Summary & Overview
CPT 67299: Unlisted Posterior Segment Ocular Procedure
CPT code 67299 designates an unlisted procedure for the posterior segment of the eye and is used when a documented posterior segment ocular procedure lacks a specific CPT code. Nationwide, unlisted codes like 67299 matter because they require clear documentation and often additional claim substantiation to support medical necessity and appropriate payment. This code typically applies to ophthalmic surgical or procedural interventions performed in hospital outpatient departments or ambulatory surgical centers.
Key payers referenced in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of the code’s clinical scope, common billing considerations, and the payer landscape. The publication outlines typical use cases for 67299, documentation expectations associated with unlisted posterior segment procedures, and how major payers approach coverage and adjudication for unlisted ophthalmic services.
The report also summarizes benchmarks and policy considerations relevant to payers and providers, without state-level specificity. Where input data is incomplete, the publication notes absent items such as specific associated taxonomies, ICD-10 diagnoses, or related codes as "Data not available in the input."
Billing Code Overview
CPT code 67299 is an unlisted procedure code for the posterior segment of the eye. It is used to report posterior segment ocular procedures that do not have a more specific CPT code.
Service type: Ophthalmic posterior segment surgery or procedure
Typical site of service: Hospital outpatient department or ambulatory surgical center
Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A 68-year-old patient presents to a tertiary ophthalmology center with a complex posterior segment eye problem that does not fit an existing specific CPT code — for example, a novel combined vitrectomy maneuver with experimental membrane peeling technique for dense proliferative vitreoretinopathy in a single eye. The clinical workflow begins with outpatient preoperative evaluation including visual acuity, intraocular pressure, dilated fundus exam, ocular imaging (OCT, widefield fundus photography), and informed consent. The patient is brought to the operating room for a posterior segment procedure under monitored anesthesia care or general anesthesia. The surgeon documents operative indications, detailed intraoperative steps, any additional procedures performed (e.g., endolaser, membrane dissection, tamponade), and estimated operative time. Postoperative care includes immediate recovery room assessment, short-term topical and systemic medication instructions, scheduled post-op visits with retinal exam and OCT, and documentation of any complications. Billing uses 67299 to report the posterior segment procedure when no specific CPT accurately describes the work; appropriate modifier(s) from the operative and billing documentation are appended as indicated by payer policy. Typical site of service is an operating room in an ambulatory surgery center or hospital outpatient department. Typical patient scenario: a unilateral, complex posterior segment surgical intervention not otherwise classified, performed by a vitreoretinal specialist, with pre- and post-operative professional services and facility technical components depending on setting and contractual arrangements.
Coding Specifications
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