Summary & Overview
CPT 66150: Iris Trephination and Fistula Formation for Glaucoma
CPT code 66150 denotes an ophthalmic surgical procedure that creates a fistula by trephination with removal of iris tissue to relieve elevated intraocular pressure in glaucoma patients. This procedure is an established, procedure-specific intervention in the surgical management of glaucoma and is performed when medical or less invasive surgical treatments are insufficient. Nationally, procedural coding clarity for 66150 affects clinical documentation, facility billing, and payer coverage determinations for ophthalmic surgery.
Key payers addressed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. The publication outlines payer coverage considerations and common billing practices observed across commercial and public payers.
Readers will learn the clinical context and purpose of 66150, expected sites of service, and the typical service type involved. The report summarizes common modifiers used with this code and highlights areas where documentation and coding precision are important for claim adjudication. Policy and reimbursement trends, billing nuances, and benchmarks are presented to help coding professionals, practice managers, and policy analysts understand how 66150 is applied in practice and how payers commonly process related claims. Data not available in the input is noted where applicable.
Billing Code Overview
CPT code 66150 describes a surgical procedure in which the provider creates a fistula by trephination and removes a portion of the iris to relieve intraocular pressure in patients with glaucoma. This procedure is an operative ophthalmology service aimed at improving aqueous outflow to lower intraocular pressure.
-
Service type: Surgical ophthalmic procedure
-
Typical site of service: Ambulatory surgical center or hospital operating room
Clinical & Coding Specifications
Clinical Context
A typical patient is a 68-year-old with chronic angle-closure glaucoma who presents with progressively worsening intraocular pressure (IOP) despite maximally tolerated topical therapy and selective laser trabeculoplasty. The ophthalmologist evaluates visual acuity, slit-lamp exam, gonioscopy, and IOP measurements, documents optic nerve cupping and visual field progression, and determines a surgical intervention is indicated. In the operating room or outpatient ophthalmic procedure suite under monitored anesthesia care or local anesthesia with sedation, the surgeon performs trephination of the peripheral cornea or limbus and removes a segment of iris to create a fistula to facilitate aqueous outflow and lower IOP. Intraoperative documentation includes laterality, anesthesia type, estimated blood loss, any complications (e.g., hyphema, wound leak), and placement of sutures or adjunctive medications. Postoperative follow-up occurs within 24–48 hours, then at 1 week and monthly as needed to monitor IOP, assess wound healing, and manage medications.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services | Use when work, time, or complexity substantially exceeds typical for 66150 due to dense adhesions or extensive iris removal. |