CPT CODE LIST
CPT CODE LIST – 2014- 2015
CPT CODE
DESCRIPTION OF SERVICE
FEE
EYEBALL – REMOVAL OF EYE
65091
EVISCERATION OF EYE, WITHOUT IMPLANT
389.63
65093
EVISCERATION OF EYE WITH IMPLANT
388.84
65101
ENUCLEATION WITHOUT IMPLANT
448.91
65103
ENUCLEATION W/IMPLANT, MUSCLES NOT ATTACHED
469.19
65105
ENUCLEATION W/IMPLANT, MUSCLES ATTACHED TO IMPLANT
517.99
65110
EXENTERATION OF ORBIT W/O SKIN GRAFT REM ORBIT
CONTENT
757.20
65112
EXENTERATION, W/THERAPEUTIC REMOVALOF BONE
890.15
65114
EXENTERATION, WITH MUSCLE OR MYOCUTANEOUS FLAP
927.92
SECONDARY IMPLANT(S) PROCEDURES
65125
MODIFICATION, OCULAR IMPLANT (SEPARATE PROCEDURE)
275.36
65130
EVISCERATION, EYE IMPLANTATION IN SCLERAL SHELL
444.63
65135
AFTER ENUCLEATION, MUSCLES NOT ATTAHCED TO IMPLANT
452.88
65140
AFTER ENUCLEATION, MUSCLES ATTACHED TO IMPLANT
493.55
65150
REINSERTION/OCULAR IMPLANT W/WO CONJUNCTIVAL GRAFT
356.78
65155
WITH USE OF FOREIGN MATERIAL FOR REINFORCEMENT
AND/OR ATTACHMENT OF MUSCLES TO IMPLANT
520.71
65175
REMOVAL OCULAR IMPLANT
400.19
REMOVAL OF FOREIGN BODY
65205
REMOVAL FOREING BODY EXTERNAL EYE CONJUNCTIVA
35.39
CPT
DESCRIPTION OF SERVICES
FEE
REMOVAL OF FOREIGN BODY
65210
REMOVAL EMBEDDED CONJUNCTIVAL/SCLERAL
NONPERFORATING
43.25
65220
REMOVAL, CORNEAL WITHOUT SLIT SLAMP
36.15
65222
REMOVAL, CORNEAL WITH SLIT LAMP
47.56
65235
REMOVAL, INTRAOCULAR, ANTERIOR CHAMBER OR LENS
429.03
65260
REMOVAL, POSTERIOR SEGMENT MAGNETIC EXTRACTION
588.65
65265
REMOVAL, POSTERIOR SEGMENT NONMAGNETIC EXTRACTION
663.29
REPAIR OF LACERATION
65270
REPAIR LACERATION CONJUNCTIVA W-W/O DIRECT CLOSURE
161.68
65272
REPAIR CONJUNCTIVA MOBILE & REARRANGE W/O HOSPITAL
300.48
65273
REPAIR CONJUNCTIVA MOBILE & RERRANGE W/HOSPITAL
234.23
65275
REPAIR CORNEA NONPERFORATING W-W/O REM FORGN BODY
339.37
65280
CORNEA AND/OR SCLERA, PEFORATING, NOT INVOLVING
UVEAL TISSUE
411.04
CORNEA/SCLERA, PERFORATING W/REPOSITION OR RESECTION
OF UVEAL TISSUE
642.35
65286
APPLICATION, TISSUE GLUE, WOUNDS CORNEA/SCLERA
425.44
65290
REPAIR WOUND, EXTRAOCULAR MUSCLE TENDON - CAPSULE
301.30
65285
CORNEA- Excision
65400
EXCISION LESION, CORNEA EXCEPT PTERYGIUM
65410
BIOPSY, CORNEA
65420
EXCISION OR TRANSPOSITION OF PTERYGIUM WITHOUT GRAFT
407.34
88.37
311.02
CPT CODE
DESCRIPTION OF SERVICE
FEE
CORNEA- REMOVAL OR DESTRUCTION
65426
EXCISION OR TRANSPOSITION OF PTERYGIUM WITH GRAFT
393.74
65430
SCRAPING CORNEA, DIAGNOSTIC, FOR SMEAR/CULTURE
72.06
65435
REMOVAL CORNEAL EPITHELIUM W-W/O
CHEMOCAUTHERIZATIO
49.58
65436
REMOVAL WITH APPLICATION CHELATING AGENT (EDTA)
236.09
65450
DESTRUCTION LESION CORNEA (CRYTO/PHOTO/THERMO)
194.12
65600
MULTIPLE PUNCTURES OF ANTERIOR CORNEA
KERATOPLASTY (Corneal Transplant)
65710
KERATOPLASTY (CORNEAL TRANSPLANT), ANTERIOR LAMELLAR
677.77
65730
KERATOPLASTY, PENETRATING (EXCEPT APHAKIA OR PSEUDO)
754.53
65750
KERATOPLASTY PENETRATING (IN APHAKIA)
765.81
65755
KERATOPLASTY, PENETRATING (IN PSEUDOPHAKIA)
761.32
65756
KERTOPLASTY ENDOTHELIAL
734.32
65757
BACKBENCH PREPARATION OF CORNEAL ENDOTHELIAL
ALLOGRAFT PRIOR TO TRANSPLANTATION (USE IN CONJUCTION
WITH 65756)
65760
KERATOMILEUSIS
873.97
65765
KERATOPHAKIA
873.97
65767
EPIKERATOPLASTY
873.97
65770
KERATOPROSTHESIS
876.31
65772
CORNEAL RELAXING INCISION SURGICALLY INDUCED ASTIGMATISM
272.66
65775
CORNEAL WEDGE RESECTION CORRECTION SURG. ASTIIGMATISM
336.34
M
CPT CODE
DESCRIPTION OF SERVICE
FEE
ANTERIOR CHAMBER - INCISION
65800
PARACENTESIS, ANTERIOR CHAMBER W/DIAGNOSTIC ASP
94.11
65810
PARACENTESIS W/REMOVAL OF VITREOUS AND/OR DISCISSION
HYALOID MEMBRANE, WITH/WO AIR INJECTION
285.11
65815
PARACENTESIS, W/REML BLOOD W-W/O IRRIGATION/AIR
385.37
65820
GONIOTOMY
458.06
65850
TRABECULTOMY AB EXTERNO
523.57
65855
LASER TRABECULOPLASTY; ONE OR MORE SESSIONS
208.44
65860
SEVERING ADHESIONS OF ANTERIOR SEGMENT, LASER
192.38
65865
SEVERING ADESIONS OF ANTERIOR SEGMENT OF EYE
291.55
65870
ANTERIOR SYNCHEIAE
360.33
65875
POSTERIOR SYNECHIAE
383.00
65880
SEVERING CORNEOVITREAL ADHESIONS (BR)
403.95
65900
ANTERIOR CHAMBER - REMOVAL
REMOVAL OF EPITHELIAL DOWNGROWTH, ANTERIOR
CHAMBER OF EYE
593.29
65920
REMOVAL OF IMPLANTED MARTERIAL, ANTERIOR CHAMBER
479.74
65930
REMOVAL OF BLOOD CLOT, ANTERIOR SEGMENT
395.23
66020
INJECTION, ANTERIOR CHAMBER, AIR/LIQUID, SEP PROC
113.08
66030
INJECTION, ANTERIOR CHAMBER, MEDICATION
99.69
ANTERIOR SCLERA - EXCISION
66130
EXCISION OF LESION, SCLERA
431.76
66150
FISTUIZATION OF SCLERA FOR GLAUCOMA; TREPHINATION
WITH IRIDECTOMY
526.38
CPT CODE
DESCRIPTION OF SERVICES
FEE
ANTERIOR SCLERA - EXCISION
66155
THERMOCAUTERIZATION WITH IRIDECTOMY
524.96
65160
SCLERECTOMY WITH PUNCH OR SCISSORS, WITH IRIDECTOMY
598.33
66165
IRIDENCLEISIS OR IRIDOTASIS
514.16
66170
TRABECLECTOMY AB EXTERNO IN ABSENCE OF PREVIOUS SURGERY
724.53
66172
TRABECULECTOMY (INCLUED INJECTION OF ANTIFIBROTIC
AGNT)
910.38
65174
TRANSLUMINAL DILATION OF AQUEOUS OUTFLOW CANAL;
WITHOUT RETENTION OF DEVICE OR STENT
570.82
WITH RETENTION OF DEVICE OR STENT
623.72
65175
AQUEOUS SHUNT
66180
AQUEOUS SHUNT TO EXTRAOCULAR RESERVIOR (MOLTENO)
723.63
66183
INSERTION OF ANTERIOR SEGMENT AQUEOUS DRAINAGE
DEVICE, WITHOUT EXTRAOCULAR RESERVIOR, EXTERNAL
APPROACH
592.43
66185
REVISION OF AQUEOUS SHUNT – EXTRAOCULAR RESERVIOR
455.39
REPAIR OR REVISION
66220
REPAIR OF SCLERAL STAPHYLOMA; WITHOUT GRAFT
444.47
66225
REPAIR OF SCLERAL STAPHYLOMA; WITH GRAFT
573.60
66250
REVISION, REPAIR OPERATIVE WOUND OF ANTERIOR SEGMENT
452.81
IRIS, CILIARY BODY
66500
IRIDOTOMY BY STAB INCISION, EXCEPT TRANSFIXION
214.55
66505
IRIDOTOMY WITH TRANSFIXION AS FOR IRIS BOMBE
234.92
EXCISION
66600
IRIDECTOMY, WITH CORNEOSCLERAL OR CORNEAL SECTION;
FOR REMOVAL OF LESION
500.01
66605
IRIDECTOMY; WITH CYCLECTOMY
651.48
CPT CODE
DESCRIPTION OF SERVICES
FEE
EXCISION
66625
IRIDECTOMY; PERIPHERAL FOR GLAUCOMA
262.69
66630
IRIDECTOMY; SECTOR FOR GLAUCOMA
346.36
66635
IRIDECTOMY; “OPTICAL”
349.91
REPAIR
66680
REPAIR OF IRIS, CILIARY BODY (IRIDODIALYSIS)
312.74
66682
SUTURE OF IRIS CILIARY BODY (SEPERATE PROCEDURE)
379.84
DESTRUCTION
66700
CILIARY BODY DESTRUCTION; DIATHERMY
273.30
66710
CYCLOPHOTOCOAGULATION; TRANSSCLERAL
268.85
66711
CYCOLPHOTOCOAGULATION, ENDOSCOPIC
386.56
66720
CILIARY BODY DESTRUCTION; CRYOTHERAPY
280.93
66740
CILIARY BODY DESTRUCTION; CYCLODIALYSIS
267.03
66761
IRIDOTOMY/IRIDECTOMY BY LASER SURGERY (FOR GLAUCOMA
PER SESSION)
273.58
66762
IRIDOPLASTY, PHOTOCOAGULATION (1 OR MORE SESSIONS)
286.94
66770
DESTRUCTION OF CYST OR LESION IRIS OR CILIARY BODY
319.07
LENS – INCISION
66820
DISCUSSION – SECONDARY MEMBRANOUS CATARACT (KNIFE)
240.38
66821
LASER SURGRY (YAG LASER) (1 OR MORE STAGES)
195.71
66825
REPOSITIONING OF INTRAOCULAR LENS PROTHESIS, REQUIRING
AN INCISION (SEPARATE PROCEDURE)
464.44
CPT CODE
DESCRIPTION OF SERVICES
FEE
LENS - REMOVAL
66830
REMOVAL SECONDARY MEMBRANOUS CATARACT
437.09
66840
REMOVAL OF LENS; ASPIRATION (ONE OR MORE SESSIONS)
425.74
66850
REMOVALOF LENS; PHACOFRAGMENTATION, W/ASPIRATION
486.10
66852
REMOVAL OF LENS; PARS PLANA W-W/P VITRECTOMY
520.49
66920
REMOVAL OF LENS; INTRACAPSULAR
464.30
66930
REMOVAL OF LENS; INTRACAPSULAR F/DISLOCATED LENS
527.90
66940
REMOVAL OF LENS; EXTRACAPSULAR
479.01
INTRAOCULAR LEN PROCEDURES
66982
EXTRACAPULAR CATARACT EXTRACTION W/IOL
661.11
66983
INTRACAPSULAR CATARACT EXTRACTION W/IOL
457.17
66984
EXTRACAPSULAR CATARACT EXTRACTION W/IOL
473.73
66985
INSERTION OF I.O.L. , (SECONDARY IMPLANT) NOT ASSOCIATED
WITH CONCURRENT CATARACT REMOVAL
467.61
66986
EXCHANGE OF INTRAOCULAR LENS
572.38
66990
USE OF OPHTHALMIC ENDOSCOPE (LIST SEPARETLY IN
ADDITION TO CODE FOR PRIMARY PROCEDURE)
59.16
VITREOUS
67005
REMOVAL – VITREOUS, ANTERIOR APPROACH (SKY/LIMBAL)
287.66
67010
REMOVAL – VITREOUS, SUBTOTAL/MECHANICAL VITRECTOMY
333.57
67015
ASPIRATION OR RELEASE OF VITREOUS; PARS PLANA APPROACH
355.13
67025
INJECTION, VITREOUS SUBSTITUTE, PARS PLANA/LIMBAL
440.12
CPT CODE
DESCRIPTION OF SERVICES
FEE
VITREOUS
67027
IMPLANTATION OF INTRAVITREAL DRUG DELIVERY SYSTEM
INCLUDES CONCOMITANT REMOVAL OF VITREOUS
527.12
67028
INTRAVITREALM INJECTION OF PHARMACOLOGIC AGENT
132.30
67030
DISCUSSION, VITREOUS STRANDS W/O REML PARS PLANA
316.84
67031
SEVERING OF VITREOUS STRANDS
234.20
67036
VITRECTOMY, MECHANICAL, PARS PLANA APPROACH
595.99
67039
VITRECTOMY, WITH FOCAL ENDOLASER PHOTOCOAGULATION
762.59
67040
VITRECTOMY; WITH ENDOLASER, PANRETINAL
PHOTOCOAGULATI
880.43
67041
VITRECTOMY; WITH REMOVAL OF PRERETINAL CELLULAR
MEMB
825.40
67042
VITRECTOMY; WITH REMOVAL OF INTERNAL LIMITING MEMBR
946.31
67043
VITRECTOMY; WITH REMOVAL OF SUBRETINAL MEMBRANE
992.28
RETINA OR CHOROID - REPAIR
67101
REPAIR RETINAL DETACHMENT (ONE OR MORE SESSIONS)
471.63
67105
PHOTOCOAGULATION W-W/O DRAINAGE SUBRETINAL
437.33
67107
REPAIR OF RETINA DETACHMENT, SCLERAL BUCKLING
749.22
67108
REPAIR, SCLERAL BUDKLING W/VITRECTOMY
999.00
67110
BY INJECTION OF AIR OR OTHER GAS (PNEUMATIC RETINOPEXY)
529.03
67112
REPAIR BY SCLERAL BUCKLING OR VITRECTOMY, ON PATIENT
HAVING HAD PREVIOUS DETACHMENT REPAIR
824.09
67113
REPAIR OF COMPLEX RETINAL DETACHMENT
67115
RELEASE ENCIRCLING MATERIAL (POSTERIOR SEGMENT)
1,086.28
300.20
CPT CODE
DESCRIPTION OF SERVICES
FEE
RETINA OR CHOROID - REPAIR
67120
REMOVAL OF IMPLANTED MATERIAL, EXTRAOCULAR
397.11
67121
REMOVAL OF IMPLANTED MATERIAL, INTRAOCULAR
558.07
PROPHYLAXIS
67141
PROPHYLAXIS RETINAL DETACHMENT
DIATHERMY/CRYOTHERAP
316.06
67145
PROPHYSAXIS PHOTOCOAGULATION LASER
318.93
67208
DESTRUCTION OF LOCALIZED LESION OF RETINA – 1 SESSION
366.53
67210
PHOTOCOAGULATION, LASER OR SENON ARC – FOCAL LASER
429.38
67218
RADIATION BY IMPLANTATION OF SOURCE (INC. REMOVAL)
873.99
67220
DESTRUCTION OF LOCALIZED LESION OF CHOROID
658.91
DESTRUCTION
DESTRUCTION
67221
PHOTODYNAMIC THERAPY (INCLUDES INTRAVENOUS
INFUSION)
184.95
67225
PHTODYNAMIC THERAPY, (SECOND EYE) LIST SEPERATELY IN
ADDITION TO PRIMARY CODE (USE IN CONJUNCTION WITH
67221)
19.34
67227
DESTRUCTION, EXTENSIVE/PROGRESSIVE RETINOPATHY
372.58
67228
PHOTOCOAGULATION – PAN RETINAL (SAME EYE – 6 MONTHS)
732.72
POSTERIOR SCLERA - REPAIR
67250
SCLERAL REINFORCEMENT; WITHOUT GRAFT
482.55
67255
SCLERAL REINFORCEMENT; WITH GRAFT
515.89
ORBIT – EXPLORATION, EXCISION, DECOMPRESSION
67400
ORBITOTOMY WITHOUT BONE FLAP (FRONTAL OR
TRANSCONJUNTIVAL APPROACH); FOR EXPLORATION, WITH OR
WITHOUT BIOPSY
573.32
CPT CODE
DESCRIPTION OF SERVICES
FEE
ORBIT – EXPLORATION, EXCISION, DECOMPRESSION
67405
ORBITOTOMY WITH DRAINAGE ONLY
487.33
67412
ORBITOTOMY WITH REMOVAL OF LESION
530.95
67413
ORBITOTOMY W/REMOVAL OF FOREIGN BODY
530.99
67414
ORBITOTOMY WITH REMOVAL OF BONE FOR DECOMPRESSION
819.03
67415
FINE NEEDLE ASPIRATION OF ORBITAL CONTENTS
68.23
67420
ORBITOTOMY W/BONE FLAP/WINDOW LATERIAL APP
W/LESION
67430
OBITOTOMY WITH REMOVAL OF FOREIGN BODY
770.71
67440
ORBITOTOMY WITH DRAINAGE
748.86
67445
ORBITOTOMY WITH REMOVAL OF BONE FOR DECOMPRESSION
877.80
67450
ORBITOTOMY FOR EXPLORATION, WITH OR WITHOUT BIOPSY
772.08
1,018.21
ORBIT – OTHER PROCEDURES
67500
RETROBULBAR INJECTION; MEDICATION (SEPARATE
PROCEDURE, DOES NOT INCLUDE SUPPLY OF MEDICATION)
57.20
67505
RETROBUBAR INJECTIONS; ALCOHOL
55.47
67515
INJECTION OF THERAPEUTIC ANGENT INTO TENON CAPSULE
59.13
67550
ORBITAL IMPLANT (OUTSIDE MUSCLE CONE); INSERTION
597.17
67560
REMOVAL OF REVISION
908.98
67570
OPTIC NERVE DECOMPRESSION (INCISION/FENESTRATION
716.17
EYELIDS – EXCISION, DESTRUCTION
67800
EXCISION OF CHALAZION; SINGLE
77.70
67801
EXCISION OF CHALAZION; MULTIPLE, SAME LID
99.92
CPT CODE
DESCRIPTION OF SERVICES
FEE
EYELIDS – EXCISION, DESTRUCTION
67700
BLEPHAROTOMY, DRAINAGE OF ABSCESS, EYELID
160.23
67710
SEVERING OF TARSORRHPHY
134.89
67715
CANTHOTOMY (SEPARATE PROCEDURE)
142.43
67805
EXCISION OF CHALAZION; MULTIPLE, DIFFERENCE LIDS
123.53
67808
EXCISION, GEN ANESTHESIA, REQD HOSP SINGLE/MULTI
223.20
67810
BIOPSY EYELID
138.47
67820
CORRECTION OF TRICHIASIS; EPILATION BY FORCEPS
32.96
67825
EPILATION, BY ELECTROSURGERY OR CRYOTHERPHY
78.75
67830
INCISION OF LID MARGIN FOR TRICHIASIS
161.28
67835
INCISION OF LID MARGIN, WITH MUCOUS MEMBRANE GRAFT
271.70
67840
EXCISION OF LESION EYELID (EXCEPT CHALZAION)
169.31
67850
DESTRUCTION OF LESIONOFLID MARGIN (UP TO 1 CM)
136.41
TARSORRHAPHY
67875
TEMPORARY CLOSURE OF EYELIDS BY SUTURE (FROST)
105.89
67880
CONSTRUCTION, INTERMARGINAL ADHESIONS, MEDIAN
276.21
67882
WITH TRANSPOSITION OF TRASAL PLATE
341.59
REPAIR (BROW PTOSIS, BLEPHAROPTOSIS, LID
RETRACTION)
67900
REPAIR OF BROW PTOSIS
394.32
67901
REPAIR OF BLEPHAROPTOSIS; FRONTAL MUSCLE TECHNIQUE
425.92
67902
REPAIR; FRONTAL MUSCLE TECHNIQUE W/FASCIAL SLING
442.46
CPT CODE
DESCRIPTION OF SERVICES
FEE
REPAIR (BROW PTOSIS, BLEPHAROPTOSIS, LID
RETRACTION)
67904
(TARSO) LEVATOR RESECTION OR ADVANCEMENT, EXTERNAL
APPROCAH
589.37
CONJUNCTIVA – INCISION AND DRAINAGE
68020
INCISION OF CONJUNCTIVA, DRAINAGE OF CYST
73.24
68040
EXPRESSION CONJUNCTIVAL FOLLICLES F/TRACHOMA
40.98
EXCISION AND/OR DESTRUCTION
68100
BIOPSY OF CONJUNCTIVA
105.12
68110
EXISION OF LESION OF CONJUNCTIVA UP TO 1 CM
136.87
68115
EXCISION OF LESIONOF CONJUNCTIVA OVER 1 CM
189.78
68130
EXCISION OF LESION/CONJUNCTIVA W/ ADJACENT SCLERA
328.43
68135
DESTRUCTION OF LESION, CONJUNCTIVA
96.28
INJECTION
68200
SUBCONJUCTIVAL INJECTIONS
13.14
CONJUNCTIVOPLASTY
68320
CONJUNCTIVOPLASTY W/GRAFT OR REARRANGEMENT
434.59
68325
CONJUNCTIVOPLASTY W/BUCCAL MUCOUS MEMBRANE GRAFT
404.77
68326
CONJUNCTIVOPLASTY/ RECONSTRUCTION CUL-DE-SAC W/G-R
394.42
68330
REPAIR SYMBLEMPHARON, CONJUNCTIOPLASTY, NO GRAFT
365.55
68335
REPAIR SYBLEPHARON; W/FREE GRAFT CONJ/BUCCAL MUCO
395.67
68340
DIVISION OF SYMBLEPHARON, WITH OR WITHOUT INSERTION
OF CONFORMER OF CONTACT LENS
328.68
CPT CODE
DESCRIPTION OF SERVICES
FEE
OTHER PROCEDURES
68360
CONJUNCTIVAL FLAP; BRIDGE OR PARTIAL
321.17
68362
CONJUNCTIVAL FLAP; TOTAL
401.17
LACRIMAL SYSTEM - INCISION
68400
INCISION DRAINAGE LACRIMAL GLAND
169.95
68420
INCISION, DRAINAGE LACRIMAL SAC
195.59
68440
SNIP INCISION OF LACRIMAL PUNCTUM
65.10
68500
EXCISION, LACRIMAL BLAND; TOTAL EXCEPT FOR TUMOR
597.60
LACRIMAL SYSTEM - INCISION
68505
EXCISION, LACRIMAL GLAND; PARTICAL EXCEPT FOR TUMOR
600.95
68510
BIOPSY OF LACRIMAL GLAND
280.63
68520
EXCISION OF LACRIMAL SAC
422.64
68525
BIOPSY OF LACRIMAL SAC
172.72
68530
REMOVAL FOREIGN BOYD OF DACRYOLITH, LACRIMAL PATH
266.07
68540
EXCISION OF LACRIMAL GLAND TUMOR, FRONTAL APPROCAH
571.53
68550
EXCISION OF LACRIMAL GLAND TUMOR, W/OSTEOTOMY
702.33
LACRIMAL SYSTEM -REPAIR
68700
PLASTIC REPAIR OF CANALICULI
368.89
68705
CORRECTION OF EVERTED PUNCTUM CAUTERY
145.15
68720
DACRYOCYSTORHINOSTOMY (FISTULIZATION LACRIMAL SAC)
268.24
68745
CONJUNCTIVORHINOSTOMY (FIST CONJUNCTIVAL) W/O TUBE
469.54
68750
CONJUNCTIVORHINOSTOMY (FIST CONJUNCTIVA) W/TUBE
482.88
CPT CODE
DESCRIPTION OF SERVICES
FEE
LACRIMAL SYSTEM -REPAIR
68760
CLOSURE OF LACRIMAL PUNCTUM
123.00
68761
CLOSURE OF LACRIMAL PUNCTUM BY PLUG
89.79
68770
CLOSURE OF LACRIMAL FISTULA (SEPARATE PROCEDURE)
365.79
68840
PROBING OF LACRIMAL CANALICULI, W-W/O IRRIGATION
75.99
68850
INJECTION CONTRAST MEDIUM F/DARCRYOCYSTOPRAPHY
42.88
DIAGNOSTIC ULTRASOUND - SCANS
76510
OPHTHALMIC ULTRASOUND, DIAGNOSTIC; B-SCAN AND
QUANTITATIVE A-SCAN PERFORMED DURING THE SAME
PATIENT ENCOUNTER
INTREPRETATION
106.80
76511
26
QUANTITATIVE A-SCAN ONLY
INTREPRETATION
69.24
36.25
76512
26
B-SCAN (W-W/O SUPERIMPOSED NON-QUANTITATIVE A-SCAN)
INTREPRETATION
64.90
36.38
76513
ANTERIOR SEGMENT ULTRASOUND, IMMERSION (WATER
BATH) B-SCAN OR HIGHER RESOLUTION BIOMICROSCOPY0
INTREPRETATION
59.33
76514
26
CORNEAL PACHYMETRY, UNILATERIAL OR BILATERAL
INTREPRETATION
9.11
6.69
76516
26
OPHTHALMIC BIOMETRY BY ULTRASOUND ECHOGRAPHY, ASCAN
INTREPRETATION
47.57
20.67
76519
26
OPTHALMIC BIOMETRY ULTRASD E’GRAPHY A-SCAN W/ LENS
INTREPRETATION
50.86
20.93
26
26
60.04
24.94
OPHTHALMOLOGY – NEW PATIENT
92002
INTERMEDIATE EYE EXAM – NEW PATIENT
49.48
92004
COMPREHENSIVE EYE EXAM – NEW PATIENT
93.50
CPT CODE
DESCRIPTION OF SERVICES
FEE
LOW VISION EXAM
92005
LOW VISION EXAMINATION (SCCB CLINIC)
95.00
ESTABLISHED PATIENT
92012
INTERMEDIATE/RE-EXAM ESTABLISHED PATIENT
52.13
92014
DILATED/INTERMEDIATE EXAM ESTABLISHED PATIENT
76.26
SPECIAL OPHTHALMOLOGICAL SERVICES
92015
DETERMINATION OF REFRACTIVE STATE
24.65
92020
GONIOSCOPY, NOT PART OF COMPLETE EYE EXAM
17.67
92025
22.59
26
COMPUTERIZED CORNEAL TOPOGRAPHY, UNILATERAL OR
BILATERAL,
INTERPRETATION AND REPORT
92081
26
VISUAL FIELDS EXAMINATION, UNILATERAL OR BILATERIAL
INTREPRETATION
34.59
13.56
92082
26
HUMPHREY VISUAL FIELDS EXAMINATION, INTERMEDIATE
INTREPRETATION
45.76
16.58
92083
26
GOLDMANN VISUAL FIELDS EXTENDED EXAM
INTREPRETATION
52.29
19.03
92100
SERIAL TONOMETRY (SEPARATE PROCEDURE) WITH MULTIPLE
MEASUREMENTS OF INTRAOCULAR PRESSURE
59.01
13.28
92132
26
SCANNING COMPUTERIZED OPHTHALMIC DIAGNOSTIC
IMAGING
INTERPRETATION
21.47
12.45
92133
26
SCANNING COMPUTERIZED OPHTHALMIC DIAGNOSTIC (OCT)
INTREPRETATION
26.41
17.38
92134
26
SCANNING COMPUTERIZED OPHTHALMIC (OCT)
INTREPRETATION
26.41
17.38
92136
OPHTHALMIC BIOMETRY BY PARTIAL COHERENCE
INTERFEROMETRY WITH IOL POWER CALCULATION
INTREPRETATION
53.91
26
20.93
CPT CODE
DESCRIPTION OF SERVICES
FEE
SPECIAL OPHTHALMOLOGICAL SERVICES
92140
PROVOCATIVE TESTS FOR GLAUCOMA, WITH INTREPRETATION
AND REPORT, WITHOUT TONOGRAPHY
37.89
OPHTHALMOSCOPY
92225
OPHTHALMOSCOPY, EXTENDED W/RETINAL DRAWING
16.93
92226
OPHTHALMOSCOPY - SUBSEQUENT
15.70
92227
6.79
92228
REMOTE IMAGING FOR DETECTION OF RETINAL DISEASE
REMOTE IMAGING FOR MONITORING AND MANAGEMENT OF
ACTIVE RETINAL DISEASE
17.79
92230
FLRORESCEIN ANGIOSCOPY W/INTERPRETATION AND REPORT
40.07
92235
26
FLUROESCEIN ANGIOGRAPHY
INTREPRETATION
83.69
31.45
92250
26
FUNDUS PHOTO
INTREPRETATION
47.03
16.58
92285
26
EXTERNAL OCULAR PHOTOGRAPHY
INTERPRETATION
27.28
7.79
92286
26
ANTERIOR SEGMENT IMAGING
INTERPRETATION
78.20
25.19
CONTACT LENS FITTING
92071
FITTING OF CONTACT LENS FOR TREATMENT OF OCULAR
SURFACE DISEASE
19.80
92072
INITIAL FITTING OF CONTACT LENS – FOR MANAGEMENT OF
KERATOCONUS; INITIAL FITTING
87.00
92310
PRESCRIPTION OF OPTICAL AND PHYSICAL CHARACTERISTICS OF
AND FITTING OF CONTACT LENS
69.27
92311
CORNEAL LENS FOR APHAKIA, 1 EYE
62.62
92312
CORNEAL LENS FOR APHAKIA, BOTH EYES
72.25
CPT CODE
DESCRIPTION OF SERVICE
FEE
CONTACT LENS FITTING
92313
CORNEOSCLERAL LENS
60.03
FITTING FOR GLASSES
92340
FITTING, SPECTACLES EXCEPT FOR APHAKIA, MONOFOCAL
26.53
CONTACT LENS SERVICES
(for treatment of eye disease only)
LENS SOFT – ONE EYE
125.00
LENS HARD – ONE EYE
150.00
OFFICE VISIT - MEDICAL
99201
INITIAL OFFICE VISIT – EXAM
26.80
99202
INITIAL OFFICE VISIT - EXAM
46.53
99203
INITIAL OFFICE VISIT - EXAM
67.37
99204
LEVEL IV MEDICAL EXAM; NEW PATIENT
104.69
99205
GENERAL MEDICAL – HEMOGLOBIN & URINALYSIS
132.41
OFFICE VISIT – ESTABLISHED PATIENT
99211
LEVEL I FOLLOW UP; ESTABLISHED PATIENT
13.52
99212
LEVEL II FOLLOWUP; ESTABLSHED PATIENT
27.05
99213
LEVEL III FOLLOWUP; ESTABLISHED PATIENT
45.37
99214
LEVEL V FOLLOWUP; ESTABLSIHED PATIENT
68.36
99215
LEVEL V FOLLOWUP; ESTABLISHED PATIENT
92.44
INITIAL CONSULTATION
99241
INITIAL OFFICE CONSULTATION
35.45
99242
INITIAL OFFICE CONSULTATION
66.48
99243
INITIAL OFFICE CONSULTATION
91.48
99244
INITIAL OFFICE CONSULTATION
136.16
CPT CODE
DESCRIPTION OF SERVICE
FEE
AUDIOLOGICAL EVALUATION
99245
INITIAL OFFICE CONSULTATION
167.31
92550
TYMPANOMETRY AND RELFEX THRESHOLD MEASUREMENTS
12.70
92551
SCREENING TEST, PURE TONE, AIR ONLY
7.77
92552
PURE TONE AUDIOMETRY (THRESHOLD) AIR ONLY
14.52
92553
AIR AND BONE
19.69
92555
SPEECH AUDIOMETRY THRESHOLD
10.69
92557
COMPREHENSIVE AUDIOMETRY THRESHOLD EVALUATION
31.89
92592
HEARING AID CHECK, MONAURAL
17.91
HEARING AIDS – CONSULT JERRY FRANCIS
ANESTHESIA
ANESTHEISA – ESTIMATION ONLY
(once invoice has been received actual amount will be
calculated)
150.00
CORNEA TISSUE
V2785
CORNEA TISSUE
2,880.00
INJECTION
J9035
AVASTIN USE IN CONJUNCTION WITH 67028
64.62
CPT CODE
DESCRIPTION OF SERVICE
FEE
ASSESSMENT SERVICES
PSYCHIATRIC SERVICES
90791
PSYCHIATRIC DIAGNOSTIC EVALUATION
115.38
90792
PSYCHIATRIC DIAGNOSTIC EVALUATION WITH MEDICAL
SERVICES
115.38
90832
PSYCHOTHERAPHY, 30 MINUTES WITH PATIENT AND/OR
FAMILY MEMBER
33.87
90833
PSYSCHOTHERAPHY, 30 MINUTES WITH PATIENT AND/OR
FAMILY MEMBER WHEN PERFORMED WITH AN EVALUATION
AND MANAGEMENT SERVICE (LIST SEPERATELY IN ADDITION TO
THE CODE OF PRIMARY PROCEDURE)
22.60
90834
PSYCHOTHERAPHY, 45 MINTUES WITH PATIENT AND/OR
FAMILY MEMBER
43.95
90836
PSYCHOTHERAPHY, 45 MINUTES WITH PATIENT AND/OR
FAMILY MEMBER WHEN PERFORMED WITH AN EVALUATION
AND MANAGEMENT OF SERVICE (LIST SEPERATELY IN ADDITION
TO THE CODE FOR PRIMARY PROCEDURE)
36.73
90837
PSYCHOTHERAPHY, 60 MINUTES WITH PATIENT AND/OR
FAMILY MEMBER
64.37
90838
PSYCHOTHERAPHY, 60 MINUTES WITH PATIENT AND/OR
FAMILY MEMBER WHEN PERFORMED WITH AN EVALUATION
AND MANAGEMENT SERVICE (LIST SEPERATELY IN ADDITION TO
THE CODE FOR PRIMARY PROCEDURE)
59.13
96101
PHYCHOLOGICAL TESTING – PER HOUR
63.91
MOST FREGUENTLY USED OUTPATIENT FACILITY FEES
Outpatient Facility Fees
65103
Enucleation w/Implant muscle not attached
to implant
1,585.73
65105
Enucleation of eye w/implant, muscle
Attached to eye
1,585.73
65420
Cornea, Excision or transposition of
Pterygium; without graft
65710
Keratoplasty (Cornea Transplant Lamellar)
2,936.54
65730
Keratoplasty; Penetrating (non-aphakia)
2,936.54
65755
Keratoplasty; Penetrating
2,936.54
65850
Trabeculectomy
65855
Trabeculoplasty Laser (one or more
sessions)
(in pseudoaphakia)
822.23
1,339.05
822.23
66170
Trabeculectomy ab externo in absence of
previous surgery
1.339.05
66172
Trabeculectomy ab externo w/scarring from
previous ocular surgery or trauma (includes
injection of antifibrotic agents)
1,339.05
66174
Transluminal dilation of aqueous outflow
canal; without retention of device or stent
1,339.05
Transluminal dilation of aqueous outflow
canal; with retention of device or stent
1,339.05
66175
Outpatient Facility Fees
66180
Aqueous Shunt to extra ocular reservoir
1,585.73
66630
Iridectomy; sector for Glaucoma
1,585.73
66821
Yag Laser – one or more sessions
1,339.05
66982
Extra capsular cataract removal
975.00
66984
Cataract Extraction with Primary
Insertion of Intraocular Lens
975.00
66985
Insertion of I.O.L., Subsequent of Extraction
975.00
67036
Vitrectomy, mechanical, pars plana approach
1,339.05
67039
Vitrectomy, W/ focal endolaser, PRP
1,339.05
67040
Vitrectomy, with endolaser panretinal
photocoagulation
1,339.05
67041
Vitrectomy, with removal of pre-retinal
cellular membrane
1,339.05
67042
Vitrectomy, with removal of internal limiting
membrane
1,339.05
67043
Vitrectomy, with removal of sub-retinal
membrane
1,339.05
67107
Repair of retinal detachment – sclera
bucking w/without implant
1,339.05
Outpatient Facility Fees
67108
Repair retinal detachment with vitrectomy –
any method
1,339.05
67110
Repair of retinal detachment by injection of
air or other gas
1,339.05
67112
Repair of retinal detachment by sclera
buckling or vitrectomy
1,339.05
67113
Repair of complex retinal detachment
1,339.05
67228
“For Use of Laser Machine “
Only use when a PRP laser is done in a
hospital or outpatient facility NOT when it is
done in the doctor’s office
125.00