Find policies, billing codes, payers, states, and providers
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.
Customize your policy alerts
Sign up for cpt 67145 policy alerts
Get alerted when payer policies referencing 67145 are released or updated.
Monitor payer policy activity
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.
-
Service type: Ophthalmic laser photocoagulation for retinal prophylaxis
-
Typical site of service: Outpatient ophthalmology clinic or ambulatory surgery center where laser retinal procedures are performed
National Reimbursement Benchmarks
Across national benchmarks, Medicare's mean rate of $254.3 sits substantially below BUCA's average commercial mean of $729.3, indicating a large gap between public and that commercial benchmark for CPT 67145. This gap of $475.0 highlights how reimbursement levels can diverge by payer type, with Medicare clustered near its $251 median while BUCA reflects a higher commercial average around $670.9.
Examining dispersion via the interquartile range (P75 minus P25) shows varied concentration: Blue Cross Blue Shield has the widest IQR at $522.8 (P75 $1,077.8 minus P25 $535.6), followed by UnitedHealth Group at $479.1 and BUCA at $513.6. The tightest spreads are Aetna at $348.9 and Cigna at $405.8, indicating more concentrated commercial contracting for those payers relative to BCBS and UnitedHealth Group.