📋 CPT 67110: Pneumatic Retinopexy

Official Descriptor: Repair of retinal detachment; by injection of air or other gas (eg, pneumatic retinopexy). ^[4][9]

🔍 1. What is CPT Code 67110?

CPT code 67110 represents a surgical procedure used to repair a retinal detachment by injecting an expandable gas bubble (air or other specialized gas like SF6 or C3F8) into the vitreous cavity of the eye. ^[9]

Procedure Goal: To reattach the retina without making large incisions. The gas bubble floats and presses against the area of detachment, pushing the retina back against the eye wall (retinal pigment epithelium). ^[1][9]
Common Name: Pneumatic Retinopexy.
Approach: This is a minimally invasive procedure often performed in an outpatient setting or office-based lab. It is favored for select retinal detachments due to its effectiveness and lower complication profile compared to more invasive surgeries like scleral buckling (67107) or full vitrectomy (67108). ^[9]
Key Components: The injection is often followed by cryotherapy or laser photocoagulation to permanently seal the retinal break(s). These adjunctive treatments are bundled into the code and not billed separately. ^[5][9]

💰 3. Reimbursement & Valuation

Work Relative Value Unit (wRVU)

The specific wRVU for 67110 is subject to annual updates by CMS. Historically, this code has seen adjustments; for example, in 2016 it underwent a valuation reduction along with other retinal detachment codes. ^[7] As of recent data, it carries significant wRVU weight (e.g., approximately 25.09 total RVUs), reflecting the complexity of patient selection and post-operative management. ^[10]

Action Item: Verify the current year’s wRVU using the CMS MPFS Lookup Tool.

Assistant at Surgery

Assistant Surgeon (Modifier -80, -82, -AS): Typically, pneumatic retinopexy is a standalone procedure that does not require a surgical assistant. However, in rare instances of patient instability or extreme medical necessity, an assistant may be utilized.
Assistant Payable Indicator: Check the CMS MPFS Database.
- Indicator 0: Payment restriction applies unless supporting documentation is submitted.
- Indicator 1: Statutory payment restriction applies. Assistant may not be paid (most common for this code). ^[2]
- Indicator 2: Payment restriction does not apply. Assistant may be paid.

If an assistant is used and payable, the claim is submitted separately with the appropriate modifier (80 for MD, AS for PA/APNP) and reimbursed at 16% of the surgeon’s fee (or 13.6% for non-physicians). ^[2]

Practice Expense (PE)

The PE covers the cost of the office or ASC setting, the operating microscope, the gas (SF6/C3F8), and cryotherapy/laser equipment. ^[6]

➕ 4. Includes & Excludes

Includes (Bundled Services)

Injection of air or expandable gas (SF6, C3F8).
Drainage of subretinal fluid (if performed via the injection or external approach).
Cryotherapy or laser photocoagulation to seal the retinal tear(s) performed at the time of the gas injection. ^[5]
Subsequent positioning and follow-up within the global period related to the reattachment.

Excludes

67101: Repair of retinal detachment by cryotherapy or diathermy (without gas injection). ^[5]
67105: Repair of retinal detachment by photocoagulation (without gas injection). ^[5]
67107: Repair of retinal detachment with scleral buckling (encircling band/exoplant). ^[5][8]
67108: Repair of retinal detachment with vitrectomy. ^[5][8]
67113: Repair of complex retinal detachment (e.g., proliferative vitreoretinopathy). ^[5][7]
67025: Injection of gas for vitreous hemorrhage (different indication/diagnosis). ^[10]
67208 / 67210: Destruction of retinopathy (not for detachment repair). ^[5]

🧩 5. Code Tree & Hierarchy

Surgery of the Eye (65000-69999) → Repair Procedures on the Retina or Choroid (67101-67229) ^[4] → Retinal Detachment Repair Codes

67101: Cryotherapy or diathermy (no buckle, no gas)
67105: Photocoagulation (no buckle, no gas)
67110: Pneumatic Retinopexy (Gas injection) << Current Code
67107: Scleral buckling (with or without implant)
67108: Vitrectomy with retinal detachment repair
67113: Complex retinal detachment repair
Note: Code 67112 has been deleted. To report repeat repairs, use the appropriate technique code with modifiers. ^[5]

↔️ 6. Common Modifiers

-22 - Increased Procedural Services: Use if the detachment is complex or requires significantly more effort (e.g., multiple tears, cloudy media).
-50 - Bilateral Procedure: Rare, but if pneumatic retinopexy is performed on both eyes during the same session.
-51 - Multiple Procedures: If performed on the same day as another distinct procedure (e.g., cataract extraction).
-58 - Staged or Related Procedure: Use if a subsequent laser or cryotherapy is planned to be performed in the postoperative period to augment the repair. ^[5]
-78 - Unplanned Return to the OR: If the patient requires a return to the operating room for a complication (e.g., increased pressure, failure to reattach) during the global period. ^[1]
-79 - Unrelated Procedure: If an unrelated procedure is performed during the postoperative period.
-LT / -RT - Left/Right Eye: Mandatory for all unilateral ocular procedures. ^[1]

🔗 7. ICD-10 Crosswalk & Medical Necessity

The diagnosis must support the medical necessity of repairing a detached retina. The primary diagnosis determines which code family is used. ^[10]

Primary Diagnoses (Retinal Detachments)

H33.001 - H33.059: Retinal detachment with retinal break (specify laterality and stage).
H33.101 - H33.129: Retinoschisis and retinal cysts.
H33.201 - H33.229: Serous retinal detachment.
H33.301 - H33.329: Retinal breaks without detachment (if treated prophylactically with laser/cryo, but detachment repair code requires detachment).
H33.401 - H33.409: Traction detachment of retina.
H33.501 - H33.509: Other retinal detachments with retinal break.
H35.71: Separation of retinal pigment epithelium (if associated with serous detachment).

Supporting Diagnoses (History/Context)

[[H35.371]] - H35.372: Puckering of macula (if ERM present, but not primary reason for gas).
Z98.89x: Personal history of surgery (relevant for recurrent detachment coding). ^[5]
S05.8X-: Ocular trauma codes (if detachment is traumatic). ^[5]

HCC Association (Hierarchical Condition Category)

ICD-10 codes for Retinal Detachment (H33) may contribute to risk adjustment scores if they lead to significant visual impairment or are associated with systemic conditions (e.g., diabetes). ^[3]
Key ICD-10 for HCCs: Look for codes indicating the stage of disease or associated blindness/low vision (H33.0xx with severity).

🏥 8. MS-DRG Mapping (Inpatient)

While 67110 is almost exclusively performed in an Ambulatory Surgical Center (ASC) or Hospital Outpatient Department (HOPD), if the patient is admitted as an inpatient (e.g., for monitoring of intraocular pressure or due to systemic comorbidities), it will map to a Medicare Severity-Diagnosis Related Group (MS-DRG).

Primary MS-DRG: 124 (OTHER DISORDERS OF THE EYE WITH MCC)
Secondary MS-DRG: 125 (OTHER DISORDERS OF THE EYE WITHOUT MCC)

(Note: Assignment depends on the presence of Major Complications or Comorbidities [MCC] documented in the ICD-10 codes.)

📝 9. Coding Examples

Scenario	Patient History	Procedure Performed	Coding Rationale
Example 1	55-year-old with sudden flashes and floaters, diagnosed with a superior retinal detachment in the right eye with a single tear at 11 o’clock. Macula is still attached.	Pneumatic retinopexy with injection of SF6 gas and cryotherapy to the tear.	CPT: 67110-RT DX: H33.001 (Retinal detachment with retinal break, right eye). The procedure is the least invasive option for a superior detachment. ^[9]
Example 2	70-year-old with a history of cataract surgery presents with recurrent retinal detachment in the left eye. The detachment is localized and suitable for gas.	Pneumatic retinopexy with C3F8 gas injection and laser photocoagulation.	CPT: 67110-LT DX: H33.012 (Retinal detachment with retinal break, left eye), Z98.89 (history of surgery). ^[5]
Example 3	Patient presents with a large, complex detachment with PVR. Not a candidate for pneumatic retinopexy.	Pars Plana Vitrectomy, gas tamponade, membrane peel.	Do not use 67110. CPT: 67113 (Complex retinal detachment repair). The diagnosis (proliferative vitreoretinopathy) drives the code selection, not just the technique. ^[5][10]

🔬 10. Relevant Terminology

Pneumatic Retinopexy: A procedure involving the injection of a gas bubble into the vitreous cavity to create pressure on a torn area of the retina, facilitating its reattachment. ^[9]
Cryoprobe/Cryotherapy: A long, slender surgical instrument that applies extreme cold temperature to tissues, used to freeze and seal retinal tears. ^[9]
Photocoagulation: The use of a laser beam that produces heat to coagulate and destroy abnormal tissues, often employed to seal retinal tears. ^[9]
Vitreous Cavity: The space within the eye between the lens and the retina, filled with vitreous humor. ^[9]
Tamponade: The use of a gas bubble to apply internal pressure to the retina, holding it in place against the eye wall while healing occurs.

📌 11. Important Billing Notes

Diagnosis-Driven Coding: Do not code based on technique alone. Pneumatic retinopexy (67110) is for retinal detachment. If you inject gas for a vitreous hemorrhage or a macular hole, you must use a different code (e.g., 67025 or 67042). ^[10]
Bundling: Cryotherapy and laser photocoagulation performed at the time of the gas injection are bundled into 67110. Do not bill them separately. ^[5]
Global Period: This code has a 90-day global period. All related follow-up visits within 90 days are bundled unless a distinct, unrelated problem is addressed (modifier 79 may apply).
Repeat Surgeries: If a patient requires a repeat retinal detachment repair during the global period, use the appropriate technique code (67107, 67108, 67110, 67113) with modifier -58 (staged) or -78 (unplanned return), depending on the circumstances. ^[5]
Patient Positioning: Document patient compliance with post-operative positioning. This is critical for medical necessity and outcome tracking.

Sources: ^{[1] MD Clarity, CPT Code 67110 Overview and Modifiers} ^{[2] Medical Billers and Coders, Assistant-at-Surgery Billing Guidelines} ^{[3] athenahealth, HCC 2025 Specifications} ^{[4] AAPC, CPT Code 67110 - Repair Procedures on the Retina} ^{[5] Retina Today, Updates for Retina Coding (2016)} ^{[6] Cornell Law, 20 CFR § 10.807 Payment Calculation} ^{[7] Part B News, Ophthalmology Code Changes (2015)} ^{[8] Find-A-Code, PQRS Measure 385} ^{[9] Coding Ahead, How To Use CPT Code 67110} ^{[10] Healthcare Communications Network, Properly Coding Retina Surgeries}

Explorer

67110