Crystal's MCW Coder Hub⚕️CPT Code 67027 — Implantation of Intravitreal Drug Delivery System
Quick Reference
CPT: 67027 | Global Period: 090 Days | wRVU: 9.31 Assistant Payable: No | Specialty: Ophthalmology - Vitreoretinal Surgery Status: Active | MDC: 02 - Diseases & Disorders of the Eye
📖 Official CPT Descriptor
Implantation of intravitreal drug delivery system (e.g., ganciclovir implant), includes concomitant removal of vitreous
CPT 67027 describes the surgical implantation of a sustained-release drug delivery device into the vitreous cavity of the eye via a pars plana approach. The descriptor explicitly includes the concomitant vitrectomy required to create a pocket and seat the device — the vitrectomy is not separately reportable with 67036.
🏥 Clinical Overview
CPT 67027 is a major intraocular surgical procedure performed by a vitreoretinal surgeon. A sustained-release implant is placed directly into the vitreous cavity to deliver therapeutic drug concentrations to the posterior segment of the eye over months to years — far exceeding what standard intravitreal injections can achieve in a single administration.
🔬 Device Context & History
| Device | Drug | Indication | Status | Note |
|---|---|---|---|---|
| Vitrasert® | Ganciclovir 4.5 mg | CMV retinitis (HIV/AIDS) | Discontinued | Historical basis of this code |
| Retisert® | Fluocinolone acetonide 0.59 mg | Non-infectious uveitis, posterior segment | Active | Currently most common use of 67027 |
| Ozurdex® | Dexamethasone 0.7 mg | DME, uveitis, BRVO/CRVO | Active | Use 67028 — injected, not surgically implanted |
| Iluvien®/Yutiq® | Fluocinolone acetonide 0.19 mg | DME, posterior uveitis | Active | Use 67028 — delivered via applicator/injection |
Critical Distinction
CPT 67027 is for surgically implanted devices requiring a sclerotomy, vitrectomy, and anchoring sutures (e.g., Retisert® sutured to the sclera). Injected or applicator-delivered intravitreal implants (Ozurdex®, Iluvien®, Yutiq®) use 67028. Confusing these two codes is one of the most common billing errors in vitreoretinal ophthalmology.
🔬 Key Anatomical Concept
The surgery accesses the vitreous cavity through the pars plana — the flat, avascular portion of the ciliary body approximately 3.5-4 mm posterior to the limbus — minimizing retinal disruption. This approach is the same used in pars plana vitrectomy (67036).
⚕️ Procedure Details
- Anesthesia — General or monitored anesthesia care (MAC); patient positioned supine.
- Prep — Conjunctival peritomy and topical/subconjunctival povidone-iodine prep.
- Sclerotomy — A controlled incision is made through the sclera at the pars plana (typically 3.5-4.0 mm posterior to the limbus).
- Vitrectomy — A core pars plana vitrectomy is performed to remove vitreous and create a pocket for device placement. This step is bundled and not separately reportable.
- Device implantation — The drug delivery implant is inserted into the vitreous cavity through the sclerotomy.
- Device fixation — For sutured implants such as Retisert®, a polypropylene or nylon suture is passed through the device strut and anchored to the sclera to prevent migration or extrusion.
- Wound closure — The sclerotomy and conjunctiva are closed in layers; topical antibiotics and anti-inflammatory agents are applied.
✅ Includes
| Included Component | Rationale |
|---|---|
| Concomitant vitrectomy / removal of vitreous | Explicitly stated in the CPT descriptor; do not separately code 67036 |
| Pars plana sclerotomy | Integral surgical approach; not separately reportable |
| Suture fixation of device to sclera | Standard step in anchored implant placement |
| Conjunctival peritomy and closure | Routine wound management; bundled |
Unbundling Risk
The vitrectomy performed as part of 67027 is explicitly included by descriptor. Separately billing 67036 alongside 67027 constitutes unbundling, is subject to claim denial under NCCI edits, and may trigger audit risk.
❌ Excludes / Separately Reportable Codes
| Code | Description | Separately Reportable? |
|---|---|---|
| 67028 | Intravitreal injection of pharmacologic agent (e.g., Ozurdex®, anti-VEGF, Iluvien® via applicator) | ✅ Yes — distinct procedure and device type |
| 67036 | Vitrectomy, mechanical, pars plana approach | ❌ No — bundled into 67027 |
| 67025 | Injection of vitreous substitute, pars plana or limbal approach | ✅ Yes — if distinct and separately documented |
| 67120 | Removal of implanted material, posterior segment; intraocular | ✅ Yes — separate encounter for device removal |
| 67121 | Removal of implanted material, posterior segment; extraocular | ✅ Yes — separate encounter; verify which code applies to the specific device’s removal |
| 67113 | Repair of complex retinal detachment (e.g., with PVR) | ✅ Yes — only if separate, distinct service; document thoroughly |
| 67108 | Repair of retinal detachment with vitrectomy | ✅ Yes — if clearly distinct from 67027 session |
🧬 ICD-10-CM Indications & HCC Mapping
Laterality Required
Where the ICD-10-CM code includes eye laterality options, you must specify the affected eye (right, left, bilateral). Failure to indicate laterality may result in payer rejection.
Primary Diagnosis Codes
| ICD-10-CM | Description | HCC? | HCC Category (v28) |
|---|---|---|---|
| B25.8 | Other cytomegaloviral diseases (CMV retinitis coded here) | ✅ Yes | HCC 6 - Opportunistic Infections 1 |
| H30.90 | Unspecified chorioretinal inflammation, unspecified eye | ❌ No | — |
| H30.91 | Unspecified chorioretinal inflammation, right eye | ❌ No | — |
| H30.92 | Unspecified chorioretinal inflammation, left eye | ❌ No | — |
| H30.10 | Unspecified disseminated chorioretinal inflammation, unspecified eye | ❌ No | — |
| H30.20 | Posterior cyclitis (pars planitis), unspecified eye | ❌ No | — |
| H30.21 | Posterior cyclitis, right eye | ❌ No | — |
| H30.22 | Posterior cyclitis, left eye | ❌ No | — |
| E11.311 | Type 2 diabetes mellitus with unspecified diabetic retinopathy with macular edema | ✅ Yes | HCC 18 - Diabetes with Chronic Complications 1 |
HCC Detail — B25.8
The HCC weight for B25.8 is most clinically relevant when it occurs as an opportunistic infection in the context of HIV disease (B20). When B20 is documented and coded as the principal/first-listed diagnosis, B25.8 contributes to the HCC 6 risk score. CMV retinitis in a non-immunocompromised patient is rare and may not carry the same HCC impact — always code and document the underlying immunocompromising condition when present.
HCC Detail — E11.311
Diabetic retinopathy with macular edema maps to HCC 18 (Diabetes with Chronic Complications) in the CMS-HCC v28 model. This is a higher-weighted diabetes category than uncomplicated diabetes (HCC 19). Thorough documentation of the specific type of retinopathy and the presence of macular edema is critical for accurate HCC capture.
Secondary / Supporting Diagnoses
| ICD-10-CM | Description | Use Case |
|---|---|---|
| B20 | Human immunodeficiency virus (HIV) disease | Code first when CMV retinitis is HIV-related; per ICD-10-CM sequencing guidelines |
| Z79.899 | Other long-term (current) drug therapy | When patient is on chronic immunosuppressants (e.g., for uveitis management) |
| H57.10 | Ocular pain, unspecified eye | Supporting symptom if documented |
| Z96.89 | Presence of other specified functional implants | Use at subsequent encounters once the intravitreal implant is in place (verify specificity with current ICD-10-CM edition) |
HIV Sequencing Rule
Per ICD-10-CM Official Coding Guidelines, when a patient with HIV disease presents for any condition related to HIV, B20 must be sequenced first, followed by the opportunistic infection or related condition (B25.8). This applies even when the presenting reason for the encounter is the eye surgery itself.
🔧 Applicable Modifiers
| Modifier | Description | Application to 67027 |
|---|---|---|
| -RT | Right side (right eye) | Required for unilateral procedure — right eye |
| -LT | Left side (left eye) | Required for unilateral procedure — left eye |
| -50 | Bilateral procedure | Same surgeon, same session, both eyes; expect 150% of fee schedule allowance |
| -58 | Staged or related procedure by same physician, postoperative period | Planned staged procedure during 90-day global (e.g., second eye implantation planned from outset) |
| -78 | Unplanned return to OR for related procedure, postoperative period | Unplanned complication-related return to OR during 90-day global (e.g., device extrusion, wound dehiscence) |
| -79 | Unrelated procedure by same physician, postoperative period | Completely unrelated new procedure performed on the same patient during the global period |
| -24 | Unrelated E/M service during postoperative period | E/M visit provided during the 90-day global that is entirely unrelated to 67027 |
Laterality is Non-Negotiable
-50 vs. Separate Line Items
Medicare accepts modifier -50 for bilateral same-session procedures. However, some commercial payers prefer two separate claim lines — one with -RT and one with -LT — rather than a single line with -50. Always verify the individual payer’s bilateral billing policy before submission to avoid unnecessary denials.
💰 Billing & Payment
| Parameter | Value / Status |
|---|---|
| wRVU | 9.31 2 |
| Global Period | 090 Days (Major Surgery) |
| Assistant at Surgery | Not Permitted — CMS Indicator 2 |
| Co-Surgeon | Not Permitted |
| Team Surgery | Not Permitted |
| Multiple Procedure Indicator | 2 — Standard multiple procedure reduction (100% primary; 50% additional) |
| Bilateral Payment | 150% of fee schedule when performed bilaterally, same operative session |
| Anesthesia | General or MAC — reported separately by the anesthesia provider |
Reporting the Device — J7311
When implanting Retisert® (fluocinolone acetonide 0.59 mg), report HCPCS J7311 separately in the outpatient facility or ASC setting to capture the device/drug cost. Verify individual payer policies — some payers bundle J7311 into the procedure payment rather than allowing separate reimbursement.
In the inpatient hospital setting, device and supply costs are included in the MS-DRG global payment and are not separately billable on the facility claim.
🏨 MS-DRG Mapping (Inpatient Setting)
Procedural Setting Context
67027 is overwhelmingly performed in the outpatient or ASC setting. Inpatient admission is reserved for patients with significant systemic comorbidities (e.g., advanced HIV/AIDS, post-transplant immunosuppression) or when postoperative complications require monitoring. The MS-DRG mapping below applies when this procedure drives an inpatient stay.
When 67027 is the operative procedure driving an inpatient admission, it maps to MDC 02 — Diseases and Disorders of the Eye, surgical partition:
| MS-DRG | Description | Key Driver |
|---|---|---|
| 116 | Intraocular Procedures with MCC | Presence of Major Complication or Comorbidity (e.g., sepsis, respiratory failure) |
| 117 | Intraocular Procedures with CC | Presence of Complication or Comorbidity (e.g., uncontrolled DM, renal failure stage 3) |
| 118 | Intraocular Procedures without CC/MCC | No qualifying CC or MCC present |
CC/MCC Optimization Note: In the inpatient setting, thorough documentation and coding of qualifying comorbidities (e.g., B20 HIV disease, diabetes with complications, immunosuppressed state) can appropriately shift the DRG from 118 → 117 or 116, reflecting the true clinical complexity of the admission.
ICD-10-PCS for Inpatient Coding: In the inpatient setting, CPT codes are not used on the UB-04. The equivalent ICD-10-PCS code is assigned. The appropriate root operation would be Insertion (H) within the Eye body system (Section 0, Body System 8), with a device value reflecting the sustained-release intravitreal implant. Consult your facility’s PCS encoder and coding resources for the specific valid code string.
🌳 Code Tree & Related CPT Codes
CPT Surgery → Eye and Ocular Adnexa (65091-68899)
└─ Vitreous (67005-67043)
├─ 67005 Removal of vitreous, anterior approach; mechanical
├─ 67010 Removal of vitreous, anterior approach; aspiration or mechanical
├─ 67015 Aspiration/release of vitreous, subretinal or choroidal fluid; pars plana
├─ 67025 Injection of vitreous substitute; pars plana or limbal approach
├─ 67027 ★ Implantation of intravitreal drug delivery system ← YOU ARE HERE
│ (includes concomitant vitrectomy — 67036 is BUNDLED)
└─ 67028 Intravitreal injection of pharmacologic agent (separate procedure)
Bundled Into 67027 — Do NOT Report Separately:
└─ 67036 Vitrectomy, mechanical, pars plana approach
Related — Separately Reportable When Distinct:
├─ 67108 Repair of retinal detachment; with vitrectomy, any method
├─ 67113 Repair of complex retinal detachment (e.g., with PVR)
├─ 67120 Removal of implanted material, posterior segment; intraocular
└─ 67121 Removal of implanted material, posterior segment; extraocular
📝 Coding Examples
Example 1 — CMV Retinitis in HIV-Positive Patient
Clinical Scenario: A 41-year-old male with documented HIV disease presents with CMV retinitis of the left eye, confirmed on dilated fundus exam and OCT. He is unable to tolerate systemic ganciclovir due to renal insufficiency. The vitreoretinal surgeon performs a pars plana vitrectomy with implantation of an intravitreal drug delivery system, left eye.
| Field | Code | Descriptor |
|---|---|---|
| CPT | 67027 - LT | Implantation of intravitreal drug delivery system, left eye |
| ICD-10-CM (1st) | B20 | Human immunodeficiency virus (HIV) disease |
| ICD-10-CM (2nd) | B25.8 | Other cytomegaloviral diseases (CMV retinitis) |
Sequencing
Example 2 — Non-Infectious Uveitis, Posterior Segment, Right Eye (Retisert®)
Clinical Scenario: A 55-year-old female with chronic non-infectious uveitis involving the posterior segment of the right eye, recalcitrant to systemic corticosteroids and methotrexate. Following discussion of risks and benefits, the vitreoretinal surgeon implants a Retisert® (fluocinolone acetonide 0.59 mg) device via pars plana approach with concomitant vitrectomy, right eye.
| Field | Code | Descriptor |
|---|---|---|
| CPT | 67027 - -RT | Implantation of intravitreal drug delivery system, right eye |
| HCPCS | J7311 | Fluocinolone acetonide, intravitreal implant, 0.59 mg (Retisert®) |
| ICD-10-CM | H30.91 | Unspecified chorioretinal inflammation, right eye |
| Secondary | Z79.899 | Other long-term (current) drug therapy (prior immunosuppressants) |
Example 3 — Posterior Cyclitis (Pars Planitis), Left Eye
Clinical Scenario: A 29-year-old male with bilateral pars planitis, predominantly symptomatic and vision-threatening in the left eye with persistent cystoid macular edema unresponsive to periocular steroid injections. Vitreoretinal surgeon implants Retisert® in the left eye.
| Field | Code | Descriptor |
|---|---|---|
| CPT | 67027 - -LT | Implantation of intravitreal drug delivery system, left eye |
| HCPCS | J7311 | Fluocinolone acetonide, intravitreal implant, 0.59 mg |
| ICD-10-CM | H30.22 | Posterior cyclitis (pars planitis), left eye |
Example 4 — Bilateral Same-Session Implantation
Clinical Scenario: Patient with severe, bilateral, non-infectious posterior uveitis undergoes Retisert® implantation in both eyes during the same operative session.
| Field | Code | Descriptor |
|---|---|---|
| CPT | 67027 - -50 | Implantation of intravitreal drug delivery system, bilateral |
| HCPCS | J7311 × 2 | Report J7311 twice to reflect two device units |
| ICD-10-CM | H30.90 | Unspecified chorioretinal inflammation, unspecified eye |
Bilateral Payer Policy
Example 5 — Unplanned Return to OR, Device Complication (Global Period)
Clinical Scenario: Fourteen days after Retisert® implantation (right eye), the patient returns with pain, redness, and documented device extrusion noted on slit-lamp exam. The vitreoretinal surgeon performs an unplanned return to the OR to manage the complication during the 90-day global period.
| Field | Code | Descriptor |
|---|---|---|
| CPT | 67120 - -RT - -78 | Removal of implanted material, posterior segment; intraocular — right eye — unplanned return to OR, related procedure during global period |
| ICD-10-CM | T85.398A | Other mechanical complication of other ocular prosthetic devices, implants and grafts, initial encounter |
Global Period & Modifier -78
⚠️ Coding Tips, Traps & Caveats
Do Not Separately Code the Vitrectomy
These two codes are frequently confused:
- 67027 = Surgical implantation — sclerotomy, vitrectomy, device sutured or anchored into vitreous cavity. Requires an OR. Used for Retisert® and historically Vitrasert®.
- 67028 = Intravitreal injection — needle/applicator delivery, no vitrectomy, no surgical anchoring. Used for anti-VEGF agents (bevacizumab, ranibizumab, aflibercept), Ozurdex®, Iluvien®, Yutiq®, and similar injected agents.
The distinction is surgical approach and device design, not just drug type.
Medical Necessity Documentation
Payers, especially for Retisert®, routinely require prior authorization and extensive documentation:
- Confirmed diagnosis of non-infectious uveitis affecting the posterior segment
- Evidence of failure or contraindication to systemic immunosuppressive therapy
- Documentation of laterality and visual acuity impact
- Surgeon’s clinical rationale for sustained-release implant over continued injection therapy
Inadequate documentation is the primary reason for prior authorization denial and post-pay audit recoupment.
Global Period — Day Counting
The 90-day global period for 67027 begins the day after the procedure date. Any E/M visits, minor procedures, or follow-up visits for surgical aftercare during this window are bundled into the global payment and not separately billable unless a recognized exception modifier applies (-24, -25, -57, -58, -78, -79).
Inpatient vs. Outpatient Setting — DRG Implications
In the rare inpatient scenario, all comorbidities should be captured with equal rigor to optimize DRG assignment. The difference between MS-DRG 118 (no CC/MCC) and MS-DRG 116 (with MCC) can be substantial in terms of facility reimbursement. Ensure HIV disease (B20), diabetes with complications (E11.311), and other qualifying conditions are fully documented and coded.
ICD-10-PCS in the Inpatient Setting
Inpatient coders: remember that CPT codes are not used on the inpatient claim (UB-04). The operative report for 67027 must be translated to the appropriate ICD-10-PCS code string. The root operation for device placement is typically Insertion (H), Eye body system, with the appropriate body part, approach (percutaneous), and device values. Consult your facility encoder and coding clinic guidance for the valid PCS string.
📚 Sources
1 CMS-HCC Risk Adjustment Model v28 - 2024 Coefficient & Mapping Tables, Centers for Medicare & Medicaid Services
2 CMS Physician Fee Schedule 2025 - National Relative Value File (verify wRVU against current year PFS data)
3 CPT® Professional Edition 2025, American Medical Association
4 ICD-10-CM Official Guidelines for Coding and Reporting, FY2026, CMS & NCHS
5 Retisert® [Prescribing Information], Bausch + Lomb, Inc.
6 CMS Medicare Claims Processing Manual, Chapter 12 - Physicians/Nonphysician Practitioners
7 NCCI Policy Manual for Medicare Services, CMS
8 AAPC Ophthalmology Coding Reference & CPC/CIC Exam Preparation Materials