Summary & Overview
CPT 66505: Iridotomy for Angle-Closure Glaucoma
CPT code 66505 represents an ophthalmic surgical procedure used to relieve acute angle-closure glaucoma by creating two puncture-like openings in the iris (iridotomy/iridectomy-type intervention) to decompress an iris bombe. This procedure is clinically significant because it provides rapid intraocular pressure reduction in settings where forward bowing of the iris obstructs aqueous outflow and threatens vision.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. The summary addresses national relevance for hospital and ambulatory surgical settings where ophthalmologists deliver urgent or elective care to manage angle-closure physiology.
Readers will find concise clinical context about when CPT code 66505 is used, an overview of typical service settings, and the types of benchmarks and policy considerations commonly associated with ophthalmic surgical billing. Where specific data points are not provided in the input, the publication notes that data are not available in the input and focuses on clinical description, coding scope, and payer coverage context relevant to national stakeholders.
Billing Code Overview
CPT code 66505 describes a surgical procedure that creates two small puncture openings in the iris to rapidly lower intraocular pressure caused by an iris bombe. The maneuver addresses anatomic obstruction of the anterior chamber angle that produces a form of angle-closure glaucoma.
-
Service type: Ophthalmic surgical intervention to relieve acute angle-closure physiology
-
Typical site of service: Hospital operating room or ambulatory surgery center where ophthalmic surgical procedures are performed
Clinical & Coding Specifications
Clinical Context
A typical patient is an older adult presenting to an ophthalmology clinic or emergency department with acute onset severe eye pain, decreased vision, halos around lights, a mid-dilated nonreactive pupil, conjunctival injection, and a markedly elevated intraocular pressure due to a pupillary block leading to an iris bombe and secondary angle-closure glaucoma. After history, slit-lamp exam, gonioscopy, tonometry, and topical or systemic pressure-lowering therapy are performed, the ophthalmologist schedules/performes an urgent laser peripheral iridotomy to create two small full-thickness puncture-like openings in the peripheral iris to immediately relieve pupillary block and re-establish aqueous flow from the posterior to anterior chamber. The procedure is commonly performed in an outpatient ophthalmic procedure room, ambulatory surgical center, or emergency department procedure area under topical anesthesia with or without a procedural sedation or retrobulbar block. Typical workflow: triage and urgent evaluation → pretreatment with intraocular pressure-lowering medications (e.g., topical beta-blocker, alpha-agonist, osmotic agent) → informed consent and documentation of laterality and indication (acute angle-closure, narrow angles, prophylactic iridotomy) → topical anesthesia, laser iridotomy performed (often two small perforations) → immediate postprocedure intraocular pressure check, gonioscopy to confirm patency, topical anti-inflammatory and IOP-lowering drops, and postprocedure discharge instructions with follow-up within 24–72 hours.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 |