Summary & Overview
CPT 67225: Intraocular Photodynamic Therapy, Second Eye Add-On
CPT code 67225 is an add-on ophthalmic procedure for intraocular photodynamic therapy used to treat a localized cancerous focus within the middle layer of a second eye at the same operative session as the first eye. The service is delivered by infusing a photosensitive medication that is activated by a laser to ablate the targeted intraocular lesion. As an add-on code, 67225 is reported in conjunction with the primary procedure performed on the first eye and specifies treatment of the second eye during the same surgical encounter.
Nationally, accurate reporting of 67225 matters for clinical documentation, correct bundling with the primary procedure, and consistent reimbursement across major payers. The analysis covers common commercial and public payers: Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise explanation of clinical context, typical sites of service, common modifiers used with this code, and guidance on how the add-on nature of the code affects claim construction. The publication also outlines benchmarking considerations and recent policy updates that influence coverage and coding practice for intraocular photodynamic procedures.
This resource is intended for coding professionals, billing staff, and clinicians involved in ophthalmic surgical care who require a clear, national-level summary of what CPT code 67225 represents and how it fits into procedural reporting for same-session bilateral intraocular treatment.
Billing Code Overview
CPT code 67225 describes an add-on ophthalmic procedure in which the clinician treats a localized cancerous focus within the middle layer of a second eye during the same operative session as the first eye. The service involves infusion of a photosensitive drug that is activated by application of a laser beam to the targeted intraocular lesion.
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Service type: Intraocular photodynamic therapy as an add-on procedure for treatment of a localized middle-layer ocular malignancy in a second eye during the same operative session
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Typical site of service: Hospital outpatient department or ambulatory surgery center where intraocular laser activation and infusion can be performed under appropriate ophthalmic procedural conditions
Clinical & Coding Specifications
Clinical Context
A 62-year-old patient with a previously diagnosed unilateral choroidal melanoma undergoes intraoperative photodynamic therapy (PDT) on the affected eye. During the same operative session, the ophthalmic surgeon identifies a second, smaller localized malignant focus in the fellow eye involving the middle layer (choroid). The surgeon infuses the photosensitizing agent systemically and activates it with a laser applied to the second eye during that same operative encounter, documenting the treatment of the second eye as an add-on service.
The clinical workflow includes preoperative consent and ocular oncology evaluation, perioperative anesthesia evaluation (local or monitored anesthesia care), systemic administration of the photosensitizer, positioning and ocular preparation, laser activation targeted to the tumor in the second eye, immediate postoperative ophthalmic assessment, and brief observation prior to discharge or admission as indicated. Operative documentation must specify that the service was provided to the second eye at the same session as the first eye and include the agent used, laser settings, tumor location and size, and perioperative findings.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
50 | Bilateral procedure | When both eyes are being billed as separate primary procedures (note: 67225 is an add-on code for the second eye; use cautiously and only if payer allows) |