Summary & Overview
CPT 67120: Removal of Implanted Extraocular Material From Posterior Segment
CPT code 67120 identifies the surgical removal of previously implanted extraocular material from the posterior segment of the eye. This intraocular posterior-segment procedure is clinically significant because it addresses complications or device revisions involving the vitreous cavity and adjacent structures, and it has implications for surgical complexity, site-of-service decisions, and payer coverage policies nationwide. Key payers examined include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of the code’s clinical definition and typical settings, a summary of payer coverage patterns and common billing modifiers, and context on how the procedure fits into ophthalmic surgical practice. The publication highlights benchmark considerations for coding and claims submission, describes typical sites of service (hospital operating room and ambulatory surgical center), and summarizes policy considerations that affect prior authorization and documentation. Data not available in the input are noted where applicable. This analysis is intended to inform coding professionals, billing teams, and policy analysts about the clinical scope and payer relevance of CPT code 67120 on a national level.
Billing Code Overview
CPT code 67120 describes the surgical removal of previously implanted extraocular material from the posterior segment of the eye — the back two-thirds of the globe. This procedure involves intraocular surgical techniques to extract devices, implants, or foreign material that were placed within the vitreous cavity or attached to posterior segment structures.
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Service Type: Posterior segment intraocular surgical removal (posterior ocular surgery)
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Typical Site of Service: Hospital operating room or ambulatory surgical center, given the intraocular posterior segment surgical setting
Clinical & Coding Specifications
Clinical Context
A 62-year-old pseudophakic patient with a prior pars plana vitrectomy returns with floaters, visual disturbance, and evidence on ophthalmoscopic exam of retained extraocular material (such as a silicone oil droplet fragment or residual intraocular lens fragment) in the posterior segment. The retina specialist schedules a procedure to remove the previously implanted extraocular material from the back two-thirds of the eye under monitored anesthesia care or general anesthesia. Preoperative workflow includes informed consent, ocular imaging (OCT, B-scan if media opacity), review of prior operative notes and implanted materials, and preoperative medical clearance. Intraoperative steps typically involve placement of standard pars plana trocars, vitrectomy instrument use to access the posterior segment, identification and retrieval of the foreign/implanted material, confirmation of retinal integrity, and intraocular tamponade or wound closure as indicated. Postoperative workflow includes immediate recovery monitoring, intraocular pressure checks, postoperative topical medications, retina clinic follow-up within 24–72 hours, and documentation of removed material and implant history in the operative report.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | Use when reporting only the physician’s professional component separate from technical facility charges, if applicable to diagnostic imaging or services bundled with the procedure. |