2025 CPT code 66225

Repair of scleral staphyloma with scleral graft implantation.

Refer to the official CPT guidelines for detailed instructions on the appropriate use of code 66225. Ensure proper documentation to justify medical necessity and the specific procedure performed.

Modifiers may be applicable depending on the circumstances of the procedure (e.g., 51 for multiple procedures, 52 for reduced services, 22 for increased procedural services). Refer to the CPT manual for the appropriate modifier use.

Medical necessity for code 66225 is established when the patient's scleral staphyloma causes significant visual impairment or threatens the integrity of the eye.The procedure is indicated to restore visual function and preserve eye health.

The ophthalmologist or ophthalmic surgeon is responsible for performing the procedure. This includes pre-operative assessment, surgical repair, post-operative care, and follow-up.

IMPORTANT For scleral reinforcement without graft, consider 66225 with modifier 52 (Reduced Services), subject to payer guidelines.For scleral reinforcement procedures, see codes 67250 and 67255.

In simple words: The doctor repairs a weakened and bulging area of the white part of the eye by placing a patch of tissue (a graft) to strengthen it and fix the bulge caused by injury or illness.

This CPT code 66225 describes the surgical repair of a scleral staphyloma, a condition where the sclera (white of the eye) is thinned and stretched, causing protrusion of the uveal tissue.The procedure involves an incision in the conjunctiva and sclera at the site of the staphyloma, excision of the protruding uveal tissue, flattening of the dilated area, and suturing of an appropriately sized scleral graft.A topical antibiotic and eye patch may be applied post-operatively.

Example 1: A patient presents with a scleral staphyloma resulting from a penetrating eye injury. The surgeon performs a scleral graft repair using code 66225., A patient with a history of trauma experiences progressive thinning of the sclera and develops a staphyloma. The ophthalmologist recommends and performs a surgical repair with a scleral graft (code 66225)., A patient with a degenerative eye condition develops a scleral staphyloma requiring surgical intervention. The ophthalmologist performs a staphyloma repair with graft implantation, accurately documented with code 66225.

* Detailed preoperative assessment, including history, physical examination, visual acuity measurements, and imaging studies (e.g., OCT, ultrasound).* Operative report describing the surgical technique, including the type and size of the scleral graft used.* Postoperative examination notes documenting the patient's recovery and any complications.* Supporting medical records demonstrating medical necessity.

** Always refer to the most recent CPT codebook and your specific payer's guidelines for the most up-to-date information on coding and reimbursement.

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