Summary & Overview
CPT 67101: Retinal Detachment Repair with Cryotherapy
CPT code 67101 represents cryopexy for repair of a detached retina, a retinal surgical technique that uses extreme cold to reattach the neurosensory retina and may include subretinal fluid drainage. This code is a key surgical entry point for ophthalmology and retinal specialty billing and is relevant across hospital-based and ambulatory surgical settings nationwide. Nationally, retinal detachment repair has clinical and cost implications because timely, definitive surgical care affects visual outcomes and downstream service use.
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 67101, benchmarks and utilization patterns where available, common modifier usage, and notes on typical sites of service and procedure pairing. The content outlines billing and coding considerations commonly associated with retinal detachment repair using cryotherapy, and highlights areas where policy updates or payer-specific coverage details commonly arise. Data not provided in the input (such as associated taxonomies, ICD-10 diagnoses, or payer-specific reimbursement rates) is noted as unavailable.
Billing Code Overview
CPT code 67101 describes a surgical procedure to repair a detached retina using extreme cold (cryopexy). The procedure may include drainage of subretinal fluid when required.
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Service type: Surgical retinal repair using cryotherapy
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Typical site of service: Hospital operating room or ambulatory surgical center
Clinical & Coding Specifications
Clinical Context
A typical patient is a 62-year-old male who presents to the ophthalmology clinic with sudden onset of floaters and a shadow in the peripheral vision that progressed over 24–72 hours. Clinical exam and dilated fundus exam confirm a rhegmatogenous retinal detachment with one or more full-thickness retinal breaks and localized subretinal fluid. The surgeon elects to perform cryopexy with retinal reattachment using external cryotherapy to create a chorioretinal adhesion and, when indicated, to drain subretinal fluid through a small external retinotomy. Preoperative workflow includes informed consent, visual acuity and intraocular pressure documentation, biomicroscopy and wide-field fundus photography, and discussion of anesthesia options (local retrobulbar block or monitored anesthesia care). The procedure is typically performed in an ambulatory surgery center or hospital operating room under sterile conditions. Postoperative workflow includes topical antibiotic and steroid drops, activity restrictions, positioning instructions if required, follow-up within 24–72 hours for IOP check and wound assessment, and scheduled retinal re-evaluation for retinal reattachment and visual recovery monitoring.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | Use when submitting only the physician’s professional portion if technical component billed separately by facility. |