2025 CPT code 65820
(Active) Effective Date: N/A Revision Date: N/A Surgery - Surgical Procedures on the Eye and Ocular Adnexa Surgery Feed
Goniotomy is a surgical procedure where the limbus is incised to improve drainage of aqueous humor in the eye, often used to treat congenital glaucoma in children.
Modifiers 50 (bilateral procedure) and 63 (procedure performed on infants less than 4 kg) are not applicable. Other modifiers may be applicable depending on the circumstances of the procedure.
Goniotomy is medically necessary for patients with congenital glaucoma or other forms of glaucoma where aqueous humor outflow is significantly impaired and medical management has failed to adequately control intraocular pressure. Documentation must support the need for the procedure and the expected benefit.
The ophthalmologist performs the goniotomy, requiring expertise in ophthalmic microsurgery. This includes prepping the patient, administering anesthesia, making the incision in the limbus using a gonioknife, opening the trabecular meshwork, and ensuring proper drainage of aqueous humor. Post-operative care and monitoring are also part of the ophthalmologist’s responsibility.
In simple words: This surgery helps drain fluid from the eye to lower pressure. A small cut is made near the edge of the colored part of the eye to improve drainage, often used in children with glaucoma since birth.
Goniotomy is an ophthalmic surgical procedure involving an incision of the limbus to enhance the outflow of aqueous humor.This is typically performed on pediatric patients to address congenital glaucoma.The procedure involves the use of a gonioknife to incise the trabecular meshwork, improving drainage.The extent of the incision is significant;the trabecular meshwork should be opened for at least 3 contiguous clock hours or multiple incisions should open it over at least 90 degrees. This procedure is not appropriate for use with other angle surgeries, stent insertions, or Schlemm canal implants if the incision is minimal or incidental to those procedures.It should not be reported with codes for aqueous drainage device insertion.
Example 1: A 6-month-old infant is diagnosed with congenital glaucoma.The ophthalmologist performs a goniotomy to improve aqueous humor drainage, reducing intraocular pressure., A 2-year-old child with elevated intraocular pressure and evidence of congenital glaucoma undergoes goniotomy as a primary treatment modality. The procedure is performed under general anesthesia., A 5-year-old child presents with worsening congenital glaucoma despite prior medical management.A goniotomy is performed, along with postoperative monitoring of intraocular pressure.
Detailed patient history including glaucoma diagnosis and severity;pre-operative intraocular pressure measurements; operative report specifying the extent of the trabecular meshwork incision (at least 3 contiguous clock hours or 90 degrees);post-operative intraocular pressure measurements; and any complications encountered.
** Goniotomy procedures are rapidly evolving, and coding guidelines may require frequent updates. Always refer to the most recent CPT® codebook,payer-specific policies, and other relevant coding resources for accurate reporting.This Fact Sheet should be considered as guidance and not a definitive statement of coding rules.
- Revenue Code: P6C (MINOR PROCEDURES - OTHER)
- RVU: Information not available in source. Refer to CMS fee schedules for current RVU values.
- Global Days: Information not available in source.Global surgical days vary by payer and may depend on additional procedures performed.
- Payment Status: Active
- Modifier TC rule: A technical component (TC) modifier is not typically applicable to this code as it represents the entire procedure.
- Fee Schedule: Information not available in source. Refer to historical CMS fee schedules.
- Specialties:Ophthalmology
- Place of Service:Ambulatory Surgical Center, Office, Inpatient Hospital