Summary & Overview
CPT 67031: Laser Removal of Vitreous Opacities Obstructing Vision
CPT code 67031 represents a laser procedure to remove vitreous material that is obstructing a patient’s vision. This ophthalmic therapeutic intervention addresses symptomatic vitreous opacities that impair visual function and can be performed in ambulatory or hospital outpatient settings. Nationally, the code is relevant for specialty ophthalmology practices, ambulatory surgical centers, and payers managing coverage for vision-restorative procedures.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of clinical context for the procedure, expected sites of service, and the typical coding considerations tied to ophthalmic laser vitreous removal. The publication summarizes available benchmarks and coverage trends, highlights relevant billing considerations, and outlines the clinical scenarios that commonly lead to use of the code.
The content is intended for billing professionals, ophthalmology administrators, and payer policy analysts seeking a concise reference on CPT code 67031, its clinical purpose, and where it fits within outpatient ocular surgical services. Data not available in the input are noted where applicable.
Billing Code Overview
CPT code 67031 describes a procedure in which a provider uses a laser to remove vitreous material that is obstructing a patient’s vision. This is an ophthalmic therapeutic procedure focused on clearing visually significant vitreous opacities.
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Service type: Laser vitreous removal procedure (ophthalmic therapeutic service)
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Typical site of service: Usually performed in an outpatient ophthalmology clinic, ambulatory surgical center, or hospital outpatient department depending on clinical complexity and facility resources.
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Clinical & Coding Specifications
Clinical Context
A 68-year-old patient presents to an outpatient ophthalmology surgical center with progressive visual impairment in the affected eye due to vitreous opacities (floaters) centrally obstructing the visual axis. The ophthalmologist documents symptomatic visual disturbance and confirms the presence of dense vitreous debris on slit-lamp and indirect ophthalmoscopy. Preoperative evaluation includes informed consent, ocular history, medication review (anticoagulants noted), and ocular imaging when indicated. On the day of service the patient is placed under monitored anesthesia care or local retrobulbar block per surgeon preference. The provider uses a laser to fragment or vaporize obstructing vitreous material and restore visual axis clarity. The procedure is performed in an ambulatory surgery center or hospital outpatient department using sterile technique with ocular surface preparation and appropriate laser parameters. Post-procedure recovery includes topical antibiotics and anti-inflammatory drops, intraocular pressure monitoring, and instructions for activity restrictions and follow-up with the operating ophthalmologist for assessment of visual improvement and detection of complications such as retinal tear or infection.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | When billing separately for the physician’s interpretation or professional portion when facility bills technical component |