2025 CPT code 67041
(Active) Effective Date: N/A Revision Date: N/A Surgery - Surgical Procedures on the Eye and Ocular Adnexa Surgery Feed
Vitrectomy with removal of preretinal cellular membrane (e.g., macular pucker).
Modifiers may be applicable depending on the circumstances.For instance, modifier 50 (bilateral procedure) could be used if performed on both eyes.Modifier 59 may be applied only under very specific circumstances and after thorough review of NCCI edits. Consult your payer for further information.
Medical necessity for this procedure is established by documented visual impairment due to macular pucker that significantly impacts the patient's quality of life.Conservative treatments should be ruled out or proven ineffective.
The ophthalmologist performs the pars plana vitrectomy, removes the preretinal cellular membrane, closes the incision, restores intraocular pressure, administers topical antibiotics, and applies an eye patch.
In simple words: The doctor removes scar tissue from the back of the eye that's blocking vision.They use a special tool to remove some of the eye's gel-like substance to reach the scar tissue, then carefully peel away the scar to improve vision.The eye is then stitched closed, and an antibiotic and eye patch are applied.
This procedure involves a pars plana approach vitrectomy using a mechanical cutting tool to remove vitreous humor.The preretinal cellular membrane (e.g., macular pucker) is then removed using intraocular micro forceps. The incision is closed with sutures, intraocular pressure is restored, and a topical antibiotic is administered followed by an eye patch.
Example 1: A 60-year-old patient presents with decreased vision due to macular pucker.A pars plana vitrectomy with removal of the preretinal membrane is performed using a mechanical vitrector and intraocular forceps. , A 75-year-old patient with diabetic retinopathy experiences vision loss from macular pucker. A vitrectomy with membrane removal is completed, with post-operative care including antibiotic drops and an eye patch., A 45-year-old patient with a history of eye trauma develops macular pucker. A pars plana vitrectomy with removal of preretinal membrane is carried out, resolving visual distortion caused by the scar tissue.
Operative report detailing the pars plana approach, type of vitrector used, description of membrane removal, suture details, intraocular pressure measurement, antibiotic administration, and application of the eye patch.Preoperative and postoperative visual acuity measurements should also be documented.Medical necessity documentation supporting the need for the procedure should be included.
** Always refer to the most recent CPT codebook and NCCI edits for the most up-to-date information.The selection of this code is dependent upon the specifics of the procedure and medical necessity.Review payer specific guidelines before submitting claims.
- Revenue Code: P4C (EYE PROCEDURE - RETINAL DETACHMENT)
- RVU: RVUs vary by payer and region. Consult your local Medicare fee schedule or payer-specific information.
- Global Days: 0 days
- Payment Status: Active
- Modifier TC rule: A technical component (TC) modifier likely does not apply to this code.It is a comprehensive code representing the entire procedure. Consult your payer for further guidance.
- Fee Schedule: The fee schedule varies widely by region and payer, even historically. Consult the relevant payer's historical fee schedules for specific information.
- Specialties:Ophthalmology, Vitreoretinal Surgery
- Place of Service:Office, Ambulatory Surgical Center (ASC), Inpatient Hospital