CPT 67107 Scleral Buckle Reimbursement & Policy | OpenPayer

Summary & Overview

CPT 67107: Scleral Buckle Repair for Retinal Detachment

CPT code 67107 represents a scleral buckle procedure to repair retinal detachment, a vision‑threatening condition that requires timely surgical management. Nationally, this code is used to report procedures where a flexible band or implant is secured to the sclera, often combined with cryotherapy or laser photocoagulation and possible drainage of subretinal fluid. The code matters because scleral buckling remains a core surgical option alongside vitrectomy for retinal detachment, and accurate coding affects clinical registries, quality measurement, and payer reimbursement processes.

Key payers addressed in this overview include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise clinical context for the procedure, the typical site of service, and what to expect from payer coverage patterns. The publication also covers where to look for benchmarks and policy updates related to operative reporting, coding nuances, and documentation considerations tied to this surgical service. This executive summary equips clinicians, coding professionals, and policy analysts with a clear framing of CPT code 67107, its clinical purpose, and the payer landscape relevant to national practice.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicare67107CPTretinal-detachmentscleral-buckleophthalmologysurgical-procedureoperating-roomophthalmic-surgery

Billing Code Overview

CPT code 67107 describes a surgical procedure to repair a detached retina by creating a scleral buckle. The provider places a flexible band or implant on the sclera in the area of retinal detachment, using techniques such as lamellar scleral dissection, imbrication, or encircling sutures. The procedure may include placement of a synthetic band (implant), application of cryotherapy (extreme cold) or photocoagulation (laser) to seal retinal tears, and drainage of subretinal fluid when indicated.

Service type: Surgical retinal detachment repair (scleral buckle procedure)

Typical site of service: Operating room / ambulatory surgery center

Data not available in the input.

Clinical & Coding Specifications

Clinical Context

A 58-year-old patient presents to the ophthalmology clinic with acute onset of flashing lights, floaters, and a curtain-like shadow in the visual field of the right eye. Clinical exam and dilated indirect ophthalmoscopy confirm a rhegmatogenous retinal detachment with a single identifiable retinal break and shallow subretinal fluid involving the superior-temporal quadrant. The surgeon schedules a scleral buckle procedure to reattach the retina: creation and placement of an encircling silicone band with cryotherapy applied to the retinal tear and external drainage of subretinal fluid. The typical clinical workflow includes preoperative informed consent, surgical site verification, general or monitored anesthesia care in an outpatient ambulatory surgery center or hospital operating room, placement of the scleral buckle and securing sutures, optional placement of an implant (band), intraoperative cryotherapy or laser photocoagulation to seal the break, controlled external drainage of subretinal fluid as indicated, closure, and postoperative recovery with immediate ophthalmic exam and scheduled follow-up visits for retinal status and visual acuity monitoring.

Coding Specifications

Modifier	Description	When to Use
`26`	Professional component	When billing only the surgeon's professional interpretation or service separate from technical facility charges (rare for this global surgical procedure).

CPT 67108: Retinal Detachment Repair with Laser or Cryotherapy

CPT-67115-SCLERAL-BUCKLE-ADJUSTMENT-RETINAL-TEAR

CPT 67115: Scleral Buckle Adjustment for Retinal Tear Repair

CPT-67105-RETINAL-DETACHMENT-LASER-PHOTOCOAGULATION-DRAINAGE

CPT 67105: Retinal Detachment Repair with Laser Photocoagulation

CPT-67121-INTRAOCULAR-LENS-REMOVAL-POSTERIOR-SEGMENT

CPT 67121: Removal of Displaced Intraocular Lens from Posterior Segment

CPT-67113-RETINAL-REATTACHMENT-COMPLEX-DETACHED-RETINA

CPT 67113: Complex Retinal Reattachment Surgery

CPT-67110-RETINAL-TAMPONADE-GAS-INJECTION

CPT 67110: Retinal Tamponade with Intravitreous Gas Injection

CPT-67101-RETINAL-DETACHMENT-REPAIR-CRYOPEXY

CPT 67101: Retinal Detachment Repair with Cryotherapy

CPT-67120-POSTERIOR-SEGMENT-IMPLANT-REMOVAL

CPT 67120: Removal of Implanted Extraocular Material From Posterior Segment

Taxonomy Code	Specialty	Notes
207W00000X	Ophthalmology	Retinal surgeons and general ophthalmologists who perform scleral buckle procedures.
207WP2300X	Ophthalmology - Vitreoretinal Surgery	Subspecialists in vitreoretinal surgery commonly performing retinal detachment repair.
2080P0005X	Optometry	May participate in diagnosis, preoperative and postoperative care but do not perform surgery in most jurisdictions.
2084P0800X	Ophthalmic Plastic and Reconstructive Surgery	Occasionally involved for complex periocular or orbital considerations; limited role in primary scleral buckle placement.
363L00000X	Anesthesiology	Anesthesia providers who deliver general or monitored anesthesia care for the procedure.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`H33.00`	Retinal detachment, unspecified, unspecified eye	General code for retinal detachment when laterality or type not documented; indicates need for repair such as scleral buckle.
`H33.00`	Retinal detachment, unspecified	Used when documentation lacks specification; necessitates surgical intervention based on examination.
`H33.011`	Rhegmatogenous retinal detachment with single tear, right eye	Classic indication for scleral buckle to indent sclera and close the retinal break.
`H33.012`	Rhegmatogenous retinal detachment with single tear, left eye	Same clinical indication for left-eye involvement.
`H33.021`	Rhegmatogenous retinal detachment with multiple tears, right eye	Multiple breaks may still be managed with scleral buckle or buckle combined with other techniques.
`H33.022`	Rhegmatogenous retinal detachment with multiple tears, left eye	Multiple tears management considerations similar to right eye.
`H33.8`	Other retinal detachments and defects	Used for less common detachments where scleral buckle may be considered depending on pathology.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`67036`	Scleral buckling; with cryotherapy for retinal detachment, single lesion	Often used for focal buckle procedures or when cryotherapy alone is applied without extensive buckling; may be an alternative or adjunct depending on technique.
`67101`	Repair of retinal detachment; with photocoagulation or cryotherapy and/or drainage of subretinal fluid, small posterior segment work	Codes for related retinal repair techniques that may be performed if limited or localized procedures are done instead of full buckle.
`67110`	Repair of retinal detachment; with vitrectomy, with or without scleral buckle	Performed when pars plana vitrectomy is combined with scleral buckling or used instead of buckle; commonly combined in complex detachments.
`67038`	Scleral buckling; with external drainage of subretinal fluid	Describes scleral buckling when external drainage is a primary component; may be reported in conjunction when coding rules allow.
`66984`	Cataract extraction with intraocular lens (complex)	Cataract surgery may be performed before, during, or after retinal detachment repair in patients with coexisting cataract that affects visualization or visual rehabilitation.

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