Summary & Overview
CPT 67316: Strabismus Repair - Extraocular Muscle Resection or Recession
CPT code 67316 denotes strabismus repair involving recession or resection of extraocular muscles to correct ocular misalignment. This surgical procedure is a core component of pediatric and adult ophthalmology for restoring binocular alignment, improving vision function, and reducing diplopia. Nationally, strabismus surgery carries clinical and resource implications for surgical suites, anesthesia, and postoperative ophthalmic follow-up.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a clinical context for the procedure, typical sites of service, commonly used modifiers (listed separately), and a discussion of billing and coverage considerations across major payers. The publication outlines benchmarks for utilization, coding nuances specific to strabismus procedures, and policy or reimbursement updates that affect coverage determinations.
This summary equips clinicians, coding professionals, and policy analysts with the essential facts about CPT code 67316, what the procedure entails, and where to look for payer-specific guidance. Data not available in the input is noted where applicable in detailed sections.
Billing Code Overview
CPT code 67316 describes a surgical procedure for strabismus repair, in which an ophthalmic surgeon weakens (recession) or strengthens (resection) extraocular muscles to realign the eye and improve ocular alignment and binocular vision. This service is a form of ophthalmic surgical intervention focused on correcting misalignment of the eyes.
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Service type: Surgical correction of extraocular muscle function (strabismus surgery)
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Typical site of service: Hospital outpatient department or ambulatory surgical center; may also be performed in inpatient settings when clinically indicated.
Clinical & Coding Specifications
Clinical Context
A 7-year-old child presents to the ophthalmology clinic with a long-standing convergent strabismus (esotropia) causing abnormal binocular alignment and decreased stereopsis. Conservative measures including refractive correction and patching yielded insufficient improvement. After clinical evaluation with ocular motility testing, measurement of deviation (prism cover test), and counseling with the family, the pediatric ophthalmologist schedules a strabismus surgical repair under general anesthesia. Intraoperatively, the surgeon performs a medial rectus recession on the involved eye to weaken the muscle and realign the visual axes. The typical workflow includes preoperative consent and anesthesia evaluation, operating room time with microscope and sterile field, administration of general anesthesia, intraoperative forced duction and saccadic checks as needed, the muscle recession or resection procedure, wound closure, immediate postoperative recovery with discharge instructions, and scheduled postoperative visits to monitor alignment and diplopia. Typical site of service is an ambulatory surgical center or hospital outpatient department. Service type is operative/major surgery for ophthalmic muscle surgery indicated to correct ocular misalignment and improve binocular function.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | Default, no modifier | Use when no specific modifier applies and standard billing is appropriate |