Summary & Overview

CPT 00145: Anesthesia for Vitreoretinal Surgery

CPT code 00145 denotes anesthesia services furnished for vitreoretinal surgery, covering anesthetic management during procedures on the vitreous and retina. This code is nationally relevant because vitreoretinal surgery is a common subspecialty ophthalmic procedure that often requires specialized anesthesia techniques to manage patient immobility, ocular physiology, and potential intraoperative complications. Accurate coding affects clinical workflow, reimbursement, and quality reporting across surgical and anesthesiology practices.

Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna Health, United Healthcare, and Medicare. Readers will find a concise overview of clinical context for anesthesia in vitreoretinal procedures, expected sites of service, and how this code fits within related ophthalmic and anesthesia service lines. The publication also highlights typical billing considerations and comparator procedure codes used in ophthalmic surgery bundles.

The analysis provides national benchmarks and policy-relevant guidance on coding alignment (where available), reimbursement patterns across major payers, and common clinical scenarios that drive use of this anesthesia code. The goal is to help hospital administrators, anesthesiologists, and coding professionals understand the role of CPT code 00145 in perioperative documentation and claims submission for vitreoretinal surgical cases.

AetnaBlue Cross Blue ShieldCigna HealthUnited HealthcareMedicareCPT 00145anesthesiaophthalmologyvitreoretinal surgerysurgical anesthesiaanesthesiologyoperating roomambulatory surgery center

Billing Code Overview

CPT code 00145 describes anesthesia services provided for vitreoretinal surgery. The service involves administration and management of anesthesia by an anesthesiology provider for a patient undergoing procedures on the vitreous and/or retina.

Service type: Anesthesia for ophthalmic surgery (vitreoretinal procedures)
Typical site of service: Operating room or ambulatory surgical center where vitreoretinal surgery is performed

Clinical & Coding Specifications

Clinical Context

A 72-year-old patient with progressive visual decline from an age-related cataract (H25.9) presents for vitreoretinal surgery to address a complicated lens and posterior segment pathology. The ophthalmic surgeon schedules a pars plana vitrectomy with possible membrane peel and intraocular lens manipulation under anesthesia. Preoperative evaluation by the anesthesia team documents medical history including hypertension and controlled diabetes, assigns an ASA physical status of P3, and discusses anesthesia options with the patient.

On the day of surgery the typical workflow includes preoperative regional anesthesia (peribulbar or retrobulbar block) or monitored anesthesia care with sedation, induction of general endotracheal anesthesia when required (for complex cases or patient factors), intraoperative anesthetic management during vitreoretinal maneuvers, and immediate postoperative recovery in the PACU with monitoring for ocular and systemic complications. Communication between the ophthalmic surgeon and anesthesiologist guides intraoperative adjustments for patient positioning, airway management, and hemodynamic control. Typical settings are an ambulatory surgery center or hospital operating room experienced in ophthalmic microsurgery.

Coding Specifications

The following modifiers are most clinically relevant for anesthesia services for vitreoretinal surgery. Use the modifier that accurately reflects the clinical circumstance per CMS definitions.

Modifier	Description	When to Use
`AA`	Anesthesia services performed personally by an anesthesiologist	Use when the named anesthesiologist personally performs the anesthesia service.
`AD`	Medical supervision by a physician; more than four concurrent anesthesia procedures	Use when the anesthesiologist supervises CEs and is responsible for more than four cases concurrently.
`QK`	Medical direction of two, three, or four concurrent anesthesia procedures involving qualified individuals	Use when the anesthesiologist medically directs multiple concurrent qualified anesthesia providers (CRNAs) for this case.
`QX`	CRNA service with medical direction by a physician (QK-QX combination)	Use on the CRNA claim when the anesthesiologist medically directs the CRNA for this procedure.
`QS`	Monitored anesthesia care service	Use when the service provided is monitored anesthesia care rather than general or regional anesthesia.
`62`	Two surgeons	Use when two surgeons of different specialties or same specialty perform distinct portions of the procedure requiring two surgeons.
`78`	Unplanned return to the operating room by the same physician following initial procedure for a related procedure during the postoperative period	Use when an unplanned return to OR for a complication of the vitreoretinal procedure occurs.
`23`	Unusual surgical procedure requiring markedly greater anesthesia than is usually required	Use when the procedure necessitates significantly greater anesthesia resources than typical for ophthalmic cases.
`52`	Reduced services	Use when the anesthesia service provided is partially reduced or not completed as originally intended.
`53`	Discontinued procedure	Use when the procedure is terminated due to patient condition or intraoperative complications before completion.
`55`	Postoperative management only	Use when the anesthesiologist only provides postoperative pain management separate from intraoperative care.

Taxonomy Code	Specialty	Notes
`207L00000X`	Anesthesiology Physician	Primary provider taxonomy for physician anesthesiologists delivering general, regional, or MAC services for vitreoretinal surgery.
`208D00000X`	Ophthalmology	Ophthalmic surgeons perform the vitreoretinal procedure; listed here as collaborating specialty (billing under surgeon taxonomies).
`363LP0200X`	Certified Registered Nurse Anesthetist (CRNA)	Common qualified provider for anesthesia delivery under medical direction or supervision models.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`H25.9`	Unspecified age-related cataract	Age-related lens opacity that may coexist with vitreoretinal disease and influence surgical planning and anesthesia.
`H26.9`	Unspecified cataract	General cataract diagnosis relevant when lens opacity contributes to visual impairment and may be addressed during vitreoretinal procedures.
`H27.00`	Aphakia, unspecified eye	Absence of the crystalline lens; relevant for intraocular lens management during posterior segment surgery and anesthetic considerations.
`H28`	Cataract in diseases classified elsewhere	Cataract secondary to systemic or ocular disease; influences combined surgical approaches with vitreoretinal intervention.
`H52.4`	Presbyopia	Age-related loss of near vision; often present in the surgical population but not a direct indication for vitreoretinal surgery; relevant to overall visual rehabilitation planning.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`66984`	Extracapsular cataract removal with insertion of intraocular lens prosthesis	Cataract extraction and IOL placement may occur concurrently with or prior to vitreoretinal surgery when lens pathology contributes to posterior segment disease.
`66982`	Complex cataract surgery with insertion of intraocular lens prosthesis	Used for cataract procedures with unusual complexity that may be performed in conjunction with vitreoretinal surgery.
`66821`	Discission of secondary membranous cataract	Performed when posterior capsular opacification or secondary membranes require treatment during the same operative episode.
`67028`	Intravitreal injection of a pharmacologic agent	May be performed preoperatively, intraoperatively, or postoperatively for adjunctive pharmacologic therapy related to vitreoretinal conditions.