2025 CPT code 66180
(Active) Effective Date: N/A Revision Date: N/A Surgery - Surgical Procedures on the Eye and Ocular Adnexa Surgery Feed
Surgical implantation of an aqueous shunt with a graft to treat refractory glaucoma.
Modifiers may be applicable depending on the circumstances of the procedure.Consult the CPT manual for appropriate modifier usage (e.g., 50 for bilateral procedures, 22 for increased procedural service, 51 for multiple procedures).
Medical necessity is established when a patient has refractory glaucoma, defined as glaucoma that is not controlled by maximal tolerated medical therapy and/or prior glaucoma surgeries.Documentation should clearly demonstrate failure of conservative management strategies and the clinical need for an aqueous shunt with a graft to control intraocular pressure and prevent vision loss.The justification should be supported by thorough documentation of the severity of glaucoma, associated visual field loss, and potential for vision loss without intervention.
The ophthalmologist or a qualified surgeon performs this procedure.Pre-operative evaluation, intraoperative management, and post-operative care are all part of the clinical responsibility.
In simple words: The doctor inserts a tiny tube (a shunt) into the eye to help drain fluid and lower pressure, which is helpful for people with a type of glaucoma that doesn't respond to other treatments.A small piece of tissue is used to help hold the tube in place.
This CPT code describes the surgical procedure involving the implantation of an aqueous shunt into the anterior chamber of the eye, along with the use of a graft to reinforce the tissue securing the shunt plate.The procedure is performed to facilitate the drainage of aqueous humor and reduce intraocular pressure in patients with refractory glaucoma—glaucoma unresponsive to conventional treatments. The surgeon makes an incision in the conjunctiva, creates a conjunctival flap, positions the plate reservoir beneath the flap, and extends the connected tube into the upper nasal quadrant.The flap is then closed over the plate, and a tissue graft is applied to strengthen the plate's fixation. A topical antibiotic and eye patch may be applied post-procedure.
Example 1: A 65-year-old male patient with refractory glaucoma, unresponsive to medical management and laser treatments, undergoes an aqueous shunt implantation with graft. This is done to lower intraocular pressure and prevent further vision loss., A 72-year-old female patient with severe glaucoma and complications from previous trabeculectomy procedures requires an aqueous shunt with graft to control intraocular pressure and prevent vision impairment., A 50-year-old patient with neovascular glaucoma (glaucoma with abnormal blood vessel formation in the iris) undergoes an aqueous shunt implantation with a graft to reduce pressure and prevent further vision loss. This patient did not respond to the previous treatment.
Detailed ophthalmologic examination records including visual acuity, intraocular pressure measurements, gonioscopy findings (to assess the drainage angle of the eye), and optic nerve evaluation. Preoperative and postoperative photographs.Complete anesthesia record.Operative report detailing the procedure, including type of shunt used and graft material. Postoperative follow-up notes with intraocular pressure readings and assessment of any complications.Medical records documenting failed or contraindicated medical and laser therapy for glaucoma.
** This procedure is considered complex and is not as frequently performed as other glaucoma surgeries.Accurate documentation is crucial for appropriate reimbursement.
- Revenue Code: P4E (EYE PROCEDURE - OTHER)
- Payment Status: Active
- Modifier TC rule: The application of a TC modifier (Technical Component) would depend on whether the procedure is performed in an outpatient setting, and whether the service falls under a bundled payment arrangement.The payment for a technical component (TC) vs. professional component (PC) would be determined based on payer-specific policies.
- Specialties:Ophthalmology
- Place of Service:Ambulatory Surgical Center, Hospital Outpatient, Office