FEB 02, 2023
Amniotic Membrane Graft for Macular Hole
Question: My physician did a vitrectomy with an internal limiting membrane (ILM) peel for a macular hole, then placed an amniotic membrane (AMT) under the macular hole. Are we able to bill for the placement of the AMT and, if so, what is the correct CPT code?
Answer: This case would be billed as CPT code 67042 Vitrectomy, mechanical, pars plana approach; with removal of internal limiting membrane of retina (e.g., for repair of macular hole, diabetic macular edema), includes, if performed, intraocular tamponade for the pars plana vitrectomy and ILM peel. The AMT placement for macular hole does not have a CPT code, best to report as 67299 Unlisted procedure, posterior segment.
Additional coding guidance can be found in
Retina Coding: Complete Reference Guide.