CPT 67113: Complex Retinal Detachment Repair

Medicare pays $1141 on average nationally for this procedure.

CPT code 67113 describes complex repair of a detached retina involving vitrectomy with membrane peeling, reattachment using cryotherapy or diathermy, possible placement of a scleral buckle, drainage of subretinal fluid, and may include lens removal or intraocular tamponade; service type: surgical retinal detachment repair (pars plana vitrectomy with retinal membrane peel and reattachment) and typical site of service: hospital operating room or ambulatory surgery center.

For related coverage guidance, see recent payer policy updates: Evaluation of Dry Eyes, Evaluation of Dry Eyes, Ophthalmic Prostaglandin Analog Prior Authorization Criteria.

Customize your policy alerts

Sign up for cpt 67113 policy alerts

Get alerted when payer policies referencing 67113 are released or updated.

Monitor payer policy activity

Receive email alerts as soon as relevant payer policies are published or updated.

Explore openpayer tools

View all tools

CPT 67113: Complex Retinal Detachment Repair

Medicare pays $1141 on average nationally for this procedure.

For related coverage guidance, see recent payer policy updates: Evaluation of Dry Eyes, Evaluation of Dry Eyes, Ophthalmic Prostaglandin Analog Prior Authorization Criteria.

Customize your policy alerts

Sign up for cpt 67113 policy alerts

Get alerted when payer policies referencing 67113 are released or updated.

Monitor payer policy activity

Receive email alerts as soon as relevant payer policies are published or updated.

Clinical & Coding Specifications

Clinical Context

A 62-year-old patient presents with progressive vision loss and flashes/floaters in the affected eye. Ophthalmic examination and dilated fundoscopy confirm a rhegmatogenous retinal detachment with proliferative vitreoretinopathy (PVR) and extensive subretinal fluid. The patient is scheduled for a primary complex retinal reattachment procedure under regional or general anesthesia.

Preoperative workflow includes informed consent, ocular imaging (optical coherence tomography, B-scan ultrasonography if view is limited), biometry if lens removal is anticipated, and medical clearance. In the operating room, the vitreoretinal surgeon performs a pars plana vitrectomy with removal of vitreous gel, membrane peeling of epiretinal or subretinal membranes, and retinopexy using cryotherapy and/or endolaser. A scleral buckle may be placed to support the retinal break(s) and subretinal fluid may be drained. If required for access or lens opacities, the surgeon performs a lensectomy or phacoemulsification with or without intraocular lens placement. Intraocular tamponade (gas or silicone oil) may be instilled to reapproximate the retina postoperatively. Postoperative care includes positioning instructions, topical antibiotics and steroids, intraocular pressure monitoring, and early follow-up to assess attachment and identify complications such as elevated IOP, infection, or recurrent detachment.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`67036`	Vitrectomy, pars plana; removal of vitreous opacities, with or without air/fluid exchange — non-complex vitrectomy	Performed for simpler vitrectomy cases; less extensive than `67113`, may be used for diagnostic or less complicated detachments
`67110`	Repair of retinal detachment; with photocoagulation, cryotherapy, or diathermy — without vitrectomy	External approaches for certain detachments; may be performed instead of or prior to vitrectomy in select cases
`66710`	Removal of vitreous, surgical; removal of lens and implantation of intraocular lens (when cataract extraction is performed with vitrectomy)	Used when concurrent lens removal and IOL placement are necessary during retinal repair
`67121`	Repair of recurrent retinal detachment, complicated, with vitrectomy (often includes membrane peeling and tamponade)	Used for complex recurrent detachments; relates to management of persistent or recurrent detachments following initial surgery
`67039`	Vitrectomy, pars plana; with removal of subretinal fluid or internal tamponade (complex vitrectomy)	Performed as part of complex retinal reattachment procedures when extensive internal work is required

Notes:

If no related CPT codes were provided in the input, commonly associated codes are listed above as typically performed alongside or sequentially with 67113.

Related Modifiers

5 rows

Modifier	Description	When to Use
25	CPT modifier 25 indicates that on the same day as another procedure or service, the same physician or other qualified health care professional provided a significant, separately identifiable…	- When to apply: Use modifier 25 only on an E/M code to indicate the same provider delivered a significant, separately identifiable E/M service on the same day as another procedure or service — i.e.,…
22	Modifier –22 (Increased Procedural Services) is used when a reported procedure is substantially more extensive than normally required. The CPT Manual and CMS state it may be appended only when the…	- When to use: Append modifier -22 to a procedural CPT code when the service performed is substantially more extensive than the usual service described by that code — i.e., the procedure required…
91	Modifier 91 — “Repeat Clinical Diagnostic Laboratory Test” — is appended when the exact same CPT laboratory test is performed more than once for the same patient on the same day because serial,…	- Use modifier 91 when the exact same CPT laboratory test is performed more than once on the same patient on the same date because serial or repeated testing is medically necessary to monitor…
P5	Modifier P5 denotes a moribund patient who is not expected to survive without the operative procedure and is used only with anesthesia CPT codes 00100–01999. The anesthesia provider must append P5…	- Use modifier P5 only when the anesthesia provider determines the patient is moribund and not expected to survive without the operation, and append it only to anesthesia CPT codes 00100–01999…
[object Object]

Related Provider Taxonomies

8 rows

Taxonomy Code	Specialty	Notes
207W00000X	Ophthalmology Physician	An ophthalmologist has the knowledge and professional skills needed to provide comprehensive eye and vision care. Ophthalmologists are medically train…
2080P0207X	Pediatric Hematology & Oncology Physician	A pediatrician trained in the combination of pediatrics, hematology and oncology to recognize and manage pediatric blood disorders and cancerous disea…
237600000X	Audiologist-Hearing Aid Fitter	An audiologist/hearing aid fitter is the professional who specializes in evaluating and treating people with hearing loss, conducts a wide variety of …
2086S0122X	Plastic and Reconstructive Surgery Physician	A surgeon who specializes in plastic and reconstructive surgery.
1223X2210X	Orofacial Pain Dentistry	A dentist who assesses, diagnoses, and treats patients with complex chronic orofacial pain and dysfunction disorders, oromotor and jaw behavior disord…
367H00000X	Anesthesiologist Assistant	An individual certified by the state to perform anesthesia services under the direct supervision of an anesthesiologist. Anesthesiologist Assistants …
171100000X	Acupuncturist	An acupuncturist is a person who performs ancient therapy for alleviation of pain, anesthesia and treatment of some diseases. Acupuncturists use long,…
3336H0001X	Home Infusion Therapy Pharmacy	Pharmacy-based, decentralized patient care organization with expertise in USP 797-compliant sterile drug compounding that provides care to patients wi…

Related ICD-10-CM Codes

15 rows

ICD-10-CM Code	Description
E11.319	Type 2 diabetes mellitus with unspecified diabetic retinopathy without macular edema
H11.10	Unspecified conjunctival degenerations
H11.129	Conjunctival concretions, unspecified eye
H33.001	Unspecified retinal detachment with retinal break, right eye
H33.002	Unspecified retinal detachment with retinal break, left eye
H33.41	Traction detachment of retina, right eye
H33.42	Traction detachment of retina, left eye
H33.8	Other retinal detachments
H35.30	Unspecified macular degeneration
H35.33	Angioid streaks of macula

Showing 1–10 of 15

Related Payer Policy Updates

Specialty: Ophthalmology/Optometry1 / 3

10 rows

Policy	Payer	Effective Date
Evaluation of Dry Eyes	Oscar Health	2026-10-01
Evaluation of Dry Eyes	Blue Cross Blue Shield - New Mexico	2026-09-04
Ophthalmic Prostaglandin Analog Prior Authorization Criteria	medimpact	2026-09-01
revakinagene taroretcel-lwey (Encelto) coverage for idiopathic macular telangiectasia (MacTel) type 2	blue cross blue shield - louisiana	2026-09-01
Glaucoma Prostaglandins	Cigna	2026-08-15
Corneal Cross‑linking (CXL) Procedure	husky_health	2026-08-01
Corneal surgical procedures (excluding corneal collagen cross-linking)	husky_health	2026-08-01
Intracanalicular and Intravitreal Corticosteroid Implants	UnitedHealthcare	2026-08-01
Eye Optical Coherence Tomography	Premera Bluecross	2026-08-01
Encelto (Revakinagene Taroretcel-Lwey) implant — coverage criteria	Colorado Rocky Mountain Health Plans	2026-08-01

CPT 67101: Retinal Detachment Repair with Cryotherapy

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

CPT 67105: Retinal Detachment Repair with Laser and Drainage

CPT-67107-SCLERAL-BUCKLE-RETINAL-DETACHMENT-REPAIR

CPT 67107: Scleral Buckle Repair for Retinal Detachment

CPT-67108-RETINAL-DETACHMENT-REPAIR-LASER-CRYOTHERAPY-VITRECTOMY

CPT 67108: Retinal Detachment Repair with Vitrectomy/Scleral Buckle

CPT-67110-RETINAL-TAMPONADE-GAS-INJECTION

CPT 67110: Pneumatic Retinopexy (Vitreous Gas Injection)

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

CPT 67115: Scleral Buckle Adjustment

CPT-67120-POSTERIOR-SEGMENT-IMPLANT-REMOVAL

CPT 67120: Removal of Implanted Extraocular Material, Posterior Segment

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

CPT 67121: Removal of Subluxed Intraocular Lens, Posterior Segment

Frequently Asked Questions

References

1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.

Published by

Trek Health powers OpenPayer with a leading commercial payer intelligence platform, seamlessly converting fragmented payer data into actionable insights for provider organizations.

Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

Explore openpayer tools

View all tools

Clinical & Coding Specifications

Clinical Context

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`67036`	Vitrectomy, pars plana; removal of vitreous opacities, with or without air/fluid exchange — non-complex vitrectomy	Performed for simpler vitrectomy cases; less extensive than `67113`, may be used for diagnostic or less complicated detachments
`67110`	Repair of retinal detachment; with photocoagulation, cryotherapy, or diathermy — without vitrectomy	External approaches for certain detachments; may be performed instead of or prior to vitrectomy in select cases
`66710`	Removal of vitreous, surgical; removal of lens and implantation of intraocular lens (when cataract extraction is performed with vitrectomy)	Used when concurrent lens removal and IOL placement are necessary during retinal repair
`67121`	Repair of recurrent retinal detachment, complicated, with vitrectomy (often includes membrane peeling and tamponade)	Used for complex recurrent detachments; relates to management of persistent or recurrent detachments following initial surgery
`67039`	Vitrectomy, pars plana; with removal of subretinal fluid or internal tamponade (complex vitrectomy)	Performed as part of complex retinal reattachment procedures when extensive internal work is required

Notes:

If no related CPT codes were provided in the input, commonly associated codes are listed above as typically performed alongside or sequentially with 67113.

Related Modifiers

5 rows

Modifier	Description	When to Use
25	CPT modifier 25 indicates that on the same day as another procedure or service, the same physician or other qualified health care professional provided a significant, separately identifiable…	- When to apply: Use modifier 25 only on an E/M code to indicate the same provider delivered a significant, separately identifiable E/M service on the same day as another procedure or service — i.e.,…
22	Modifier –22 (Increased Procedural Services) is used when a reported procedure is substantially more extensive than normally required. The CPT Manual and CMS state it may be appended only when the…	- When to use: Append modifier -22 to a procedural CPT code when the service performed is substantially more extensive than the usual service described by that code — i.e., the procedure required…
91	Modifier 91 — “Repeat Clinical Diagnostic Laboratory Test” — is appended when the exact same CPT laboratory test is performed more than once for the same patient on the same day because serial,…	- Use modifier 91 when the exact same CPT laboratory test is performed more than once on the same patient on the same date because serial or repeated testing is medically necessary to monitor…
P5	Modifier P5 denotes a moribund patient who is not expected to survive without the operative procedure and is used only with anesthesia CPT codes 00100–01999. The anesthesia provider must append P5…	- Use modifier P5 only when the anesthesia provider determines the patient is moribund and not expected to survive without the operation, and append it only to anesthesia CPT codes 00100–01999…
[object Object]

Related Provider Taxonomies

8 rows

Taxonomy Code	Specialty	Notes
207W00000X	Ophthalmology Physician	An ophthalmologist has the knowledge and professional skills needed to provide comprehensive eye and vision care. Ophthalmologists are medically train…
2080P0207X	Pediatric Hematology & Oncology Physician	A pediatrician trained in the combination of pediatrics, hematology and oncology to recognize and manage pediatric blood disorders and cancerous disea…
237600000X	Audiologist-Hearing Aid Fitter	An audiologist/hearing aid fitter is the professional who specializes in evaluating and treating people with hearing loss, conducts a wide variety of …
2086S0122X	Plastic and Reconstructive Surgery Physician	A surgeon who specializes in plastic and reconstructive surgery.
1223X2210X	Orofacial Pain Dentistry	A dentist who assesses, diagnoses, and treats patients with complex chronic orofacial pain and dysfunction disorders, oromotor and jaw behavior disord…
367H00000X	Anesthesiologist Assistant	An individual certified by the state to perform anesthesia services under the direct supervision of an anesthesiologist. Anesthesiologist Assistants …
171100000X	Acupuncturist	An acupuncturist is a person who performs ancient therapy for alleviation of pain, anesthesia and treatment of some diseases. Acupuncturists use long,…
3336H0001X	Home Infusion Therapy Pharmacy	Pharmacy-based, decentralized patient care organization with expertise in USP 797-compliant sterile drug compounding that provides care to patients wi…

Related ICD-10-CM Codes

15 rows

ICD-10-CM Code	Description
E11.319	Type 2 diabetes mellitus with unspecified diabetic retinopathy without macular edema
H11.10	Unspecified conjunctival degenerations
H11.129	Conjunctival concretions, unspecified eye
H33.001	Unspecified retinal detachment with retinal break, right eye
H33.002	Unspecified retinal detachment with retinal break, left eye
H33.41	Traction detachment of retina, right eye
H33.42	Traction detachment of retina, left eye
H33.8	Other retinal detachments
H35.30	Unspecified macular degeneration
H35.33	Angioid streaks of macula

Showing 1–10 of 15

Related Payer Policy Updates

Specialty: Ophthalmology/Optometry1 / 3

10 rows

Policy	Payer	Effective Date
Evaluation of Dry Eyes	Oscar Health	2026-10-01
Evaluation of Dry Eyes	Blue Cross Blue Shield - New Mexico	2026-09-04
Ophthalmic Prostaglandin Analog Prior Authorization Criteria	medimpact	2026-09-01
revakinagene taroretcel-lwey (Encelto) coverage for idiopathic macular telangiectasia (MacTel) type 2	blue cross blue shield - louisiana	2026-09-01
Glaucoma Prostaglandins	Cigna	2026-08-15
Corneal Cross‑linking (CXL) Procedure	husky_health	2026-08-01
Corneal surgical procedures (excluding corneal collagen cross-linking)	husky_health	2026-08-01
Intracanalicular and Intravitreal Corticosteroid Implants	UnitedHealthcare	2026-08-01
Eye Optical Coherence Tomography	Premera Bluecross	2026-08-01
Encelto (Revakinagene Taroretcel-Lwey) implant — coverage criteria	Colorado Rocky Mountain Health Plans	2026-08-01

CPT 67101: Retinal Detachment Repair with Cryotherapy

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

CPT 67105: Retinal Detachment Repair with Laser and Drainage

CPT-67107-SCLERAL-BUCKLE-RETINAL-DETACHMENT-REPAIR

CPT 67107: Scleral Buckle Repair for Retinal Detachment

CPT-67108-RETINAL-DETACHMENT-REPAIR-LASER-CRYOTHERAPY-VITRECTOMY

CPT 67108: Retinal Detachment Repair with Vitrectomy/Scleral Buckle

CPT-67110-RETINAL-TAMPONADE-GAS-INJECTION

CPT 67110: Pneumatic Retinopexy (Vitreous Gas Injection)

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

CPT 67115: Scleral Buckle Adjustment

CPT-67120-POSTERIOR-SEGMENT-IMPLANT-REMOVAL

CPT 67120: Removal of Implanted Extraocular Material, Posterior Segment

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

CPT 67121: Removal of Subluxed Intraocular Lens, Posterior Segment

Frequently Asked Questions

References

1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.

Published by

Trek Health powers OpenPayer with a leading commercial payer intelligence platform, seamlessly converting fragmented payer data into actionable insights for provider organizations.

OpenPayer

CPT 67113: Complex Retinal Detachment Repair

Sign up for cpt 67113 policy alerts

OpenPayer

CPT 67113: Complex Retinal Detachment Repair

Sign up for cpt 67113 policy alerts

Clinical & Coding Specifications

Clinical Context

Related CPT Codes

Related Modifiers

Related Provider Taxonomies

Related ICD-10-CM Codes

Related Payer Policy Updates

Related Codes

References

Clinical & Coding Specifications

Clinical Context

Related CPT Codes

Related Modifiers

Related Provider Taxonomies

Related ICD-10-CM Codes

Related Payer Policy Updates

Related Codes

References

CPT 67113: Complex Retinal Detachment Repair

Sign up for cpt 67113 policy alerts

CPT 67113: Complex Retinal Detachment Repair

Sign up for cpt 67113 policy alerts

Clinical & Coding Specifications

Clinical Context

Related CPT Codes

Related Modifiers

Related Provider Taxonomies

Related ICD-10-CM Codes

Related Payer Policy Updates

Related Codes

What does CPT 67113 cover and where is it typically performed?

Which CPT codes are commonly associated with or alternative to 67113?

What ICD‑10 diagnosis codes are commonly used to support medical necessity for CPT 67113?

What preoperative and postoperative care steps are described for cases billed with 67113?

Which provider specialties/taxonomies and modifier guidance are relevant for billing 67113?

References

Clinical & Coding Specifications

Clinical Context

Related CPT Codes

Related Modifiers

Related Provider Taxonomies

Related ICD-10-CM Codes

Related Payer Policy Updates

Related Codes

What does CPT 67113 cover and where is it typically performed?

Which CPT codes are commonly associated with or alternative to 67113?

What ICD‑10 diagnosis codes are commonly used to support medical necessity for CPT 67113?

What preoperative and postoperative care steps are described for cases billed with 67113?

Which provider specialties/taxonomies and modifier guidance are relevant for billing 67113?

References