By John M. Haley, MD, Evelyn Kelly, OCS, F. Hampton Roy, MD
Sue Vicchrilli, COT, OCS, and Trexler M. Topping, MD
This article is from October 2005 and may contain outdated material.
Certain office-based services are subject to a facility-based reduction when performed in an ambulatory surgery center. This reduction applies only to services on the CMS list of ASC-covered services. From the “Eye and Ocular Adnexa” section of CPT, services that are subject to that site-of-service differential include the following:
Eyeball
65125 Modification of ocular implant with placement or replacement of pegs (e.g., drilling receptacle for prosthesis appendage), separate procedure
65205 Removal of foreign body, external eye; conjunctival superficial
65210 conjunctival embedded (includes concretions), subconjunctival, or scleral nonperforating
65220 corneal, without slit lamp
65222 corneal, with slit lamp
65270 Repair of laceration; conjunctiva, with or without nonperforating laceration sclera, direct closure
65272 conjunctiva, by mobilization and rearrangement, without hospitalization
65273 conjunctiva, by mobilization and rearrangement, with hospitalization
65275 cornea, nonperforating, with or without removal of foreign body
65286 application of tissue glue, wounds of cornea and/or sclera
Anterior Segment
65400 Excision of lesion, cornea (keratectomy, lamellar, partial), except pterygium
65410 Biopsy of cornea
65420 Excision or transportation of pterygium; without graft
65426 with graft
65430 Scraping of the cornea, diagnostic, for smear and/or culture
65435 Removal of corneal epithelium; with or without chemocauterization (abrasion, curettage)
65436 with application of chelating agent (e.g., EDTA)
65450 Destruction of lesion of cornea by cryotherapy, photocoagulation or thermocauterization
65600 Multiple punctures of anterior cornea (e.g., for corneal erosion, tattoo)
65772 Corneal relaxing incision for correction of surgically induced astigmatism
65800 Paracentesis of anterior chamber of eye (separate procedure); with diagnostic aspiration of aqueous
65805 with therapeutic release of aqueous
65815 with removal of blood, with or without irrigation and/or air injection
65855 Trabeculoplasty by laser surgery, one or more sessions (defined treatment series)
65860 Severing adhesions of anterior segment, laser technique (separate procedure)
66020 Injection, anterior chamber of eye (separate procedure); air or liquid
66030 Medication
66130 Excision of lesion, sclera
66250 Revision or repair of operative wound of anterior segment, any type, early or late, major or minor procedure
66700 Ciliary body destruction; diathermy
66710 Cyclophotocoagulation, transscleral
66720 Cryotherapy
66740 Cyclodialysis
66761 Iridotomy/iridectomy by laser surgery, one or more sessions (e.g., for glaucoma)
66762 Iridoplasty by photocoagulation, one or more sessions (e.g., for improvement of vision for widening of anterior chamber angle)
66770 Destruction of cyst or lesion iris or ciliary body (nonexcisional procedure)
66821 Discission of secondary membranous cataract (opacified posterior lens capsule and/or anterior hyaloid); laser surgery, one or more stages (e.g., YAG laser)
Posterior Segment
67025 Injection of vitreous substitute, pars plana or limbal approach (fluid-gas exchange), with or without aspiration (separate procedure)
67031 Severing of vitreous strands, vitreous face adhesions, sheets, membranes or opacities, laser surgery (one or more stages)
67101 Repair of retinal detachment, one or more sessions; cryotherapy or diathermy, with or without drainage of subretinal fluid
67105 Photocoagulation, with or without drainage of subretinal fluid
67120 Removal of implanted material, posterior segment, extraocular
67141 Prophylaxis of retinal detachment (e.g., retinal break, lattice degeneration) without drainage, one or more sessions; cryotherapy, diathermy
67145 photocoagulation (laser or xenon arc)
67208 Destruction of localized lesion of retina (e.g., macular edema, tumors), one or more sessions; cryotherapy, diathermy
67210 photocoagulation
67220 Destruction of localized lesion of choroid (e.g., choroidal neovascularization); photocoagulation (e.g. laser), one or more sessions
67221 Photodynamic therapy (includes intravenous infusion)
67225 Photodynamic therapy, second eye, at single session (List separately in addition to code for primary eye treatment)
67227 Destruction of extensive or progressive retinopathy (e.g., diabetic retinopathy), one or more sessions; cryotherapy, diathermy