Summary & Overview

CPT 66184: Revision of Aqueous Shunt for Glaucoma

CPT code 66184 denotes the surgical revision of a previously placed aqueous shunt used to treat glaucoma when the initial implant no longer provides adequate pressure control. Nationally, this code matters because shunt revisions are a component of ongoing glaucoma management, can affect costs of long-term ophthalmic care, and influence resource use in ambulatory surgical and hospital outpatient settings. Payers addressed in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare.

Readers will learn what CPT code 66184 represents clinically, where the procedure is typically performed, and which major payers cover this service. The publication summarizes common billing considerations, typical sites of service, and clinical context for revision of aqueous shunts. It also outlines available benchmarking and policy-relevant topics for payers and providers, including utilization patterns, coding guidance where applicable, and common modifier usage noted in claims practice. Data not provided in the input are identified as unavailable. This national-level overview is intended to inform coding, billing, and policy discussions related to surgical management of glaucoma requiring device revision.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicare66184CPTophthalmologyglaucomaaqueous shuntsurgical revisionambulatory surgeryhospital outpatient

Billing Code Overview

CPT code 66184 describes a revision of a previously placed aqueous shunt for the eye. The procedure is performed when a patient fails to respond or stops responding to the initial shunt surgery and revising or adjusting the device is expected to restore appropriate aqueous outflow and intraocular pressure control.

Service Type: Surgical ophthalmic procedure — shunt revision

Typical Site of Service: Hospital outpatient department or ambulatory surgery center, depending on clinical complexity and facility resources.

Data not available in the input.

Clinical & Coding Specifications

Clinical Context

A typical patient is a 56-year-old adult with an implanted aqueous glaucoma drainage device (aqueous shunt) placed previously to control intraocular pressure (IOP) that now presents with inadequate IOP control or device-related complications. The patient reports progressive vision changes, persistently elevated IOP despite medications, or signs of over- or under-drainage. The clinical workflow includes preoperative assessment (ophthalmic exam, visual acuity, slit-lamp, gonioscopy, IOP measurement, ocular imaging as indicated), informed consent, perioperative medication management, and scheduling for operative revision. In the operating room or ambulatory surgery center under local anesthesia with sedation or general anesthesia, the ophthalmic surgeon exposes the existing shunt, evaluates tubing and plate position, revises or replaces malfunctioning components (e.g., repositioning tube, removing obstructions, repairing conjunctival erosion), and confirms flow and wound integrity. Postoperative care includes topical antibiotics and steroids, IOP monitoring, follow-up visits, and documentation of the reason for revision and specific intraoperative actions performed. Billing uses 66184 for revision of a previously placed aqueous shunt when the revision is the service rendered.

Coding Specifications

Modifier	Description	When to Use
`00`	No modifier/Not applicable (placeholder)	Not typically appended; used by some payors as a neutral identifier when no other modifier applies.

Taxonomy Code	Specialty	Notes
`207W00000X`	Ophthalmology	Primary specialty performing aqueous shunt revisions.
`207WP1001X`	Glaucoma Specialist	Subspecialist in glaucoma who commonly performs revisions and complex device management.
`207K00000X`	Optometry (with therapeutic privileges)	May co-manage pre- and postoperative care, but surgical revisions are performed by ophthalmologists.
`208D00000X`	Anesthesiology	Provides perioperative anesthesia or sedation services for ambulatory or OR procedures.
`363A00000X`	Ambulatory Surgery Center	Facility taxonomy representing common site when performed in an ASC setting.

ICD-10 Code	Description	Clinical Relevance
Data not available in the input.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`66170`	Excision of implanted glaucoma drainage device, external approach	Performed when shunt removal is required rather than revision; may precede or follow revision if removal is necessary.
`66172`	Revision or repair of glaucoma drainage device, external approach (e.g., tube repositioning or patch graft)	Closely related; used for certain external revisions and may be reported when specific repair techniques match its descriptor.
`66180`	Excision of or revision of aqueous shunt, conjunctival approach	Related anterior approach procedures for addressing conjunctival erosion or tube exposure; may be used for exposure repairs.
`66984`	Removal of implanted intraocular lens (when applicable)	Used when lens removal is required during ocular surgery in the same session; occasionally relevant if intraocular lens interferes with shunt function.
`65820`	Revision of filtering procedure (trabeculectomy)	Related glaucoma revision code when a prior trabeculectomy rather than a tube shunt requires revision; may be performed in the same patient for IOP control.
`67036`	Intravitreal injection of a pharmacologic agent (e.g., antibiotics, anti-VEGF)	May be performed perioperatively for coexisting indications or complications such as endophthalmitis; reported separately when indicated.

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