Summary & Overview
CPT 66852: Pars Plana Lensectomy with Possible Vitrectomy
CPT code 66852 denotes a pars plana lensectomy, a surgical removal of lens material performed through a pars plana incision to treat a cataract that obscures vision; the procedure often includes limited removal of vitreous humor. This code is used in ophthalmology billing for cases where a posterior approach is required rather than a standard anterior approach, and it has implications for facility use, surgeon skill set, and postoperative care pathways.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise clinical context for when CPT code 66852 is reported, typical sites of service, and common billing modifiers used alongside the code. The publication summarizes national reimbursement benchmarks and utilization considerations, outlines relevant policy or coverage nuances across major payers, and highlights areas where coding clarity affects claim processing and payment. Practical information on service line placement and expected clinical workflow is provided to help coding, billing, and compliance teams understand how this ophthalmic procedure is represented on the claim form.
Data not available in the input is noted where payer-specific rates, associated taxonomies, and ICD-10 diagnosis pairings would normally appear.
Billing Code Overview
CPT code 66852 describes a surgical procedure in which the provider removes lens material through a pars plana incision to treat a visually significant cataract. The procedure may include partial removal of the vitreous humor as part of the approach to access and extract the lens material.
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Service type: Ophthalmic surgical procedure, pars plana lensectomy with possible limited vitrectomy
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Typical site of service: Hospital operating room or ambulatory surgery center
Clinical & Coding Specifications
Clinical Context
A 72-year-old patient with a dense, posteriorly dislocated cataract fragment in the vitreous cavity after complicated phacoemulsification presents with decreased vision, floaters, and intermittent photopsia. The retinal specialist evaluates the patient in clinic, documents diminished visual acuity and media opacity on exam, and schedules a pars plana lensectomy with possible limited vitrectomy to remove the cataract material and clear the visual axis. Preoperative workflow includes informed consent, anesthesia evaluation (often monitored anesthesia care or regional block), biometry review, and retinal imaging when indicated. In the operating room the surgeon makes a pars plana incision(s), performs lensectomy via vitrector through the pars plana, and removes displaced lens fragments; additional core vitrectomy is performed as needed to access and safely extract lens material. Postoperative care includes same-day recovery, topical antibiotics and steroids, retina checks in the first postoperative week, monitoring for intraocular pressure elevation, and scheduling further surgical or medical management if retinal tears or persistent inflammation occur.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | No modifier | Standard reporting when no specific modifier applies |
22 |