Summary & Overview
CPT 67250: Scleral Reinforcement Surgery for Severe Myopia
CPT code 67250 denotes scleral reinforcement surgery performed without the use of a graft to strengthen a weakened sclera and reduce the risk of macular damage from extreme myopia. This procedure is a specialized ophthalmic surgery intended to stabilize the posterior segment of the eye and preserve central vision in patients with progressive high myopia. The code matters nationally because it informs coverage, surgical utilization tracking, and clinical coding for an uncommon but vision-preserving intervention.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise briefing on the clinical context and service setting for 67250, plus an outline of typical payer considerations and common modifiers used in practice. The publication provides benchmarks where available, summarizes relevant policy and coding updates, and explains how the procedure maps to surgical service lines and sites of care. This summary is intended to help payers, coding staff, and clinicians quickly understand the purpose of CPT code 67250, its clinical role in managing extreme myopia, and the administrative elements that commonly accompany billing for this ophthalmic surgical service.
Billing Code Overview
CPT code 67250 describes a surgical procedure to strengthen and secure a weakened sclera without using a graft. The procedure is performed to reinforce the eyeball and help prevent progressive damage to the macula related to extreme myopia (nearsightedness).
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Service type: Ophthalmic scleral reinforcement surgery
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Typical site of service: Hospital outpatient department or ambulatory surgical center where ophthalmic surgical procedures are performed
Data not available in the input for associated taxonomies, ICD-10 diagnoses, related codes, and service line.
Clinical & Coding Specifications
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
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