CPT CODES

CPT Code 67108

CPT code 67108 is used for billing the surgical repair of a detached retina.

Table of Contents
What is CPT Code 67108
Does CPT 67108 Need a Modifier?
CPT Code 67108 Medicare Reimbursement
Are You Being Underpaid for 67108 CPT Code?
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What is CPT Code 67108

CPT code 67108 is used to denote a surgical procedure for the repair of a detached retina. This code specifically refers to a technique involving retinal reattachment, which may include the use of air, gas, or silicone oil injections to flatten the retina, as well as the sealing of any retinal breaks using cryotherapy or laser photocoagulation. This procedure is critical for restoring vision and preventing permanent vision loss due to retinal detachment.

Does CPT 67108 Need a Modifier?

For the CPT code 67108, which is used for the repair of a detached retina, several modifiers may be applicable depending on the specific circumstances of the surgery and billing considerations. Here’s an ordered list of common modifiers that might be used with this procedure and the reasons for each:

1. -LT (Left side): Indicates that the procedure was performed on the left eye.
2. -RT (Right side): Indicates that the procedure was performed on the right eye.
3. -50 (Bilateral procedure): Used if the procedure was performed on both eyes during the same operative session. It's important to check payer policies as some may require billing each eye separately with -LT and -RT.
4. -51 (Multiple procedures): Used when multiple procedures, other than E/M services, Physical Medicine and Rehabilitation services or provision of supplies (e.g., vaccines), are performed at the same session by the same provider.
5. -59 (Distinct procedural service): Indicates that the procedure was distinct or independent from other services performed on the same day. This modifier is used to signify that the procedure was separate and necessary at the same session.
6. -79 (Unrelated procedure or service by the same physician during the postoperative period): This is used if the repair of the detached retina occurs during the postoperative period of another unrelated procedure and is not a reoperation or continuation of the first procedure.
7. -24 (Unrelated evaluation and management service by the same physician during a postoperative period): If an evaluation and management service is performed during the postoperative period of the detached retina repair that is unrelated to the original procedure, this modifier would be appropriate.

Each of these modifiers serves to provide specific details that can affect billing and reimbursement. It is crucial to select the correct modifier to ensure accurate processing of claims and to avoid denials due to incorrect or insufficient coding.

CPT Code 67108 Medicare Reimbursement

CPT code 67108, which refers to the surgical procedure for repairing a detached retina, is typically reimbursed by Medicare. The reimbursement for this procedure, however, can vary based on several factors including the geographic location of the service provider, the setting in which the procedure is performed (hospital outpatient department vs. ambulatory surgical center), and the specifics of the patient's Medicare plan.

To determine the exact reimbursement amount for CPT code 67108, it is advisable to consult the Medicare Physician Fee Schedule (MPFS) available on the Centers for Medicare & Medicaid Services (CMS) website. This schedule provides detailed information on the reimbursement rates for all CPT codes based on the locality. Additionally, providers should verify coverage and reimbursement details with the local Medicare Administrative Contractor (MAC) as there could be regional variations and updates to the policy.

Are You Being Underpaid for 67108 CPT Code?

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