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CPT 67255: Scleral Reinforcement with Graft

CPT code 67255 denotes a scleral reinforcement procedure in which a graft is used to strengthen a weakened sclera, typically to reduce progressive macular damage from high myopia. Nationally, this procedure is a niche but clinically important ophthalmic surgery addressing structural degeneration that can threaten central vision in patients with extreme nearsightedness. Insurers assess medical necessity and coverage under ophthalmology surgical benefits, and reimbursement practice varies across payers due to procedure rarity and evolving clinical indications.

Key payers included in this analysis are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise clinical context for when 67255 is used, typical sites of service, and which payers commonly adjudicate claims for this service. The publication also summarizes expected benchmarks and policy-relevant themes: coverage variability for specialized ophthalmic grafting procedures, prior-authorization considerations, and coding clarity for surgical documentation. Practical takeaways include what elements of clinical documentation align with coverage reviews and where policy updates could affect national access to scleral reinforcement procedures.

Data not available in the input for detailed payer-specific benchmarks, modifiers usage patterns, associated taxonomies, and ICD-10 diagnosis mappings.

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Billing Code Overview

CPT code 67255 describes a surgical procedure to reinforce and secure a weakened sclera using a graft as structural support. The procedure is performed to stabilize the posterior segment of the eye and can be used to prevent progressive macular damage associated with extreme myopia (nearsightedness).

Service type: Surgical ophthalmology procedure to strengthen the sclera with grafting
Typical site of service: Operating room or ambulatory surgical center where ophthalmic surgical procedures are performed

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CPT 67255: Scleral Reinforcement with Graft

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Billing Code Overview

Service type: Surgical ophthalmology procedure to strengthen the sclera with grafting
Typical site of service: Operating room or ambulatory surgical center where ophthalmic surgical procedures are performed

Data not available in the input.

Clinical & Coding Specifications

Clinical Context

A 48-year-old patient with progressive high myopia presents with increasing visual distortion and progressive posterior scleral thinning documented on dilated ophthalmic examination and imaging. The retinal specialist evaluates the patient in an outpatient ophthalmology clinic, confirms progressive posterior staphyloma and threat to the macula from progressive elongation of the globe, and recommends a scleral reinforcement procedure to provide structural support to the posterior pole and reduce progressive macular damage. Preoperative workflow includes comprehensive ocular history, informed consent, retinal imaging (OCT, wide-field fundus photography), preoperative anesthesia assessment, and scheduling for an operating room procedure. Intraoperative workflow involves periocular or general anesthesia, placement and fixation of a scleral graft to reinforce the weakened posterior sclera, hemostasis, wound closure, and immediate postoperative assessment. Postoperative workflow includes recovery monitoring, topical antibiotics and steroids, scheduled follow-up visits with imaging to document graft position and macular stability, and coordination of billing and documentation for the procedure coded as 67255.

Coding Specifications

Modifier	Description	When to Use
`22`	Increased procedural services	Use when the procedure required substantially greater work than typical due to complexity or complications.
`23`	Unusual anesthesia	Use when general anesthesia is medically necessary for a procedure that is normally performed with local/regional anesthesia.
`50`	Bilateral procedure	Use when scleral reinforcement is performed on both eyes during the same operative session.
`51`	Multiple procedures	Use when `67255` is billed with other distinct surgical procedures performed at the same session.
`52`	Reduced services	Use when the procedure is partially reduced or not completed as originally planned.
`53`	Discontinued procedure	Use when the procedure is started but terminated due to extenuating circumstances or patient safety.
`59`	Distinct procedural service	Use to indicate a procedure or service that was distinct or independent from other services performed on the same day.
`62`	Two surgeons	Use when two surgeons work together as primary surgeons performing distinct portions of the procedure.
`78`	Return to OR for related procedure during global period	Use when a return to the operating room for a related procedure occurs during the global postoperative period.
`79`	Unrelated procedure or service by the same physician during postoperative period	Use when an unrelated procedure is performed during the global period for a separate condition.
`80`	Assistant surgeon	Use when an assistant surgeon provides intraoperative assistance.
`81`	Minimum assistant surgeon	Use when a minimal assistant surgeon assists intraoperatively.
`82`	Assistant surgeon (when qualified resident not available)	Use when a qualified resident is not available and an assistant surgeon is required.
`26`	Professional component	Use when only the professional interpretation or service portion is reported (rare for this surgical procedure).

Taxonomy Code	Specialty	Notes
207W00000X	Ophthalmology	Retinal specialists and vitreoretinal surgeons perform scleral reinforcement procedures.
207WT0501X	Retina/Vitreous	Subspecialists focused on posterior segment surgery commonly perform `67255`.
2080S0125X	Anesthesiology	Provides general or monitored anesthesia care for intraoperative management.
207LP2300X	Ophthalmic Plastic and Reconstructive Surgery	May be involved for ocular adnexal or scleral graft placement in complex cases.
363L00000X	Surgical Assistant	Surgical assistants or ophthalmic surgical technologists support the operating surgeon.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`H44.2`	Degenerative myopia	High-risk progressive myopia that can cause posterior scleral thinning and macular damage prompting scleral reinforcement.
`H44.3`	Pathologic myopia with posterior staphyloma	Posterior globe ectasia threatening the macula; a primary indication for posterior scleral reinforcement.
`H35.30`	Unspecified chorioretinal degeneration, unspecified eye	Chorioretinal changes associated with high myopia that may be addressed indirectly by scleral support.
`H33.0`	Retinal detachment with retinal break	Retinal detachment may coexist and influence timing or combining of scleral procedures.
`H35.7`	Other macular disorders	Macular pathology from progressive axial elongation may motivate reinforcement to prevent further damage.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`67036`	Vitrectomy, mechanical, pars plana approach; with removal of vitreous opacities, any indication	Performed before or during scleral reinforcement if concurrent vitrectomy is required to address posterior segment pathology or to allow visualization and graft placement.
`67105`	Repair of retinal detachment; with vitrectomy, and without scleral buckle	May be performed in eyes with concurrent retinal detachment that require posterior support; however, scleral reinforcement is distinct and may be combined or staged.
`67145`	Repair of retinal detachment; with complex vitrectomy including peeling of membranes, etc.	Used when complex posterior pathology is present requiring membrane peeling or extensive vitrectomy in conjunction with scleral reinforcement.
`67121`	Scleral buckling procedure without vitrectomy	Alternative posterior support procedure; listed for comparison when choosing a surgical approach to protect the macula in myopic degeneration.
`69990`	Microsurgical techniques, requiring use of operating microscope (list separately in addition to code for primary procedure)	Reported when the operating microscope is necessary and reportable according to payer rules in addition to the primary scleral reinforcement service.

CPT 67250: Scleral Reinforcement Surgery for Severe Myopia

References

1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.

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Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

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Clinical & Coding Specifications

Clinical Context

Coding Specifications

Modifier	Description	When to Use
`22`	Increased procedural services	Use when the procedure required substantially greater work than typical due to complexity or complications.
`23`	Unusual anesthesia	Use when general anesthesia is medically necessary for a procedure that is normally performed with local/regional anesthesia.
`50`	Bilateral procedure	Use when scleral reinforcement is performed on both eyes during the same operative session.
`51`	Multiple procedures	Use when `67255` is billed with other distinct surgical procedures performed at the same session.
`52`	Reduced services	Use when the procedure is partially reduced or not completed as originally planned.
`53`	Discontinued procedure	Use when the procedure is started but terminated due to extenuating circumstances or patient safety.
`59`	Distinct procedural service	Use to indicate a procedure or service that was distinct or independent from other services performed on the same day.
`62`	Two surgeons	Use when two surgeons work together as primary surgeons performing distinct portions of the procedure.
`78`	Return to OR for related procedure during global period	Use when a return to the operating room for a related procedure occurs during the global postoperative period.
`79`	Unrelated procedure or service by the same physician during postoperative period	Use when an unrelated procedure is performed during the global period for a separate condition.
`80`	Assistant surgeon	Use when an assistant surgeon provides intraoperative assistance.
`81`	Minimum assistant surgeon	Use when a minimal assistant surgeon assists intraoperatively.
`82`	Assistant surgeon (when qualified resident not available)	Use when a qualified resident is not available and an assistant surgeon is required.
`26`	Professional component	Use when only the professional interpretation or service portion is reported (rare for this surgical procedure).

Taxonomy Code	Specialty	Notes
207W00000X	Ophthalmology	Retinal specialists and vitreoretinal surgeons perform scleral reinforcement procedures.
207WT0501X	Retina/Vitreous	Subspecialists focused on posterior segment surgery commonly perform `67255`.
2080S0125X	Anesthesiology	Provides general or monitored anesthesia care for intraoperative management.
207LP2300X	Ophthalmic Plastic and Reconstructive Surgery	May be involved for ocular adnexal or scleral graft placement in complex cases.
363L00000X	Surgical Assistant	Surgical assistants or ophthalmic surgical technologists support the operating surgeon.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`H44.2`	Degenerative myopia	High-risk progressive myopia that can cause posterior scleral thinning and macular damage prompting scleral reinforcement.
`H44.3`	Pathologic myopia with posterior staphyloma	Posterior globe ectasia threatening the macula; a primary indication for posterior scleral reinforcement.
`H35.30`	Unspecified chorioretinal degeneration, unspecified eye	Chorioretinal changes associated with high myopia that may be addressed indirectly by scleral support.
`H33.0`	Retinal detachment with retinal break	Retinal detachment may coexist and influence timing or combining of scleral procedures.
`H35.7`	Other macular disorders	Macular pathology from progressive axial elongation may motivate reinforcement to prevent further damage.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`67036`	Vitrectomy, mechanical, pars plana approach; with removal of vitreous opacities, any indication	Performed before or during scleral reinforcement if concurrent vitrectomy is required to address posterior segment pathology or to allow visualization and graft placement.
`67105`	Repair of retinal detachment; with vitrectomy, and without scleral buckle	May be performed in eyes with concurrent retinal detachment that require posterior support; however, scleral reinforcement is distinct and may be combined or staged.
`67145`	Repair of retinal detachment; with complex vitrectomy including peeling of membranes, etc.	Used when complex posterior pathology is present requiring membrane peeling or extensive vitrectomy in conjunction with scleral reinforcement.
`67121`	Scleral buckling procedure without vitrectomy	Alternative posterior support procedure; listed for comparison when choosing a surgical approach to protect the macula in myopic degeneration.
`69990`	Microsurgical techniques, requiring use of operating microscope (list separately in addition to code for primary procedure)	Reported when the operating microscope is necessary and reportable according to payer rules in addition to the primary scleral reinforcement service.

CPT 67250: Scleral Reinforcement Surgery for Severe Myopia

References

1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.

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CPT 67255: Scleral Reinforcement with Graft

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Billing Code Overview

OpenPayer

CPT 67255: Scleral Reinforcement with Graft

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Billing Code Overview

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Related Diagnoses

Related CPT Codes

Related Codes

References

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Related Diagnoses

Related CPT Codes

Related Codes

References