Summary & Overview
CPT 67145: Prophylactic Treatment of Retinal Detachment Without Drainage
CPT code 67145 represents the prophylactic treatment of retinal detachment, addressing retinal breaks or lattice degeneration without drainage. This procedure is a critical intervention in ophthalmology, aiming to prevent vision loss by treating at-risk retinal conditions before detachment occurs. Nationally, this code is widely recognized and reimbursed by major payers, including Aetna, Blue Cross Blue Shield, Cigna Health, Medicare, and UnitedHealthcare.
The publication provides a comprehensive overview of 67145, covering payer coverage, clinical context, and policy benchmarks. Readers will gain insight into the procedure's role in preventing retinal detachment, typical settings where it is performed, and the importance of accurate coding for reimbursement and compliance. The analysis includes updates on payer policies, common billing practices, and relevant clinical indications, offering a clear understanding of how this code fits into the broader landscape of ophthalmic surgical care.
Key topics include payer coverage trends, clinical benchmarks, and policy updates relevant to ophthalmology practices. The summary also highlights associated modifiers and taxonomies, as well as related CPT and ICD-10 codes, providing a well-rounded perspective for healthcare professionals, billing specialists, and policy analysts.
CPT Code Overview
CPT code 67145 is used to report the prophylactic treatment of retinal detachment, such as retinal breaks or lattice degeneration, without drainage. This procedure is performed to prevent the occurrence of retinal detachment and may involve one or more sessions. It falls under the category of ophthalmology surgical procedures focused on the eye's posterior segment, specifically the retina. The typical site of service for this procedure is the office (Non‑Facility) (POS 11), where ophthalmologists and retina specialists provide care in an outpatient setting.
Clinical & Coding Specifications
Clinical Context
A patient presents to an ophthalmology office with symptoms or findings suggestive of retinal breaks or lattice degeneration, often associated with degenerative myopia. The ophthalmologist evaluates the posterior segment of the eye and determines that prophylactic treatment is necessary to prevent retinal detachment. The procedure described by CPT code 67145 is performed without drainage, typically in one or more sessions, to reinforce the retina and reduce the risk of detachment. The clinical workflow involves pre-procedure assessment, informed consent, application of laser or cryotherapy, and post-procedure monitoring for complications.
Coding Specifications
Common Modifiers:
| Modifier Code | Description | When Used |
|---|---|---|
50 | Bilateral procedure | When the procedure is performed on both eyes in the same session |
80 | Assistant surgeon | When an assistant surgeon is required for the procedure |
82 | Assistant surgeon (when qualified resident not available) | When an assistant surgeon is needed and no qualified resident is available |
51 | Multiple procedures | When multiple procedures are performed during the same session |
66 | Team surgery | When the procedure is performed by a surgical team |
Associated Provider Taxonomies:
207W00000X– Ophthalmology: General eye care and surgical procedures207WX0009X– Retina Specialist: Focused on diseases and surgery of the retina207WX0107X– Uveitis and Ocular Inflammatory Disease Specialist: Specializes in inflammatory eye conditions affecting the posterior segment
Related Diagnoses
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H44.2– Degenerative myopia- Indicates the presence of degenerative myopia, a risk factor for retinal breaks and detachment, making prophylactic treatment relevant.
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H44.21– Degenerative myopia with choroidal neovascularization- Represents degenerative myopia complicated by abnormal blood vessel growth, which may increase the risk of retinal pathology.
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H44.22– Degenerative myopia with retinal detachment- Used when degenerative myopia has already led to retinal detachment; relevant for procedures aimed at preventing further detachment or recurrence.
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H44.23– Degenerative myopia with macular hole- Indicates a macular hole in the context of degenerative myopia, which may necessitate prophylactic intervention to prevent detachment.
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H44.24– Degenerative myopia with other maculopathy- Refers to other macular pathologies associated with degenerative myopia, which may increase the risk for retinal detachment and warrant prophylactic procedures.
Related CPT Codes
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67141– Prophylaxis of retinal detachment (eg, retinal break, lattice degeneration) without drainage, 1 or more sessions- This code is similar to
67145and may be used as an alternative depending on the specific clinical scenario and technique.
- This code is similar to
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67105– Repair of retinal detachment, 1 or more sessions- This code is used when an actual retinal detachment has occurred and repair is necessary, rather than prophylactic treatment. It may be used in conjunction with or as a follow-up to
67145if detachment develops.
- This code is used when an actual retinal detachment has occurred and repair is necessary, rather than prophylactic treatment. It may be used in conjunction with or as a follow-up to
These codes are related in the clinical workflow as options for either prevention (67145, 67141) or treatment (67105) of retinal detachment. They are not typically billed together unless clinically justified.
National Reimbursement Benchmarks
Medicare's national mean rate for CPT code 67145 is $254.27, which is substantially lower than the BUCA (average commercial) mean rate of $512.12. Commercial payers such as UnitedHealth Group and Cigna report even higher mean rates, with UnitedHealth Group at $810.19 and Cigna at $593.81, highlighting a significant gap between government and commercial reimbursement levels.
Rate dispersion, measured by the difference between the 75th and 25th percentiles, varies notably across payers. Medicare exhibits the tightest range at $26.00, indicating relatively consistent rates nationwide. In contrast, UnitedHealth Group shows the widest dispersion at $459.67, reflecting greater variability in commercial reimbursement. Blue Cross Blue Shield and Aetna also display moderate ranges, while Cigna and BUCA fall in between.
The table and chart below present a detailed breakdown of national mean rates and percentile values for each payer.
Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.