Summary & Overview

HCPCS G9376: Retina Attached at 6-Month Follow-Up After One Surgery

HCPCS Level II code G9376 documents that a patient’s retina remained attached at the six-month follow-up (±1 month) after a single retinal reattachment surgery. The code captures a specific postoperative outcome measure used in ophthalmology and surgical quality reporting. Nationally, standardized outcome codes like G9376 support consistent tracking of surgical success, quality measurement, and alignment between clinical documentation and payer reporting requirements.

Key payers addressed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find context on the clinical purpose of the code, typical use cases in outpatient ophthalmology follow-up, and what types of benchmarks and policy implications to expect from an outcomes-based HCPCS Level II measure. The publication covers how G9376 is applied in documentation and billing workflows, the typical site of service, and the role of this outcome code in quality reporting and postoperative surveillance. Data not available in the input is noted where applicable; readers will learn which fields require local payer guidance or additional clinical detail for implementation.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareG9376HCPCS Level IIretinal-reattachmentophthalmologypostoperative-outcomequality-measureoutpatient-follow-up

Billing Code Overview

HCPCS Level II code G9376 indicates that a patient's retina remained attached at the six-month follow-up visit (± one month) after undergoing only one surgery. This code documents a successful single-procedure retinal reattachment outcome during the specified postoperative monitoring interval.

Service type: Postoperative ophthalmologic outcome assessment following retinal reattachment surgery
Typical site of service: Ophthalmology clinic or outpatient surgical follow-up visit

Clinical & Coding Specifications

Clinical Context

A 62-year-old patient with a history of rhegmatogenous retinal detachment underwent a single successful pars plana vitrectomy with gas tamponade. At the 6-month follow-up visit (±1 month), the retina remains attached with no need for additional retinal reattachment surgery. The clinical workflow includes: initial postoperative visits at day 1, week 1, month 1, month 3, and the 6-month visit. At the 6-month visit the retina is assessed via dilated fundus exam, indirect ophthalmoscopy, and optical coherence tomography as indicated. Documentation confirms a single prior operative note, absence of recurrent detachment, visual acuity, intraocular pressure, and any complications such as proliferative vitreoretinopathy. This visit supports reporting of G9376 when the retina is documented as attached at the 6-month follow-up following only one surgery.

Coding Specifications

Modifier	Description	When to Use
`25`	Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service	Use when a distinct E/M visit is documented at the 6-month follow-up in addition to any procedural service on the same day.
`57`	Decision for surgery	Use when the visit results in the decision to proceed to surgery (not typical for `G9376` but applicable if further surgery is planned).
`58`	Staged or related procedure or service by same physician during the postoperative period	Use when a planned subsequent procedure related to the initial retinal surgery is performed during global period.
`79`	Unrelated procedure or service by same physician during the postoperative period	Use when an unrelated procedure is performed during the global period.
`76`	Repeat procedure or service by same physician	Use when the same procedure is repeated by the same physician on the same day.
`77`	Repeat procedure by another physician	Use when the same procedure is repeated by a different physician on the same day.
`91`	Repeat clinical diagnostic laboratory test	Use if ophthalmodiagnostic tests (e.g., OCT) are repeated on the same day for verification.
`73`	Discontinued outpatient procedure prior to anesthesia induction or surgical preparation	Use when a planned procedure is cancelled before initiation of anesthesia or prep.
`24`	Unrelated E/M service during a postoperative period	Use when an E/M visit during the global period is for a condition unrelated to the original surgery.
`GA`	Waiver of liability statement on file (advance beneficiary notice)	Use when the patient has signed an ABN for services not covered by the payer.

Taxonomy Code	Specialty	Notes
`207K00000X`	Ophthalmology	Retinal surgeons and general ophthalmologists who evaluate postoperative retinal status.
`207KR0400X`	Vitreoretinal Surgery	Subspecialists who perform pars plana vitrectomy and retinal reattachment procedures.
`207P00000X`	Optometry	Optometrists may perform postoperative visual assessments and coordinate follow-up with retina specialists.
`363L00000X`	Surgical Retina Specialist	Providers focused on complex retinal surgeries and long-term surgical outcomes.
`207Q00000X`	Pediatric Ophthalmology & Strabismus	When pediatric retinal detachments require specialized surgical and follow-up care.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`H33.00`	Retinal detachment, unspecified, with unspecified retinal break	Represents retinal detachment that would require surgical repair and subsequent 6-month attached retina documentation.
`H33.01`	Retinal detachment with single break	Describes detachment due to a single retinal break; may be repaired with a single surgery followed by `G9376` documentation.
`H33.02`	Retinal detachment with multiple breaks	Multiple breaks may still be repairable with one surgery; attachment at 6 months is documented by `G9376`.
`H33.1`	Serous retinal detachment	Different mechanism but follow-up for attachment or resolution may be relevant to postoperative outcomes.
`H33.4`	Retinal detachment with macular involvement	Macula-off detachments influence prognosis; successful reattachment at 6 months is clinically significant.
`H35.30`	Unspecified degeneration of retina	Underlying retinal pathology that may predispose to detachment; relevant when documenting postoperative stability.
`H35.60`	Unspecified noninflammatory disorder of retina	General retinal disorders that may be present in the same patient population requiring monitoring at 6 months.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`67108`	Repair of retinal detachment; with vitrectomy, pneumatic retinopexy, cryopexy or photocoagulation	Common primary surgical procedure for rhegmatogenous retinal detachment prior to the 6-month follow-up covered by `G9376`.
`67113`	Repair of retinal detachment; with vitrectomy, complex including membrane peel, internal tamponade, and/or retinectomy	Performed for more complex detachments; patient with a single complex surgery still eligible for `G9376` if retina attached at 6 months.
`67028`	Intravitreal injection of a pharmacologic agent (separate procedure)	May be performed adjunctively or postoperatively for macular edema or adjunct therapy; not the primary reattachment surgery.
`92012`	Ophthalmological services: intermediate, established patient with initiation of diagnostic and treatment; established patient	Used for intermediate postoperative follow-up visits when an E/M service is documented at the 6-month visit.
`92014`	Ophthalmological services: comprehensive, established patient; typically 45 minutes	Used for comprehensive postoperative evaluation at the 6-month visit when documentation supports a comprehensive eye exam.