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 |