👁️ CPT 67107 — Repair of Retinal Detachment; Scleral Buckling
Quick Reference
wRVU: 15.60 | Global Period: 090 | Assistant Payable: Yes | Bilateral Indicator: 1
Rule: CPT 67107 carries a 90-day global period. The bilateral indicator of 1 means a 150% payment adjustment applies if billed bilaterally with modifier -50. Modifier -54 is required if the surgeon formally or informally transfers post-operative care.1
📋 Clinical Description
CPT 67107 describes the surgical repair of a detached retina utilizing a scleral buckling technique. In this procedure, the physician places a flexible band or sponge around the eye’s outer layer to indent the wall and push it against the detached retina. This indentation helps close the retinal break and relieve the traction that caused the detachment. The code is comprehensive and includes several concurrent maneuvers if they are performed, such as placing an implant, applying cryotherapy or laser photocoagulation to seal the tear, and draining subretinal fluid to allow the retina to flatten properly.
When selecting this code, it is important to differentiate it from other retinal repair methods. For instance, CPT 67108 involves repairing a detached retina using a vitrectomy approach, which includes the internal removal of the vitreous gel, rather than relying primarily on the external scleral buckling described in 67107. Alternatively, CPT 67110 represents a less invasive technique known as pneumatic retinopexy, where a gas bubble is injected into the eye to float against and seal the retinal tear, without the application of a permanent scleral buckle. The selection between these codes relies heavily on the specific surgical approach documented in the operative report.
This procedure may be performed in the following clinical contexts:
- Rhegmatogenous Retinal Detachment — This condition occurs when a tear or break in the retina allows fluid to pass into the subretinal space, peeling the retina away. Scleral buckling is a highly effective, definitive treatment for securing the retinal tear and reattaching the layers.
- Tractional Retinal Detachment — In cases where scar tissue on the retina’s surface contracts and pulls the retina away from the underlying epithelium, a buckle can help relieve this traction. While vitrectomy is often required, scleral buckling may be used concurrently.
- Exudative Retinal Detachment — Fluid can accumulate beneath the retina without a distinct tear, often due to inflammatory or vascular conditions. Surgical intervention may be necessary if conservative or medical management fails to resolve the fluid accumulation.
- Failed Previous Repair — A patient may present with a recurrent retinal detachment following an initial pneumatic retinopexy or laser treatment. A scleral buckle procedure is frequently indicated as the secondary, more robust surgical intervention to permanently anchor the retina.
🔬 Anatomical & Procedural Considerations
| Variant | Mechanism | Key Notes |
|---|---|---|
| Lamellar Scleral Dissection | The surgeon creates a partial-thickness bed within the sclera to countersink the silicone buckling element. This technique embeds the buckle directly into the scleral wall for optimal indentation and stability. | This method is highly effective for reducing the prominence of the buckle under the conjunctiva. It requires careful dissection to avoid full-thickness perforation of the globe during the bed creation. |
| Scleral Imbrication | The surgeon overlaps and sutures opposing edges of the sclera over the buckling element. This maneuver artificially shortens the scleral circumference to push the choroid firmly against the detached retina. | Imbrication creates a permanent internal ridge that physically supports the retinal tear. It is frequently combined with the placement of a solid silicone implant to augment the buckling effect. |
| Encircling Procedure | A narrow silicone band is passed 360 degrees around the globe, securing it under the extraocular muscles. The band is tightened to create a continuous, circumferential indentation around the entire eye. | This variant provides broad, uniform support for the retina and is especially useful for patients with multiple retinal breaks or diffuse retinal pathology. It permanently alters the axial length of the eye, often inducing a myopic shift in the patient’s vision. |
Clinical Pearl
Always verify the operative report for the specific technique used to secure the retina. Even if the surgeon performs additional, inherently related procedures such as cryotherapy, photocoagulation, or subretinal fluid drainage during the scleral buckling, these actions are bundled into CPT 67107 and should not be reported separately.
✅ Procedure Includes
- Administration of local or general anesthesia and the creation of conjunctival peritomies to expose the sclera and isolate the extraocular muscles.
- Localization and marking of all retinal breaks using indirect ophthalmoscopy.
- Application of cryotherapy or laser photocoagulation to create an adhesive chorioretinal scar around the identified retinal breaks.
- Placement and suturing of the scleral buckling element, such as a silicone sponge or solid band, either locally or circumferentially.
- Drainage of subretinal fluid via a sclerotomy, if deemed clinically necessary to facilitate retinal flattening.
- Closure of Tenon’s capsule and the conjunctiva, followed by the administration of post-operative topical or subconjunctival medications.
❌ Excludes / Do Not Report Together
| Code | Description | Relationship |
|---|---|---|
| 67101 | Repair of retinal detachment; cryotherapy | Bundled. Cryotherapy is an inclusive component of the comprehensive scleral buckle repair. |
| 67105 | Repair of retinal detachment; photocoagulation | Bundled. Photocoagulation is an inclusive component of the comprehensive scleral buckle repair. |
| 67108 | Repair of retinal detachment; with vitrectomy | Mutually Exclusive. If a vitrectomy is performed as the primary procedure for detachment repair, with or without a scleral buckle, report 67108 instead. |
| 67110 | Repair of retinal detachment; by injection of air or other gas | Bundled. Pneumatic retinopexy components are generally considered part of the overarching detachment repair process. |
Bundling Alert
CPT 67107 represents a major surgical procedure with a 90-day global period. All routine pre-operative, intra-operative, and post-operative care is bundled into the reimbursement for this code. You must not report standard post-operative follow-up visits separately. If a distinctly separate and unrelated Evaluation and Management service is necessary during the global period, modifier -24 may be applied, provided there is robust clinical documentation supporting the unrelated nature of the visit.
🌳 Code Tree — Surgery: Eye and Ocular Adnexa
CPT 65091-68899 Surgery: Eye and Ocular Adnexa
│
├── 67101-67113 Repair Procedures on the Retina or Choroid
│ ├── 67101 Repair of retinal detachment, including drainage of subretinal fluid when performed; cryotherapy (Global: 090)
│ ├── 67105 Repair of retinal detachment, including drainage of subretinal fluid when performed; photocoagulation (Global: 090)
│ ├── ▶▶ 67107 ◀◀ Repair of retinal detachment; scleral buckling (such as lamellar scleral dissection, imbrication or encircling procedure), including, when performed, implant, cryotherapy, photocoagulation, and drainage of subretinal fluid ← YOU ARE HERE (Global: 090)
│ ├── 67108 Repair of retinal detachment; with vitrectomy, any method, including, when performed, air or gas tamponade, focal endolaser photocoagulation, cryotherapy, drainage of subretinal fluid, scleral buckling, and/or removal of lens by same technique (Global: 090)
│ └── 67110 Repair of retinal detachment; by injection of air or other gas (eg, pneumatic retinopexy) (Global: 090)
💰 RVU & Reimbursement Profile
| Component | Value |
|---|---|
| Work RVU | 15.60 |
| Global Period | 090 |
| Bilateral Indicator | 1 |
| Assistant Surgeon | 1 (Payable) |
| Co‑Surgeon | 0 (Not Permitted) |
| Team Surgery | 0 (Not Permitted) |
| PC/TC Split | 0 (Not Applicable) |
| Modifier -51 Exempt | No |
| Anesthesia | 00145 |
Bilateral Billing Rules
The bilateral indicator is 1, indicating that if the procedure is performed on both eyes during the same operative session, it should be billed using modifier -50. The reimbursement will generally be adjusted to 150% of the standard single-procedure allowance. Ensure that documentation clearly supports the medical necessity for bilateral intervention.
🏷️ Modifier Reference
| Modifier | Name | When to Apply |
|---|---|---|
| -RT | Right Side | Apply when the scleral buckle procedure is performed exclusively on the right eye. |
| -LT | Left Side | Apply when the scleral buckle procedure is performed exclusively on the left eye. |
| -50 | Bilateral | Apply when the scleral buckle procedure is performed on both eyes during the same surgical encounter. |
| -E1 | Upper Left Eyelid | Not applicable. This procedure occurs on the globe, not the eyelid. |
| -E2 | Lower Left Eyelid | Not applicable. This procedure occurs on the globe, not the eyelid. |
| -E3 | Upper Right Eyelid | Not applicable. This procedure occurs on the globe, not the eyelid. |
| -E4 | Lower Right Eyelid | Not applicable. This procedure occurs on the globe, not the eyelid. |
| -25 | Significant E/M | Apply to a significant, separately identifiable E/M service on the same day, though less common for a scheduled 90-day global surgery. |
| -24 | Unrelated E/M | Apply to an E/M service provided during the 90-day global period that is completely unrelated to the original detachment repair. |
| -51 | Multiple Procedures | Apply if another distinct, non-bundled procedure is performed by the same surgeon during the same session. |
| -59 | Distinct Service | Apply if a normally bundled service is performed on a different anatomical site or through a separate incision, warranting independent reporting. |
| -52 | Reduced Services | Apply if the scleral buckling procedure is partially reduced or eliminated at the physician’s discretion after it has begun. |
| -53 | Discontinued | Apply if the procedure must be terminated after anesthesia induction due to extenuating circumstances threatening the patient’s well-being. |
| -58 | Staged | Apply if a subsequent procedure during the global period was planned prospectively at the time of the initial surgery. |
| -78 | Return to OR | Apply if the patient requires an unplanned return to the operating room for a complication directly related to the scleral buckle. |
| -79 | Unrelated Procedure | Apply if an entirely distinct and unrelated surgical procedure is required during the 90-day global period of the initial repair. |
🩺 Common ICD‑10‑CM Pairings
Primary Diagnosis Group
| ICD‑10 | Description | HCC? | Notes |
|---|---|---|---|
| H33.001 | Unspecified retinal detachment with retinal break, right eye | No | Use this code when the specific type of break is not detailed, but a detachment with a break is present in the right eye. |
| H33.002 | Unspecified retinal detachment with retinal break, left eye | No | Use this code when the specific type of break is not detailed, but a detachment with a break is present in the left eye. |
| H33.011 | Retinal detachment with single break, right eye | No | Apply this code when the operative report explicitly describes a detachment caused by exactly one retinal break in the right eye. |
| H33.012 | Retinal detachment with single break, left eye | No | Apply this code when the operative report explicitly describes a detachment caused by exactly one retinal break in the left eye. |
| H33.021 | Retinal detachment with multiple breaks, right eye | No | Utilize this code when the physician identifies and addresses two or more breaks causing the detachment in the right eye. |
Secondary Group
| ICD‑10 | Description | HCC? | Notes |
|---|---|---|---|
| H33.022 | Retinal detachment with multiple breaks, left eye | No | Utilize this code when the physician identifies and addresses two or more breaks causing the detachment in the left eye. |
| H33.031 | Retinal detachment with giant retinal tear, right eye | No | Select this code for the right eye when the detachment is associated with a massive retinal tear, often requiring complex management. |
Etiology / Complication
| ICD‑10 | Description | HCC? | Notes |
|---|---|---|---|
| H33.41 | Traction detachment of retina, right eye | No | Use to indicate a right eye detachment resulting primarily from tractional forces, such as severe fibrovascular proliferation. |
| H33.42 | Traction detachment of retina, left eye | No | Use to indicate a left eye detachment resulting primarily from tractional forces, such as severe fibrovascular proliferation. |
Coding Specificity Reminder
Always strive to assign the most granular ICD-10-CM code available. Pay close attention to laterality indicators (H33.001 for the right eye, H33.002 for the left eye, or H33.003 for bilateral). Avoid unspecified codes like H33.009 whenever the laterality is clearly documented in the medical record. Precise diagnosis coding is critical to demonstrate medical necessity and support clean claims processing.
🏥 MS‑DRG Considerations
When CPT 67107 is performed in an inpatient setting, it typically crosswalks to MS-DRG 116 (Intraocular Procedures with MCC) or MS-DRG 117 (Intraocular Procedures without MCC). The final DRG assignment is heavily influenced by the patient’s principal diagnosis and the presence of any Major Complications or Comorbidities (MCCs). While there is currently no universal National Coverage Determination (NCD) exclusively restricting scleral buckling, Local Coverage Determinations (LCDs) may stipulate strict medical necessity criteria, primarily confirming the presence of an active, **sight-threatening retinal detachment**. Ensure all clinical indications are clearly documented to satisfy potential inpatient and localized MAC requirements.
🔧 ICD‑10‑PCS Equivalents
| PCS Code | Full Description | Modality |
|---|---|---|
| 08QJ3ZZ | Repair Right Retina, Percutaneous Approach | Repair |
| 08QK3ZZ | Repair Left Retina, Percutaneous Approach | Repair |
| 089J3ZZ | Drainage of Right Retina, Percutaneous Approach | Drainage |
| 089K3ZZ | Drainage of Left Retina, Percutaneous Approach | Drainage |
PCS Character Analysis
| Position | Character | Value | Definition |
|---|---|---|---|
| 1 | Section | 0 | Medical and Surgical. This section covers the vast majority of therapeutic procedures performed. |
| 2 | Body System | 8 | Eye. This designates the anatomical system targeted during the intervention. |
| 3 | Root Operation | Q | Repair. This operation is defined as restoring, to the extent possible, a body part to its normal anatomic structure and function. |
| 4 | Body Part | J | Retina, Right. This specifies the exact anatomical structure being repaired. |
| 5 | Approach | 3 | Percutaneous. This approach involves entry, by puncture or minor incision, of instrumentation through the skin or mucous membrane. |
| 6 | Device | Z | No Device. Although a buckle is placed, in PCS coding for this specific repair root operation, it is often classified without a separate device character unless specified differently by facility guidelines. |
| 7 | Qualifier | Z | No Qualifier. No additional defining attributes apply to this specific procedure code. |
Root Operation Comparison
- Repair (Q) focuses on restoring the normal anatomical alignment, which is the primary goal of securing the detached retina back against the choroid.
- Drainage (9) is utilized to classify the act of removing subretinal fluid, which is often a critical supplementary step in ensuring the retina flattens successfully during the procedure.
📝 Coding Examples
Example 1
Clinical Scenario: A 65-year-old male presents with sudden onset of flashes, floaters, and a “curtain” coming down over his vision in the right eye. Examination reveals a rhegmatogenous retinal detachment with a single large tear in the superotemporal quadrant. The patient is taken to the ASC where the surgeon performs a lamellar scleral dissection, applies cryotherapy to the tear, and secures a solid silicone scleral buckle around the globe. Subretinal fluid is drained, and the retina successfully reattaches. The procedure is performed solely on the right eye.
| Field | Code | Rationale |
|---|---|---|
| CPT | 67107--RT | CPT 67107 accurately reflects the repair of the retinal detachment via scleral buckling. Modifier -RT indicates the right eye. |
| PDx | H33.011 | This diagnosis code specifies a retinal detachment with a single break in the right eye, matching the operative findings exactly. |
Note
Cryotherapy and subretinal fluid drainage are inclusive components of 67107 and must not be billed separately.
Example 2
Clinical Scenario: A 58-year-old female presents with bilateral retinal detachments, both involving multiple breaks. She requires urgent surgical intervention. The surgeon performs sequential scleral buckling procedures on both the left and right eyes during the same operative session under general anesthesia. Both eyes undergo encircling band placement, extensive laser photocoagulation, and subretinal fluid drainage.
| Field | Code | Rationale |
|---|---|---|
| CPT 1 | 67107--50 | The procedure was performed bilaterally during the same session. Modifier -50 correctly identifies the bilateral service. |
| PDx | H33.023 | This code indicates a retinal detachment with multiple breaks occurring bilaterally. |
Warning
Example 3
Clinical Scenario: A 70-year-old male with a history of left eye retinal detachment returns to the operating room 45 days after his initial scleral buckle repair. He has developed a new, recurrent detachment in the same eye due to the formation of a new retinal break. The surgeon performs a revision and places an additional scleral sponge over the new break.
| Field | Code | Rationale |
|---|---|---|
| CPT | 67107--78--LT | The recurrent detachment requires a return to the operating room for a related condition within the global period, necessitating modifier -78. |
| PDx | H33.002 | The diagnosis is a retinal detachment in the left eye; the specific type of break is treated as the primary indication. |
Global period reminder
Because modifier -78 is used, the reimbursement will only cover the intra-operative portion of the fee schedule, and a new 90-day global period will not be initiated.
⚠️ Common Coding Pitfalls
- Pitfall 1: Billing separately for cryotherapy or laser photocoagulation. These modalities are explicitly bundled into the primary code 67107 and should never be unbundled.
- Pitfall 2: Unbundling the drainage of subretinal fluid. Similar to cryotherapy, the creation of a sclerotomy to drain fluid is an inclusive part of the scleral buckle repair.
- Pitfall 3: Misusing the vitrectomy code. If a pars plana vitrectomy is the primary method of repairing the detachment, you must report 67108, even if a scleral buckle is placed concurrently.
- Pitfall 4: Failing to apply proper laterality modifiers. Using -RT or -LT is crucial for accurate claims processing and avoiding unnecessary denials.
- Pitfall 5: Incorrectly handling the global period. Do not bill for routine post-operative visits within 90 days; ensure modifier -24 is only used for genuinely unrelated Evaluation and Management services.
- Pitfall 6: Ignoring the 2026 CMS modifier -54 mandate. When formal or informal transfer of post-operative care occurs, failing to append -54 to the surgical claim will lead to compliance risks and potential audits.
📎 Sources
1 CMS Medicare Physician Fee Schedule (MPFS) CY 2026 and 2026 CPT Guidelines.
Sources listed above correspond to superscript citations throughout this note. Verify all Medicare payment figures against your current CMS PFS Lookup tool and applicable MAC LCD prior to claim submission. Please use the latest AAPC/AHIMA Coding Books to verify each code within this note.