Summary & Overview

HCPCS M1333: Acute Vitreous Hemorrhage

HCPCS Level II code M1333 denotes acute vitreous hemorrhage, an urgent ophthalmologic condition involving bleeding into the vitreous cavity that can produce sudden vision loss and often prompts evaluation in outpatient ophthalmology clinics, emergency departments, or ambulatory surgical centers. This code matters nationally because urgent eye hemorrhages require timely diagnostic assessment and may trigger varied coverage and utilization patterns across major payers.

Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of national reimbursement and coverage context, common billing and coding considerations, and clinical context that clarifies typical sites of service and expected care pathways.

The publication provides benchmarks for utilization and payment where available, highlights payer policy patterns that affect coverage and prior authorization, and summarizes clinical implications for coding acute ophthalmologic presentations. Data limitations are noted where input fields were not provided. The content is aimed at billing managers, ophthalmology clinicians, and policy analysts seeking a concise reference on the role and administrative handling of M1333 in practice.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareM1333HCPCS Level IIophthalmologyacute vitreous hemorrhageeye emergencyambulatory surgical centeremergency departmentmedical billingdiagnostic coding

Billing Code Overview

HCPCS Level II code M1333 describes acute vitreous hemorrhage, an ocular condition characterized by bleeding into the vitreous cavity of the eye. The service type associated with this code is diagnosis and acute ophthalmologic management related to a sudden intraocular hemorrhage. The typical site of service for care tied to this code is ophthalmology clinic, emergency department, or ambulatory surgical center depending on acuity and need for intervention.

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Clinical & Coding Specifications

Clinical Context

A 62-year-old patient presents to the ophthalmology clinic with acute, painless visual loss and new floaters in the right eye that began several hours earlier after a recent episode of vigorous coughing. Examination reveals markedly reduced visual acuity, a dark red reflex, and obscured fundus view on slit-lamp and indirect ophthalmoscopy consistent with M1333 (acute vitreous hemorrhage). Typical workflow: triage and brief history, urgent ocular exam with visual acuity and intraocular pressure measurement, bedside ocular ultrasound if fundus cannot be visualized, informed consent for diagnostic/therapeutic interventions, and scheduling of procedures such as intravitreal injection for clot-dissolving agents or pars plana vitrectomy if indicated. The typical site of service is an outpatient ophthalmology clinic, ambulatory surgical center, or hospital-based operating room depending on hemorrhage severity and need for surgery. Common monitoring includes post-procedure vision checks and intraocular pressure assessment, with follow-up visits to assess hemorrhage clearance and retinal integrity.

Coding Specifications

Modifier	Description	When to Use
`22`	Increased procedural services	Use when work required is substantially greater than usual for management of an acute vitreous hemorrhage (e.g., extensive additional surgical time due to dense hemorrhage).
`23`	Unusual anesthesia	Use when general anesthesia is medically necessary for a typically non‑anesthetized ophthalmic procedure related to the hemorrhage.
`52`	Reduced services	Use when a planned procedure is partially reduced or not completed for acute intraoperative findings related to the hemorrhage.
`53`	Discontinued procedure	Use when a procedure is started but halted due to intraoperative instability or unexpected findings from the hemorrhage.
`54`	Surgical care only	Use when the billing provider is responsible only for the surgical portion of care for vitrectomy related to the hemorrhage.
`55`	Postoperative management only	Use when the billing provider is only performing postoperative care after surgery for the hemorrhage.
`56`	Preoperative management only	Use when the billing provider provides only preoperative evaluation and management for the planned surgery.
`62`	Two surgeons	Use when two surgeons of different specialties are required for complex vitreoretinal surgery related to the hemorrhage.
`AS`	Left covered by Workers' Compensation	Use when the billed service is related to a work-related injury and paid by Workers' Compensation for the left eye.
`CO`	Worker’s compensation patient	Use to indicate services paid by workers' compensation (CO) for treatment of a job-related vitreous hemorrhage.
`CQ`	Service furnished by a CRNA	Use when a certified registered nurse anesthetist provides anesthesia services for procedures related to the hemorrhage.
`FX`	Left eye	Use to indicate services specific to the left eye when laterality modifiers are needed in payer systems that accept `FX`.
`FY`	Right eye	Use to indicate services specific to the right eye when laterality modifiers are needed in payer systems that accept `FY`.
`QK`	Medical direction of two or more CRNAs	Use when the physician medically directs multiple CRNAs for anesthesia during surgery for the hemorrhage.
`QX`	CRNA service independent billing	Use when CRNA bills independently for anesthesia services related to the procedure.

Taxonomy Code	Specialty	Notes
`207W00000X`	Ophthalmology	Vitreoretinal diagnosis and surgical management, primary specialty for `M1333` care.
`207W00000X`	Retina Specialist (Ophthalmology)	Subspecialty focus on vitreoretinal surgery and management of vitreous hemorrhage.
`364S00000X`	Optometrist	Provides initial evaluation, triage, and non-surgical management and follow-up for vitreous hemorrhage.
`208600000X`	Anesthesiology	Provides anesthesia services for vitrectomy or other procedures performed in the operating room.
`207K00000X`	Emergency Medicine	Manages acute presentations and coordinates urgent ophthalmology referral when hemorrhage is severe.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`H43.11`	Vitreous hemorrhage, right eye	Common presentation code when hemorrhage is localized to the right eye and directs laterality-specific billing.
`H43.12`	Vitreous hemorrhage, left eye	Used when hemorrhage is localized to the left eye for accurate billing and laterality documentation.
`H43.13`	Vitreous hemorrhage, bilateral	Applied when both eyes are affected by hemorrhage.
`H43.10`	Vitreous hemorrhage, unspecified eye	Used when laterality is not documented at time of coding.
`H35.81`	Retinal neovascularization	Common underlying cause (e.g., proliferative diabetic retinopathy) leading to vitreous hemorrhage.
`H35.52`	Retinal detachment with detachment of macula	Important to identify because concurrent detachment can alter urgency and surgical planning.
`E11.319`	Type 2 diabetes mellitus with unspecified diabetic retinopathy without macular edema	Diabetes is a frequent underlying condition contributing to vitreous hemorrhage via proliferative changes.
`S05.89XA`	Other specified injuries of eye and orbit, initial encounter	Trauma-related vitreous hemorrhage coding when hemorrhage follows blunt or penetrating injury.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`67081`	Vitrectomy, pars plana; with removal of vitreous, complex (e.g., for non‑clearing or dense vitreous hemorrhage)	Definitive surgical treatment for dense or nonresolving acute vitreous hemorrhage when visualization or retinal repair is required.
`67036`	Vitreous hemorrhage; diagnostic vitrectomy (limited)	Diagnostic or partial vitrectomy to clear the media for retinal evaluation and possible therapeutic intervention.
`67028`	Intravitreal injection of a pharmacologic agent (e.g., tissue plasminogen activator may be used off‑label)	Office‑based treatment to assist clot lysis or address concurrent pathology contributing to hemorrhage.
`76519`	Ophthalmic ultrasound, diagnostic; B-scan with limited or complete exam	Performed when fundus view is obscured to assess for retinal detachment, vitreous hemorrhage extent, or intraocular foreign body.
`99284`	Emergency department visit, moderate to high severity	Common for initial acute presentation evaluation and stabilization prior to ophthalmology consultation and definitive care.