Summary & Overview
CPT 65767: Corneal Refractive Surgery for Ametropia
CPT code 65767 represents a corneal refractive surgery used to improve vision in patients with ametropia caused by irregular corneal shape. Nationally, this code captures surgical interventions aimed at correcting corneal-induced refractive errors and is relevant to ophthalmology practices, ambulatory surgery centers, and hospital outpatient departments. It matters for payers and providers because coverage, coding accuracy, and facility allocation affect clinical workflows and reimbursement pathways.
Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. The analysis covers payer coverage patterns, common modifiers used with this service, and the clinical context for using corneal surgery to address ametropia.
Readers will find a concise clinical description, the typical sites of service, and an outline of the operational considerations tied to CPT code 65767. The publication includes benchmark-focused content where available, summaries of policy and coding considerations, and clinical context to clarify when this procedure is reported. Data not available in the input will be explicitly noted where applicable.
Billing Code Overview
CPT code 65767 describes a corneal surgery procedure performed to improve visual acuity for patients with ametropia, a refractive condition caused by an irregular corneal shape that prevents images from focusing on the retina. The procedure involves surgical modification of the cornea to reduce or correct the refractive error.
Service Type: Ophthalmic surgical procedure, corneal refractive surgery
Typical Site of Service: Hospital outpatient department or ambulatory surgery center (eye surgery suite)
Clinical & Coding Specifications
Clinical Context
A 28-year-old patient with progressive irregular astigmatism and symptomatic ametropia presents for corneal refractive surgery to improve unaided distance vision. Preoperative evaluation includes manifest refraction, corneal topography/tomography, endothelial cell count, slit-lamp exam, and discussion of risks and benefits. The patient is scheduled for corneal reshaping surgery under topical or monitored anesthesia care in an ambulatory surgery center. On the day of service, the surgeon documents informed consent, confirms preoperative markings and sterility, performs corneal tissue reshaping using a lamellar or stromal technique tailored to correct the irregular cornea, manages intraoperative complications as needed, and provides postoperative topical antibiotics and corticosteroids. Postoperative visits occur within the first week and then at 1 month and 3 months to monitor visual acuity, refraction, corneal healing, and any enhancement needs.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services | Use when the work required is substantially greater than typical for 65767 and well-documented. |
23 |