Summary & Overview
CPT 67041: Vitrectomy with Removal of Retinal Membrane Scar Tissue
CPT code 67041 represents a pars plana vitrectomy with removal of epiretinal membrane or scar tissue that obscures vision. This posterior-segment ophthalmic surgical code is clinically significant given an aging population and the impact of retinal scarring on visual function. The procedure is typically performed in a hospital operating room or an ambulatory surgical center by vitreoretinal surgeons and often requires specialized instruments and postoperative follow-up.
Key payers covered in this overview include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise briefing on the clinical context of 67041, the common sites of service, and typical considerations tied to surgical retinal procedures.
This publication outlines what 67041 denotes clinically, why it matters nationally for surgical ophthalmology services, and what stakeholders should expect in related billing and coverage discussions. The content highlights benchmarks and policy-relevant topics such as site-of-service distinctions, payer coverage focus, and the procedural setting. Data not available in the input is noted where applicable.
Billing Code Overview
CPT code 67041 describes a surgical procedure to remove scar tissue from the retinal membrane that is impairing vision. The surgeon performs a pars plana vitrectomy, removing vitreous humor with a mechanical cutting tool to gain access to and excise the epiretinal scar tissue.
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Service type: Surgical ophthalmology — posterior segment vitrectomy with membrane peel
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Typical site of service: Hospital operating room or ambulatory surgical center
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Clinical & Coding Specifications
Clinical Context
A 68-year-old patient presents with progressive vision loss and metamorphopsia in the affected eye over several months. Clinical exam and optical coherence tomography demonstrate an epiretinal membrane (macular pucker) with traction on the macula and resulting decreased visual acuity. The retina specialist recommends pars plana vitrectomy with membrane peeling to remove the epiretinal scar tissue and release traction. The patient is prepared for an outpatient ophthalmic surgical procedure under monitored anesthesia care or general anesthesia depending on comorbidities and surgeon preference. Intraoperative steps typically include creation of three pars plana sclerotomies, removal of vitreous humor with a vitreous cutter to gain access to the retinal surface, staining and peeling of the epiretinal membrane, and fluid–air exchange or tamponade if indicated. Postoperative workflow includes same-day recovery, short-term topical antibiotics and steroids, scheduled follow-up visits to monitor retinal attachment and visual recovery, and documentation of preoperative consent, operative report describing removal of vitreous and membrane peeling, and anesthesia records. Typical site of service is an ambulatory surgical center or hospital outpatient department specializing in ophthalmic surgery.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
59 | Distinct procedural service | Use when a separate, distinct procedure is performed on the same day that is not normally reported together with vitrectomy and meets documentation requirements. |