CPT Code 67005

CPT code 67005 is a medical procedure code for the partial removal of eye fluid.

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What is CPT Code 67005

CPT code 67005 refers to a surgical procedure involving the partial removal of vitreous humor, the clear gel that fills the space between the lens and the retina of the eye. This procedure is typically performed to address issues such as vitreous hemorrhage or to facilitate the treatment of other eye conditions.

Does CPT 67005 Need a Modifier?

For CPT code 67005, which pertains to the partial removal of eye fluid (vitreous), several modifiers may be applicable depending on the specific circumstances of the procedure. Here is an ordered list of potential modifiers and the reasons for their use:

1. -LT (Left side): Indicates that the procedure was performed on the left eye.
2. -RT (Right side): Indicates that the procedure was performed on the right eye.
3. -50 (Bilateral procedure): Used when the procedure is performed on both eyes during the same surgical session.
4. -51 (Multiple procedures): Used if this procedure is performed at the same session as other separate procedures.
5. -59 (Distinct procedural service): Indicates that the procedure is distinct or independent from other services performed on the same day.
6. -78 (Unplanned return to the operating/procedure room): Used if a return to the operating room is required for a related procedure during the postoperative period.
7. -79 (Unrelated procedure or service by the same physician during the postoperative period): Used if a new procedure (unrelated to the original) is performed while the patient is still in the postoperative period for the initial surgery.
8. -24 (Unrelated evaluation and management service by the same physician during a postoperative period): Applicable if an unrelated evaluation and management service is needed during the postoperative period.

Each modifier provides specific information that affects billing and reimbursement processes, ensuring accurate claims processing and compliance with payer rules.

CPT Code 67005 Medicare Reimbursement

CPT code 67005, which pertains to the partial removal of eye fluid (also known as a partial vitrectomy), is generally reimbursable by Medicare. However, the specific reimbursement amount for this procedure can vary based on several factors including the geographic location of the service provider, the facility type where the procedure is performed (e.g., hospital outpatient department vs. ambulatory surgical center), and the Medicare Administrative Contractor (MAC) policies that apply to the region.

To determine the exact reimbursement amount for CPT code 67005, healthcare providers should consult the Medicare Physician Fee Schedule (MPFS) lookup tool available on the Centers for Medicare & Medicaid Services (CMS) website. This tool provides detailed information on reimbursement rates based on the provider's locality. Additionally, it is important for providers to verify that all documentation and coding are accurately completed to ensure compliance with Medicare's coverage and coding requirements, thereby facilitating appropriate reimbursement.

Are You Being Underpaid for 67005 CPT Code?

Discover how MD Clarity's RevFind software can enhance your revenue cycle management by accurately detecting underpayments. With the capability to scrutinize contracts and identify discrepancies down to specific CPT codes, such as 67005 for partial removal of eye fluid, RevFind ensures that each claim is fully compensated according to your payer agreements. Schedule a demo today to see how RevFind can help secure the payments you are entitled to for every procedure code, including individual payer details.

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