2025 CPT code 67042
(Active) Effective Date: N/A Revision Date: N/A Surgery - Surgical Procedures on the Eye and Ocular Adnexa Surgery Feed
Pars plana vitrectomy with removal of the internal limiting membrane of the retina; includes intraocular tamponade if performed.
Modifiers may be applicable, such as 50 (bilateral procedure), 59 (distinct procedural service), or others depending on the specifics of the procedure and the payer’s requirements.Consult the modifier guidelines in the CPT manual.
Medical necessity is supported by documentation of a macular hole, diabetic macular edema, or other retinal pathology requiring vitrectomy.The documentation should justify the need for vitrectomy and the selected surgical technique.
The ophthalmologist performs the vitrectomy using a pars plana approach, removes the internal limiting membrane, and may inject a tamponade agent to stabilize the retina. Post-operative care and follow up is also part of the clinical responsibility.
In simple words: The doctor removes some gel-like fluid from the eye and a thin layer of scar tissue on the retina to fix a hole or swelling in the center of the eye's vision.They may also inject air, gas, or oil to help the retina heal.
This procedure involves a pars plana approach for mechanical vitrectomy.The internal limiting membrane of the retina is removed.Intraocular tamponade (air, gas, or silicone oil) may be included if performed. This procedure is typically performed to treat macular holes or diabetic macular edema.
Example 1: A patient presents with a macular hole.The ophthalmologist performs a pars plana vitrectomy with removal of the internal limiting membrane and injects air as a tamponade., A patient with diabetic macular edema undergoes a vitrectomy with removal of the internal limiting membrane.Silicone oil is injected for retinal stabilization., A patient has a complex retinal detachment requiring a vitrectomy with internal limiting membrane peel, along with other procedures coded separately such as scleral buckling or laser photocoagulation.
Preoperative and postoperative exam findings, including visual acuity, retinal imaging (OCT, fundus photography), operative report detailing the vitrectomy technique, membrane removal, tamponade type, and any complications encountered.
** Always refer to the most current CPT manual and payer guidelines for detailed coding instructions, including the use of modifiers and billing practices. This information is for educational purposes only.Always confirm with your payer regarding specific reimbursement guidelines.
- Revenue Code: P4C (EYE PROCEDURE - RETINAL DETACHMENT)
- RVU: This information is not provided.Consult the Medicare Physician Fee Schedule (MPFS) or your Medicare Administrative Contractor (MAC) for reimbursement details.
- Global Days: The global period for this procedure is not specified.This will vary depending on payer and local standards.
- Payment Status: Active
- Modifier TC rule: A technical component (TC) modifier may apply depending on the service provided, and the provider's participation status. Review CPT coding guidelines and payer requirements regarding TC modifiers for this procedure.
- Fee Schedule: Historical fee schedule data is not provided. This information varies by payer and year and can be obtained from the relevant payer.
- Specialties:Ophthalmology
- Place of Service:Ambulatory Surgical Center, Hospital Outpatient Department, Office