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CPT 66185: Removal and Replacement of Aqueous Shunt with Graft

CPT code 66185 represents surgical removal of a previously implanted aqueous shunt that has failed or caused complications, with placement of a replacement shunt in a different ocular site and use of a graft to reinforce the plate. This code captures a complex ophthalmic revision and replacement procedure performed to restore aqueous outflow and manage device-related issues. Nationally, management of glaucoma and postoperative device complications drives utilization of this service across inpatient and ambulatory surgical settings.

Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise clinical and billing overview of the procedure, common modifiers and coding context, and guidance on typical sites of service. The publication highlights benchmarking points and areas where payers commonly apply clinical review or payment edits for shunt revision and replacement procedures.

The content outlines the clinical circumstances that prompt use of this code, expected care settings, and the administrative considerations that affect adjudication and billing. Data not available in the input are noted where applicable. This national-level summary is intended for coders, billing managers, and clinical leaders seeking a focused reference on CPT code 66185 and its place in ophthalmic surgical practice and reimbursement workflows.

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Billing Code Overview

CPT code 66185 describes removal of a previously implanted aqueous shunt that is not functioning properly or has device-related complications, followed by placement of a new aqueous shunt in a different ocular location. The procedure includes use of a graft to reinforce the tissue securing the shunt plate.

Service type: Surgical implant revision and replacement of an ocular drainage device
Typical site of service: Hospital operating room or ambulatory surgical center for ophthalmic surgery

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CPT 66185: Removal and Replacement of Aqueous Shunt with Graft

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Billing Code Overview

Service type: Surgical implant revision and replacement of an ocular drainage device
Typical site of service: Hospital operating room or ambulatory surgical center for ophthalmic surgery

Clinical & Coding Specifications

Clinical Context

A 68-year-old patient with primary open-angle glaucoma presents with progressive optic nerve damage and uncontrolled intraocular pressure despite maximal tolerated medical therapy and a prior placement of an aqueous shunt (glaucoma drainage device). The previously implanted device has failed to control intraocular pressure due to tube obstruction and encapsulation around the plate, or the device has developed erosion/infection. The ophthalmic surgeon schedules a case to explant the nonfunctioning aqueous shunt and implant a new glaucoma drainage device in an alternate quadrant. During the procedure the surgeon dissects fibrotic tissue around the plate, removes the old plate and tube, selects a new plate position, secures the new plate to the sclera, tunnels and inserts the tube into the anterior chamber, and places a patch graft (e.g., pericardium, sclera, or corneal tissue) to reinforce the tissue overlying the plate and tube.

Typical workflow: preoperative assessment and informed consent, measure visual acuity and intraocular pressure, topical and/or regional anesthesia, surgical explantation of the failed shunt, implantation and fixation of a new shunt in a different quadrant, coverage of plate/tube with graft material, intraoperative confirmation of tube position and flow, closure, postoperative antibiotic and steroid regimen, and scheduled follow-up visits to monitor intraocular pressure and wound healing.

Typical site of service: ambulatory surgery center or hospital outpatient department.

Service type: operative ophthalmic procedure involving removal and replacement of an implanted aqueous shunt with reinforcement graft placement.

Coding Specifications

Modifier	Description	When to Use
`00`	Procedure code change — used for updated coding when a different code is reported	Rarely used; only when payer requires legacy `00` modifier for code change reporting
`11`	Primary procedure	When this shunt removal and replacement is the primary service of the encounter
`22`	Increased procedural services	When work, time, or complexity is substantially greater than usual for `66185`
`52`	Reduced services	When the procedure is partially reduced or discontinued after anesthesia initiated
`57`	Data not available in the input.
`59`	Distinct procedural service	When another unrelated procedure is performed during the same operative session and needs to be distinguished from `66185`
`62`	Two surgeons	When two surgeons work together as primary surgeons during the operation
`78`	Return to the operating room for a related procedure during the postoperative period	If the patient returns to OR for a complication related to the original `66185` within global period
`79`	Unrelated procedure or service by the same physician during the postoperative period	When an unrelated procedure is performed during the global period for `66185`
`LT`	Left side	When the procedure is performed on the left eye
`RT`	Right side	When the procedure is performed on the right eye
`50`	Bilateral procedure	When bilateral shunt explant/reimplantation are performed (use per payer rules)
`62`	Two surgeons	When two surgeons work together as primary surgeons during the operation
`63`	Procedure performed on infants less than 4 kg	Rarely applicable; use when documented and payer requires
`80`	Assistant surgeon	When an assistant surgeon provided services during the case

Taxonomy Code	Specialty	Notes
`207W00000X`	Ophthalmology	Retinal/Glaucoma surgeons and general ophthalmologists who perform glaucoma drainage device procedures
`207WP1001X`	Ophthalmology — Glaucoma	Subspecialty glaucoma surgeons primarily performing shunt implantation and revision
`2080P0206X`	Surgery — Ophthalmic Plastic and Reconstructive Surgery	Oculoplastic surgeons who may be involved in complex anterior segment or adnexal reconstruction related to device erosion
`363L00000X`	Adult Care — Ophthalmology	Provider taxonomy used for adult ophthalmic surgical care
`208000000X`	Surgery	General surgeons are generally not applicable but listed when multidisciplinary care is involved

Related Diagnoses

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

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`66180`	Excision of implant and reinsertion of aqueous shunt into the anterior chamber; without patch graft	Alternative revision procedure when no graft is used; similar explant/reimplant technique but differs by graft placement
`66186`	Removal of ophthalmic implant (e.g., shunt) without reinsertion	Used if only explantation is performed without immediate replacement
`66183`	Revision of aqueous shunt without removal of existing plate (e.g., repositioning/tube revision)	Performed when tube or conjunctival issues are corrected without full explant and reinsertion
`65778`	Patch graft of sclera, cornea, or pericardium to cover glaucoma device	Often reported when a separate, distinct patch graft procedure is performed to cover the tube or plate (if not included in primary code per payer rules)
`66984`	Cataract extraction with intraocular lens implantation, complex	May be performed concurrently or staged if visual rehabilitation or combined surgery is planned

CPT 66179: Aqueous Shunt Placement, External Approach

CPT-66180-GLAUCOMA-DRAINAGE-DEVICE-IMPLANTATION-ANTERIOR-CHAMBER

CPT 66180: Glaucoma Drainage Device Implantation, Anterior Chamber

CPT-66183-GLAUCOMA-DEVICE-INSERTION-ANTERIOR-CHAMBER

CPT 66183: Anterior Chamber Glaucoma Device Insertion

CPT-66184-AQUEOUS-SHUNT-REVISION

CPT 66184: Revision of Aqueous Shunt for Glaucoma

References

1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.

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Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

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Clinical & Coding Specifications

Clinical Context

Typical site of service: ambulatory surgery center or hospital outpatient department.

Service type: operative ophthalmic procedure involving removal and replacement of an implanted aqueous shunt with reinforcement graft placement.

Coding Specifications

Modifier	Description	When to Use
`00`	Procedure code change — used for updated coding when a different code is reported	Rarely used; only when payer requires legacy `00` modifier for code change reporting
`11`	Primary procedure	When this shunt removal and replacement is the primary service of the encounter
`22`	Increased procedural services	When work, time, or complexity is substantially greater than usual for `66185`
`52`	Reduced services	When the procedure is partially reduced or discontinued after anesthesia initiated
`57`	Data not available in the input.
`59`	Distinct procedural service	When another unrelated procedure is performed during the same operative session and needs to be distinguished from `66185`
`62`	Two surgeons	When two surgeons work together as primary surgeons during the operation
`78`	Return to the operating room for a related procedure during the postoperative period	If the patient returns to OR for a complication related to the original `66185` within global period
`79`	Unrelated procedure or service by the same physician during the postoperative period	When an unrelated procedure is performed during the global period for `66185`
`LT`	Left side	When the procedure is performed on the left eye
`RT`	Right side	When the procedure is performed on the right eye
`50`	Bilateral procedure	When bilateral shunt explant/reimplantation are performed (use per payer rules)
`62`	Two surgeons	When two surgeons work together as primary surgeons during the operation
`63`	Procedure performed on infants less than 4 kg	Rarely applicable; use when documented and payer requires
`80`	Assistant surgeon	When an assistant surgeon provided services during the case

Taxonomy Code	Specialty	Notes
`207W00000X`	Ophthalmology	Retinal/Glaucoma surgeons and general ophthalmologists who perform glaucoma drainage device procedures
`207WP1001X`	Ophthalmology — Glaucoma	Subspecialty glaucoma surgeons primarily performing shunt implantation and revision
`2080P0206X`	Surgery — Ophthalmic Plastic and Reconstructive Surgery	Oculoplastic surgeons who may be involved in complex anterior segment or adnexal reconstruction related to device erosion
`363L00000X`	Adult Care — Ophthalmology	Provider taxonomy used for adult ophthalmic surgical care
`208000000X`	Surgery	General surgeons are generally not applicable but listed when multidisciplinary care is involved

Related Diagnoses

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

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`66180`	Excision of implant and reinsertion of aqueous shunt into the anterior chamber; without patch graft	Alternative revision procedure when no graft is used; similar explant/reimplant technique but differs by graft placement
`66186`	Removal of ophthalmic implant (e.g., shunt) without reinsertion	Used if only explantation is performed without immediate replacement
`66183`	Revision of aqueous shunt without removal of existing plate (e.g., repositioning/tube revision)	Performed when tube or conjunctival issues are corrected without full explant and reinsertion
`65778`	Patch graft of sclera, cornea, or pericardium to cover glaucoma device	Often reported when a separate, distinct patch graft procedure is performed to cover the tube or plate (if not included in primary code per payer rules)
`66984`	Cataract extraction with intraocular lens implantation, complex	May be performed concurrently or staged if visual rehabilitation or combined surgery is planned

CPT 66179: Aqueous Shunt Placement, External Approach

CPT-66180-GLAUCOMA-DRAINAGE-DEVICE-IMPLANTATION-ANTERIOR-CHAMBER

CPT 66180: Glaucoma Drainage Device Implantation, Anterior Chamber

CPT-66183-GLAUCOMA-DEVICE-INSERTION-ANTERIOR-CHAMBER

CPT 66183: Anterior Chamber Glaucoma Device Insertion

CPT-66184-AQUEOUS-SHUNT-REVISION

CPT 66184: Revision of Aqueous Shunt for Glaucoma

References

1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.

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Trek Health powers OpenPayer with a leading commercial payer intelligence platform, seamlessly converting fragmented payer data into actionable insights for provider organizations.

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CPT 66185: Removal and Replacement of Aqueous Shunt with Graft

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Billing Code Overview

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CPT 66185: Removal and Replacement of Aqueous Shunt with Graft

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Billing Code Overview

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Related Diagnoses

Related CPT Codes

Related Codes

References

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Related Diagnoses

Related CPT Codes

Related Codes

References