Summary & Overview
CPT 67115: Scleral Buckle Adjustment for Retinal Tear Repair
CPT code 67115 represents the surgical adjustment of an existing scleral buckle used to treat retinal tears and detachments. The code captures procedures that alter the position, tension, or components of a previously placed silicone, sponge, rubber, or semihard plastic buckle to improve retinal apposition. This intervention matters nationally because it is part of definitive retinal repair care that can preserve vision, reduce the need for more extensive reoperation, and influence surgical resource use across hospital and ambulatory surgery settings.
Key payers relevant to this code include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find clinical context for when a scleral buckle adjustment is performed, the typical sites of service, and the practical billing construct associated with surgical retina care. The publication outlines common modifiers (provided separately), common use cases for the procedure, and what to expect in terms of procedural classification and documentation needs. This summary is aimed at clinicians, coding professionals, and policy analysts seeking a concise reference on CPT code 67115, its clinical role in retinal surgery, and how it fits into payer coverage and procedural workflows. Data not available in the input for specific payer rates, associated taxonomies, and ICD-10 diagnoses will be noted where applicable.
Billing Code Overview
CPT code 67115 describes the adjustment of a scleral buckle, a device (silicone sponge, rubber, or semihard plastic) placed around the sclera at the site of a retinal tear to indent the sclera and hold the retina in place until scarring seals the tear. The procedure involves modifying the position, tension, or components of an existing scleral buckle to optimize apposition of the retina and address ongoing or recurrent retinal pathology.
Service type: Ophthalmic surgical procedure — scleral buckle adjustment
Typical site of service: Hospital operating room or ambulatory surgery center, performed by an ophthalmic surgeon specializing in retinal procedures.
Clinical & Coding Specifications
Clinical Context
A 58-year-old patient presents with symptomatic rhegmatogenous retinal detachment after evaluation in the ophthalmology clinic. The retina specialist performs scleral buckle adjustment of a previously placed encircling silicone sponge to optimize indentation at the retinal break site. The workflow includes preoperative assessment (visual acuity, intraocular pressure, slit-lamp and dilated fundus exam), informed consent, topical or monitored anesthesia care per protocol, intraoperative confirmation of buckle position and height, adjustment of buckle tension to re-appose the retinal tear to the sclera, confirmation of retinal apposition with indirect ophthalmoscopy, and postoperative plan with short-term follow-up for retina status and wound care. Typical site of service is an ambulatory surgical center or hospital outpatient department. The service type is an ophthalmic operative procedure to modify a previously placed scleral buckle to treat or maintain retinal reattachment.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
78 | Return to the operating room for a related procedure during the postoperative period | Use when adjustment occurs during the global period and requires a return trip to OR for related treatment |
79 |