions. Despite this, Avastin is widely used by retina specialists worldwide. Ask your doctor if it is appropriate for your condition.
How often do you need intravitreal injections?
Most patients start with monthly injections for 3 to 6 months (the "loading phase"), then may transition to a "treat-and-extend" protocol with injections every 6 to 12 weeks depending on their response. Some patients need ongoing monthly treatments indefinitely. At $562 per injection procedure plus drug costs, annual expenses can exceed $10,000 for the procedure fees alone (approximately $562 x 12 = $6,744 per year), plus $600 to $21,600 in drug costs depending on which medication is used.
Does Medicare cover intravitreal injections?
Yes, Medicare Part B covers intravitreal injections when medically necessary for conditions like wet AMD, diabetic macular edema, and retinal vein occlusion. You pay 20% of the Medicare-approved amount for both the injection procedure and the drug after meeting your Part B deductible ($257 in 2026). For the injection procedure, your 20% share is approximately $22.85. For the drug, your 20% varies: approximately $10 to $16 for Avastin, $220 for Lucentis, or $360 for Eylea per injection.
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