Summary & Overview
CPT 65875: Incisional Lysis of Posterior Synechiae, Anterior Segment
CPT code 65875 denotes an incisional ophthalmic procedure to sever posterior synechiae of the anterior segment, often performed as part of glaucoma management to restore anterior chamber anatomy and facilitate aqueous flow. Nationally, this code matters because it captures a focused anterior segment surgical intervention used by ophthalmic surgeons and impacts commercial and Medicare outpatient surgical utilization and payment for glaucoma-related care. Payers in scope include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare.
This publication provides a concise clinical and billing profile for 65875, covering expected settings of care, common procedural context, and the types of benchmarks and policy topics readers can expect: utilization benchmarks for ambulatory surgical centers and hospital outpatient departments, payer coverage patterns and prior authorization trends, and clinical context regarding when incision-based lysis of posterior synechiae is used in glaucoma treatment. Where specific data fields were not supplied in the source, the text notes that data are not available in the input. The goal is to give payers, revenue cycle teams, and clinicians a clear national-level reference for coding, site-of-service expectations, and areas where payer policy or utilization management may affect use of CPT code 65875.
Billing Code Overview
CPT code 65875 describes an incisional procedure to sever posterior synechiae in the anterior segment of the eye, performed with or without injection of air or liquid, typically as a treatment step in glaucoma management. The procedure uses an incision-based technique to break adhesions between the iris and the lens or cornea (posterior synechiae) to restore anterior chamber anatomy and improve aqueous flow.
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Service type: Surgical, anterior segment ophthalmic procedure
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Typical site of service: Ambulatory surgical center or hospital outpatient department
Clinical & Coding Specifications
Clinical Context
A 68-year-old patient with a history of chronic angle-closure glaucoma presents with decreased vision and intermittent eye pain in the affected eye. On slit-lamp exam the ophthalmologist identifies posterior synechiae between the iris and the anterior lens capsule causing pupillary irregularity and impaired aqueous outflow. Medical management with topical mydriatics and anti-inflammatory agents has been insufficient to break the adhesions. The surgeon schedules an incisional lysis of posterior synechiae under monitored anesthesia care in an ophthalmic procedure room or ambulatory surgery center. The workflow includes preoperative consent and topical or local anesthesia, intraoperative gonioscopic visualization, a small iris or synechiolysis incision using micro-instruments or scissors, with or without injection of air or balanced salt solution to reform the anterior chamber and separate the iris from the lens. Postoperative care includes topical antibiotics, steroid drops, intraocular pressure monitoring, and follow-up visits to assess pupil function and glaucoma control. Typical billing uses 65875 for the incisional synechiolysis procedure; the typical site of service is an ambulatory surgery center or hospital outpatient department, and service type is minor ophthalmic surgical procedure.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | When reporting only the surgeon's professional component separate from technical facility resources, if payer allows split billing. |