Clinical Context
A typical patient is a 45–65-year-old individual with progressive high myopia and symptomatic posterior scleral thinning or staphyloma causing macular traction, progressive visual distortion, or risk of macular degeneration. The patient presents to an ophthalmology clinic after referral from a primary care provider or optometrist for worsening central vision and documented progressive posterior scleral ectasia on dilated fundus exam and ocular imaging (optical coherence tomography and B-scan ultrasound). Preoperative evaluation includes detailed ocular history, visual acuity, intraocular pressure measurement, slit-lamp exam, dilated fundus exam, and imaging to document the extent of posterior pole changes and to rule out active infection or inflammatory disease.
Surgical workflow: Under monitored anesthesia care or general anesthesia in an ambulatory surgical center or hospital operating room, the ophthalmic surgeon performs scleral reinforcement without graft placement to strengthen and secure the weakened sclera (procedure reported with 67250). Intraoperative steps include conjunctival peritomy, placement and suturing of reinforcing material or sutures to the scleral wall, adjustment to relieve macular traction, hemostasis, and conjunctival closure. Postoperative care includes topical antibiotics and corticosteroids, pressure checks, activity restrictions, and scheduled follow-up visits with serial imaging to assess macular stability and wound healing. The procedure is typically billed by an ophthalmic surgeon or vitreoretinal specialist and may be performed in either an ambulatory surgery center or hospital outpatient setting depending on patient comorbidities and anesthesia requirements.
Coding Specifications
| Modifier | Description | When to Use |
|---|
00 | Unspecified | Use only if payer requires a placeholder; rarely appropriate for claims |
| 11 | Normal or standard service | When the service was performed under usual circumstances without unusual effort
| 22 | Increased procedural services | When the procedure required substantially greater work than typical due to complexity
| 23 | Unusual anesthesia — medically necessary | When general anesthesia is required for an otherwise non‑anesthesia procedure because of patient factors
| 26 | Professional component | When reporting only the surgeon’s professional component separate from technical facility services
| 50 | Bilateral procedure | When 67250 is performed on both eyes during the same operative session (if payer recognizes bilateral modifier)
| 51 | Multiple procedures | When additional distinct procedures are performed at the same session and payer requires reporting of multiple procedure status
| 52 | Reduced services | When the procedure is partially reduced or not completed as originally planned
| 53 | Discontinued procedure | When the procedure is terminated for patient-related or unforeseen circumstances before completion
| 62 | Two surgeons | When two surgeons with distinct roles are required and both report services
| 63 | Procedure performed on infants less than 4 kg | Applied when relevant to neonatal patients if clinically appropriate
| 66 | Surgical team approach | When a documented surgical team, rather than a single surgeon, performed the service
| 78 | Return to operating room for related procedure during postoperative period | When reoperation for complications related to the initial 67250 is performed
| 80 | Assistant surgeon | When an assistant surgeon is required and payer allows assistant surgeon reporting
| Taxonomy Code | Specialty | Notes |
|---|
207W00000X | Ophthalmology | General ophthalmologists perform scleral reinforcement in selected cases |
| 207WP2900X | Vitreoretinal Surgery | Vitreoretinal specialists commonly perform posterior scleral reinforcement for macular protection
| 2080P0221X | Ophthalmic Plastic and Reconstructive Surgery | Oculoplastic surgeons may be involved when concurrent anterior segment or orbital procedures are required
| 363A00000X | Anesthesiology | Anesthesiologists provide monitored anesthesia care or general anesthesia for the procedure
| 207L00000X | Pediatrics — Ophthalmology | Pediatric ophthalmologists may perform the procedure when indicated in younger patients
Related Diagnoses
| ICD-10 Code | Description | Clinical Relevance |
|---|
H44.2 | Degenerative myopia | Progressive axial elongation with posterior scleral thinning is a primary indication for scleral reinforcement to protect the macula |
| H35.60 | Macular degeneration, unspecified | Macular changes secondary to posterior staphyloma or myopic degeneration may prompt reinforcement to prevent further macular damage
| H33.0 | Retinal detachment with retinal break | Scleral support may be performed in conjunction with repair when scleral weakness contributes to detachment risk
| H33.4 | Traction detachment of retina | When vitreoretinal traction and scleral ectasia coexist, reinforcement may be part of combined management
| H44.89 | Other disorders of globe | Covers other anatomic scleral disorders that may indicate reinforcement
| H52.1 | Myopia | Underlying refractive condition associated with progressive pathological changes necessitating surgical reinforcement
| T85.79 | Other complications of internal prosthetic devices, implants and grafts | Relevant when prior grafts or implants have complications prompting alternative scleral reinforcement techniques
Related CPT Codes
| CPT Code | Description | Relationship to This Procedure |
|---|
67036 | Vitrectomy, pars plana, mechanical/hand-held instrumentation, with removal of vitreous opacities (separate procedure) | Performed when concurrent vitrectomy is required to address vitreoretinal traction or to improve access to the posterior pole during scleral reinforcement |
| 67039 | Vitrectomy, pars plana; with removal of internal limiting membrane, epiretinal membrane, or scar tissue | May be performed in the same operative session if macular membranes contributing to distortion are present
| 67105 | Repair of retinal detachment; complex, secondary procedures | Used when scleral reinforcement is part of a broader retinal detachment repair strategy or when significant retinal pathology coexists
| 67107 | Repair of recurrent retinal detachment | May be used if the scleral reinforcement is performed in context of recurrent detachments to support globe integrity
| 69090 | Retrobulbar injection or block | Anesthesia technique commonly used for regional anesthesia during ocular procedures including scleral reinforcement
| 99070 | Supplies and materials (eg, sutures, implants) furnished by the physician over and above those usually included with the procedure | Used when additional disposable surgical supplies not included in global surgical package are billed separately