Summary & Overview
CPT 67027: Partial Vitrectomy with Intraocular Sustained‑Release Drug Implant
CPT code 67027 describes a surgical ophthalmology procedure in which a portion of the vitreous humor is removed and a slow‑release drug implant is placed into the vitreous cavity to deliver medication directly to the posterior segment of the eye, commonly used for conditions like cytomegalovirus retinitis. This code matters nationally because it represents a specialized, resource‑intensive intraocular intervention that intersects surgical, ophthalmic, and pharmaceutical billing considerations and can influence access to advanced local drug delivery therapies.
Key payers considered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical context for the procedure, typical sites of service, and the billing framework for CPT code 67027. The publication outlines common modifiers and typical service settings, summarizes payer coverage patterns where available, and highlights areas relevant for billing teams and policy analysts, such as coding specificity and clinical indications. Data not available in the input is noted where applicable. This summary equips revenue cycle and clinical staff with the foundational information needed to interpret and apply CPT code 67027 in national billing and policy contexts.
Billing Code Overview
CPT code 67027 describes a surgical intraocular procedure in which the provider performs a partial vitrectomy (removal of a portion of the vitreous humor) and inserts an implant that delivers a slow–release medication into the vitreous cavity. The device provides a sustained supply of drug directly to the posterior segment of the eye for treatment of conditions such as retinitis due to cytomegalovirus.
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Service type: Surgical, intraocular drug delivery via implant combined with partial vitrectomy
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Typical site of service: Hospital outpatient department or ambulatory surgery center (operating room or procedure suite)
Clinical & Coding Specifications
Clinical Context
A 56-year-old immunocompromised patient with progressive vision loss and floaters is diagnosed with cytomegalovirus (CMV) retinitis of the right eye. After clinical evaluation by a retina specialist, systemic antiviral therapy has been insufficient to control local disease progression. The provider schedules a pars plana vitrectomy with intravitreal placement of a sustained-release antiviral implant to deliver consistent medication directly into the vitreous cavity. Preoperative workflow includes informed consent, ocular imaging (optical coherence tomography and fundus photography), pre-op labs if indicated, and anesthesia evaluation. Intraoperatively, the vitreous is partially removed to create space and reduce viral load; an implant is inserted into the vitreous cavity under sterile conditions. Postoperative care includes topical antibiotics and steroids, intraocular pressure monitoring, activity restrictions, and follow-up retinal exams to assess implant position and treatment response. Typical site of service is an ambulatory surgery center or hospital operating room with ophthalmic surgery capability.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | Use when billing professional interpretation/technique separate from facility technical component, if applicable for imaging or reading services related to the procedure |