Summary & Overview
CPT 67516: Suprachoroidal Injection of Medication
CPT code 67516 denotes a suprachoroidal injection procedure in which medication is delivered into the suprachoroidal space between the sclera and choroid. This targeted posterior-segment delivery approach is increasingly relevant for treating retinal and choroidal conditions where localized drug distribution can improve therapeutic effect and limit systemic exposure. Nationally, adoption of suprachoroidal delivery techniques is growing as devices and agents designed for this route enter clinical use, making clear coding guidance important for consistent billing and coverage.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of the clinical context for 67516, typical sites of service, and the types of services the code represents. The publication also summarizes common modifiers and payer considerations where available, and highlights areas where data were not provided. This resource is intended to help revenue cycle, coding, and clinical teams understand the clinical intent of the code and what to expect when documenting and submitting claims for suprachoroidal medication injections.
Data not available in the input for associated taxonomies, ICD-10 diagnoses, related codes, and detailed payer-specific coverage policies.
Billing Code Overview
CPT code 67516 describes an ocular procedure in which a provider injects medication into the suprachoroidal space (SCS), the potential space between the sclera and the choroid. This technique delivers therapeutic agents directly into the posterior segment of the eye targeting choroidal and retinal tissues.
Service type: Suprachoroidal injection of medication
Typical site of service: Outpatient ophthalmology clinic or ambulatory surgery center, where targeted intraocular drug delivery procedures are performed.
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Clinical & Coding Specifications
Clinical Context
A typical patient is an adult with symptomatic macular edema or posterior segment inflammation refractory to intravitreal therapy, referred for targeted suprachoroidal space (SCS) drug delivery. The patient presents to an ambulatory ophthalmology or retinal specialty clinic or same-day procedure suite. Pre-procedure workflow includes history, medication reconciliation (including anticoagulants), visual acuity, intraocular pressure check, slit-lamp and dilated fundus exam, and informed consent. Topical anesthesia and antisepsis are applied; the provider uses a microinjector or specially designed SCS delivery device to inject medication into the SCS under sterile technique. Post-injection, the patient is observed for intraocular pressure spike, pain, bleeding, or adverse reaction; fundus exam is repeated and post-op instructions provided. Typical site of service is an outpatient ophthalmology clinic, ambulatory surgical center, or hospital outpatient department depending on facility capability and monitoring needs. Billing uses 67516 for the suprachoroidal injection, with possible addition of facility and professional component modifiers as clinically appropriate.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
50 | Bilateral procedure | When the SCS injection is performed on both eyes during the same session and payer accepts bilateral billing. |