Summary & Overview
CPT 67145: Retinal Photocoagulation for Detachment Prophylaxis
CPT code 67145 denotes prophylactic retinal photocoagulation—application of intense light (typically laser) to reinforce retinal areas with small tears or lattice degeneration and prevent detachment. This procedure is a common ophthalmic intervention with national relevance due to the clinical goal of preserving vision and avoiding more extensive retinal detachment repairs. Payers commonly involved in coverage and reimbursement discussions include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare.
This publication provides clinicians, billing professionals, and policy analysts with an overview of clinical context, typical sites of service, and how 67145 fits among related retinal surgery codes. Readers will find a concise clinical description, the primary payer landscape, and links to related procedural codes used for retinal detachment prophylaxis and repair. The report highlights expected use cases—small retinal tears and lattice degeneration—and positions 67145 relative to surgical repair codes to clarify when prophylactic photocoagulation is the appropriate coded service. The content also outlines common documentation elements required to support medical necessity. Data not available in the input is noted where applicable.
Billing Code Overview
CPT code 67145 describes a procedure in which a provider applies intense light—commonly a laser—to the retina to create scar tissue that reinforces areas of retinal thinning or small tears (such as lattice degeneration) and prevents retinal detachment. This is a prophylactic retinal photocoagulation procedure intended to stabilize the peripheral retina.
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Service type: Ophthalmic laser photocoagulation for retinal prophylaxis
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Typical site of service: Outpatient ophthalmology clinic or ambulatory surgery center where laser retinal procedures are performed
Clinical & Coding Specifications
Clinical Context
A 58-year-old patient with high myopia presents to a retina specialist with peripheral lattice degeneration identified on dilated fundus exam and symptomatic floaters. Visual acuity is stable, but a small atrophic retinal tear without detachment is observed in the inferotemporal periphery. The retina specialist recommends prophylactic photocoagulation to reinforce the lesion and reduce the risk of progression to rhegmatogenous retinal detachment. The procedure is scheduled in an outpatient ophthalmic clinic or ambulatory surgery center under topical anesthesia with pupillary dilation. The clinical workflow includes pre-procedure counseling, informed consent, documentation of laterality, topical anesthetic and analgesia as needed, application of focal laser photocoagulation to create a grid of burn scars around the tear or lattice, immediate post-procedure fundus assessment, topical antibiotic or steroid drop per clinic protocol, and same-day discharge with return precautions and follow-up arranged.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | When billing only the physician’s interpretation/performance separate from technical facility services |
50 | Bilateral procedure |