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CPT 66160: Glaucoma Fistula with Sclera and Iris Excision
CPT code 66160 denotes a glaucoma surgery involving creation of a fistula with partial excision of the sclera and iris to reduce intraocular pressure. This procedure is a clinically significant intervention for patients with refractory or advanced glaucoma where medical therapy or less invasive procedures are insufficient. Nationally, surgical glaucoma codes like 66160 are important for access to specialty ophthalmic care and for shaping payment and utilization patterns across inpatient and outpatient surgical settings. Key payers in consideration include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical context, typical sites of service, and the scope of services captured by this code. The publication also provides benchmarking metrics, payer coverage considerations, and relevant policy developments affecting reimbursement and prior authorization for surgical glaucoma care. The content is aimed at helping coding professionals, billing analysts, and policy stakeholders understand how CPT code 66160 maps to clinical practice and payer administration at a national level. Data not available in the input is noted where necessary.
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Billing Code Overview
CPT code 66160 describes a surgical procedure for glaucoma in which the provider creates a fistula and excises portions of the sclera and iris to lower intraocular pressure. This procedure is an ophthalmic surgical intervention intended to establish an alternate aqueous outflow pathway to relieve elevated intraocular pressure associated with glaucoma.
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Service type: Surgical ophthalmology procedure
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Typical site of service: Hospital operating room or ambulatory surgical center