Summary & Overview
CPT 67208: Destruction of Retinal Lesion by Cryo- or Thermoablation
CPT code 67208 denotes the destruction of a retinal lesion using extreme cold or hot temperatures, a focal therapeutic procedure used in ophthalmology to ablate abnormal retinal tissue. Nationally, this code is relevant for clinicians who treat retinal tumors, vascular lesions, and other localized retinal pathologies that require thermal or cryogenic destruction. Proper coding affects clinical documentation, facility and professional billing, and coverage determinations across major payers.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of the clinical intent of the procedure, typical sites of service, and the elements that influence billing and coverage decisions. The publication provides benchmarks for utilization and reimbursement where available, highlights relevant policy updates affecting prior authorization and coverage, and summarizes clinical context that influences coding choices. Data on associated modifiers, taxonomies, and diagnosis coding are noted where available; if specific inputs were not provided, the report indicates that data are not available in the input. This resource is intended for billing managers, ophthalmology providers, and policy analysts seeking a national-level briefing on CPT code 67208 and its application in routine retinal practice.
Billing Code Overview
CPT code 67208 describes the destruction of a retinal lesion using extreme cold (cryoablation) or heat (thermocoagulation). This procedure targets abnormal retinal tissue such as small tumors, vascular lesions, or other focal retinal abnormalities that require focal thermal or cryogenic ablation.
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Service type: Destruction of retinal lesion using extreme cold or hot temperatures
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Typical site of service: Ophthalmology clinic, hospital outpatient department, or ambulatory surgery center where retinal procedures are performed
Clinical & Coding Specifications
Clinical Context
A 62-year-old patient presents to the ophthalmology clinic with symptomatic symptomatic peripheral retinal tears and areas of lattice degeneration identified on dilated fundus exam and confirmed by indirect ophthalmoscopy and scleral depression. The patient reports recent flashes and floaters; visual acuity is decreased in the affected eye. After informed consent, the retina specialist performs focal retinal lesion destruction using cryotherapy or trans-scleral diathermy/laser ablation as indicated to create adhesion around the tear and reduce risk of progression to rhegmatogenous retinal detachment. The procedure is typically performed in an outpatient ophthalmology procedure room or ambulatory surgery center under local or regional anesthesia with monitored anesthesia care when indicated. Pre-procedure documentation includes a focused ocular history, informed consent, baseline visual acuity, intraocular pressure, detailed retinal exam with retina drawings or imaging, and indication for retinal lesion destruction. Post-procedure workflow includes immediate post-op assessment of intraocular pressure, topical medications (antibiotic and steroid drops), activity restrictions, scheduled follow-up within 24–72 hours, and documentation of the number and location of lesions treated, modality used (cryotherapy vs diathermy/thermocoagulation), and any intraoperative complications.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | Use when billing only the physician’s interpretation or professional portion of a separately reportable service. |