Summary & Overview
CPT 67036: Pars Plana Vitrectomy for Posterior Segment Access
CPT code 67036 represents a pars plana vitrectomy — the surgical removal of vitreous gel to access the posterior segment of the eye and introduce instruments for retinal and vitreoretinal interventions. This procedure is a high-acuity ophthalmic surgery with national relevance because it is central to managing retinal detachments, vitreous hemorrhage, macular disease, and other sight-threatening conditions that require surgical access to the posterior segment.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical context and the typical sites of service (hospital operating rooms and ambulatory surgery centers), plus operational benchmarks and policy-relevant items where available. The publication outlines billing and coding considerations specific to CPT code 67036, common modifier usage, and practical notes on service lines for ophthalmology and surgical departments.
This summary equips billing managers, surgical administrators, and policy analysts with the essentials for understanding how CPT code 67036 is used in clinical practice, what types of services it represents, and which national payers are commonly involved. Data not available in the input will be noted where relevant in subsequent sections.
Billing Code Overview
CPT code 67036 describes a surgical procedure in which the provider removes vitreous fluid from the eye (vitrectomy) to access the posterior segment and introduce surgical instruments through incisions in the pars plana. This procedure is a posterior segment ophthalmic surgery used to treat a range of retinal and vitreous conditions.
Service Type: Surgical — Posterior Segment Vitrectomy
Typical Site of Service: Hospital operating room or ambulatory surgery center (ophthalmic surgical suite)
Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A 68-year-old patient with decreased vision and floaters is diagnosed with a full-thickness macular hole and vitreous hemorrhage unresponsive to medical therapy. The ophthalmic surgeon schedules a pars plana vitrectomy to remove vitreous opacities, relieve vitreoretinal traction, and allow internal access to the posterior segment for membrane peeling and possible tamponade placement. Preoperative workflow includes ophthalmic exam with slit-lamp and dilated fundus exam, optical coherence tomography (OCT) to confirm macular pathology, informed consent documenting risks/benefits, preoperative anesthesia evaluation for monitored anesthesia care or general anesthesia, and perioperative antibiotic prophylaxis per facility protocol. Intraoperative workflow encompasses sterile preparation, placement of three-port pars plana incisions, core and peripheral vitrectomy, ancillary maneuvers (e.g., epiretinal membrane peel, fluid–air exchange, endolaser, or intraocular tamponade with gas or silicone oil), and documentation of any complications. Postoperative care includes topical antibiotics and corticosteroids, positioning instructions if gas tamponade is used, early follow-up within 24–48 hours, and OCT or clinical exams to monitor retinal reattachment and macular status.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services | Use when the vitrectomy required substantially greater effort, time, or complexity than usual (extensive dissection, complex retinal work) and documentation supports the increased work. |