Summary & Overview
CPT 0936T: Retinal Photobiomodulation Therapy
CPT code 0936T denotes a single-session photobiomodulation therapy procedure targeting the retina. This emerging procedural code captures use of low-level light to stimulate retinal cell repair, reduce inflammation, and support healing. As retinal light therapies gain clinical interest, clear coding and payer coverage policies matter for access, consistency of billing, and tracking utilization nationally.
Key payers in the coverage landscape include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of the clinical service represented by the code, payer inclusion in the analysis, and what to expect in the publication: national coverage and reimbursement benchmarks where available, common billing considerations, and clinical context for appropriate use. The report highlights service settings and operational implications for ophthalmology and ambulatory procedure sites.
Data not available in the input for specific associated taxonomies, ICD-10 pairings, related codes, and service-line details are noted where applicable.
Billing Code Overview
CPT code 0936T describes a single-session photobiomodulation therapy applied to the retina, a low-level light therapy intended to stimulate healing, reduce inflammation, and promote cellular repair in the light-sensitive layer at the back of the eye. The procedure involves use of targeted low-intensity light directed to the retina by a qualified provider.
Service type: Retinal photobiomodulation therapy (single-session, procedural)
Typical site of service: Outpatient ophthalmology clinic or ambulatory surgery/procedure center, where specialized retinal imaging and controlled light-delivery equipment are available.
Clinical & Coding Specifications
Clinical Context
A typical patient is a 65-year-old with chronic, non-exudative age-related macular degeneration (AMD) or persistent diabetic macular dysfunction who presents with progressive central visual blurring and metamorphopsia despite optimized medical therapy. The ophthalmologist or retina specialist performs a focused retinal examination including visual acuity, dilated fundus exam, optical coherence tomography (OCT), and fundus photography. After confirming retinal pathology amenable to adjunctive light therapy, the provider obtains informed consent and schedules a single photobiomodulation session (0936T).
During the visit, the patient is positioned at the device, pupillary status is assessed, and ocular surface is prepared. Low-level light is applied to the posterior pole/retina per device protocol. The session is typically brief and performed in an ambulatory clinic or outpatient ophthalmology procedure suite. Post-procedure instructions are given, and follow-up imaging (OCT) is planned within weeks to assess response. Billing uses the single-session code 0936T for the photobiomodulation treatment of the retina.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services | Use when the photobiomodulation session required substantially greater work, documented rationale and additional resources beyond typical single-session care. |
50 | Bilateral procedure | Use when both eyes receive separate, reportable single-session photobiomodulation and payer policy allows bilateral modifier on this service.
51 | Multiple procedures | Use when 0936T is reported in the same encounter with other distinct procedures and payer requires a multiple-procedure modifier for secondary services.
52 | Reduced services | Use when the session was partially reduced or abbreviated and documentation supports limited service.
53 | Discontinued procedure | Use when the treatment session was started but discontinued due to patient instability or procedural complication.
73 | Discontinued outpatient hospital/ASC prior to anesthesia | Use when the outpatient photobiomodulation was discontinued before administration of anesthesia in the facility setting.
80 | Assistant surgeon | Use if an assistant surgeon actively aided the primary surgeon during a related operative retinal procedure; rarely applicable to standalone 0936T but included when combined procedures require assistance.
81 | Minimum assistant surgeon | Use when a lesser level assistant surgeon service is documented during a combined procedure.
82 | Assistant not available | Use when a qualified assistant surgeon was unavailable and an unqualified person assisted, as documented in combined-procedure settings.
AS | Physician assistant, nurse practitioner, or clinical nurse specialist billing — facility | Use when a qualified non-physician practitioner performs or assists with the service in an ambulatory surgery center and payer requires AS to denote facility-based APP service.
| Taxonomy Code | Specialty | Notes |
|---|---|---|
207W00000X | Ophthalmology | Retina and general ophthalmologists commonly perform and oversee photobiomodulation for retinal indications. |
207WR0200X | Ophthalmic Retina Specialist | Subspecialists focused on medical and surgical retina indications typically deliver or direct retinal photobiomodulation.
363L00000X | Optometry | Therapeutic optometrists may participate in referral, imaging, and post-procedure follow-up; scope varies by state.
362W00000X | Physician Assistant | PA providers in ophthalmology practices may assist with procedure setup, device operation per state scope and supervising physician protocols.
363A00000X | Nurse Practitioner | NPs in ophthalmology clinics may perform follow-up care and limited device-based treatments according to state scope and supervisory arrangements.
Related Diagnoses
| ICD-10 Code | Description | Clinical Relevance |
|---|---|---|
H35.31 | Nonexudative age-related macular degeneration | Photobiomodulation is used experimentally or adjunctively for retinal neuroprotection and inflammation modulation in dry AMD. |
H35.32 | Exudative age-related macular degeneration | May be part of combined management strategies where photobiomodulation is adjunctive to anti-VEGF therapy.
E11.329 | Type 2 diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edema | Photobiomodulation may be used as adjunctive therapy to reduce retinal inflammation and support cellular repair.
E11.311 | Type 2 diabetes mellitus with unspecified diabetic retinopathy with macular edema | Adjunctive low-level light therapy can be considered in multimodal treatment plans for diabetic macular involvement.
H35.89 | Other specified retinal disorders | Used when a specific retinal degenerative or inflammatory condition is documented and photobiomodulation is indicated.
H44.3 | Unspecified disorder of globe | Occasionally used as a provisional code pending more specific retinal diagnosis during workup prior to treatment.
Related CPT Codes
| CPT Code | Description | Relationship to This Procedure |
|---|---|---|
67028 | Intravitreal injection of a pharmacologic agent | Often performed before or after photobiomodulation in patients receiving intravitreal therapy for wet AMD or diabetic macular edema; may be part of combined management. |
92134 | Scanning computerized ophthalmic diagnostic imaging, posterior segment, with interpretation and report (OCT) | Used pre- and post-procedure to document retinal structure and monitor response to 0936T.
92250 | Fundus photography with interpretation and report | Provides baseline and follow-up photographic documentation of retinal appearance for treatment planning and outcomes tracking.
99213 | Office or other outpatient visit for the evaluation and management of an established patient, typically 15 minutes | Common E/M code for the clinic visit in which photobiomodulation is evaluated, consented, or followed up; use as appropriate for the encounter.
0100T | Photodynamic therapy (PDT) for retina (example technology-dependent code) | Represents other light-based retinal therapies; may be performed in different clinical scenarios and informs payer adjudication when combining light-based treatments.