Summary & Overview
HCPCS C1814: Retinal Tamponade Device, Silicone Oil
HCPCS Level II code C1814 designates a silicone oil retinal tamponade device used in vitreoretinal surgery to stabilize the retina intraoperatively and postoperatively. These devices are clinically important for the management of complex retinal detachments and proliferative vitreoretinopathy, and they have implications for device supply, coding accuracy, and payer coverage nationally. Coverage and coding clarity for retinal tamponade devices affect surgical billing and hospital supply costs across payers.
Key payers in this overview include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise explanation of the code's clinical purpose and typical setting, an outline of common modifiers used with device and surgical billing, payer coverage patterns where available, and benchmarking context for claims and reimbursement practice. The publication also highlights coding interactions with related ophthalmic device and procedure claims and notes areas where policy updates or prior authorization requirements commonly arise.
This summary is intended for billing managers, clinical coders, surgical administrators, and policy analysts seeking a national-level reference on HCPCS Level II code C1814 and its role in vitreoretinal surgical care.
Billing Code Overview
HCPCS Level II code C1814 describes a retinal tamponade device, silicone oil. This item is a medical implant or intraocular device used to provide internal tamponade of the retina during or after vitreoretinal surgery. Service type: implantable ophthalmic device for retinal tamponade. Typical site of service: operating room or ambulatory surgical center during vitreoretinal procedures.
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Clinical & Coding Specifications
Clinical Context
A 62-year-old patient with rhegmatogenous retinal detachment complicated by proliferative vitreoretinopathy undergoes pars plana vitrectomy with instillation of a retinal tamponade device, silicone oil (C1814), to provide long-term internal tamponade of the retina. Typical workflow: preoperative evaluation in the ophthalmology clinic with visual acuity, intraocular pressure, and retinal examination; informed consent documenting indication for silicone oil tamponade; operating room time under monitored anesthesia care or general anesthesia; pars plana vitrectomy, retinal reattachment maneuvers (membrane peeling, laser retinopexy, fluid–air exchange), and injection of silicone oil to fill the vitreous cavity; postoperative recovery with positioning instructions and serial follow-up visits to monitor intraocular pressure, retinal status, and emulsification. Silicone oil may be removed in a subsequent surgery weeks to months later depending on clinical course.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services | Use when work required is substantially greater than usual for the procedure (document justification). |
23 |