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

356.78

CONJUNCTIVAL GRAFT
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
CPT

REMOVAL FOREING BODY EXTERNAL EYE

CONJUNCTIVA
DESCRIPTION OF SERVICES

35.39
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

65285

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

CORNEA- Excision
65400

EXCISION LESION, CORNEA EXCEPT PTERYGIUM

65410

BIOPSY, CORNEA

65420

EXCISION OR TRANSPOSITION OF PTERYGIUM

WITHOUT GRAFT

CPT
CODE

DESCRIPTION OF SERVICE

407.34
88.37
311.02

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

65710

KERATOPLASTY (CORNEAL TRANSPLANT),

ANTERIOR LAMELLAR

677.77

65730

KERATOPLASTY, PENETRATING (EXCEPT APHAKIA

OR PSEUDO)

754.53

KERATOPLASTY (Corneal Transplant)

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

CPT
CODE

DESCRIPTION OF SERVICE

FEE

ANTERIOR CHAMBER - INCISION

65800

65810

PARACENTESIS, ANTERIOR CHAMBER

W/DIAGNOSTIC ASP
PARACENTESIS W/REMOVAL OF VITREOUS AND/OR
DISCISSION HYALOID MEMBRANE, WITH/WO AIR
INJECTION

94.11

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

66130

EXCISION OF LESION, SCLERA

431.76

66150

FISTUIZATION OF SCLERA FOR GLAUCOMA;

TREPHINATION WITH IRIDECTOMY

526.38

99.69

ANTERIOR SCLERA - EXCISION

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)

65174

TRANSLUMINAL DILATION OF AQUEOUS OUTFLOW

CANAL; WITHOUT RETENTION OF DEVICE OR STENT

570.82

WITH RETENTION OF DEVICE OR STENT

623.72

65175

910.38

AQUEOUS SHUNT
66180

66183

AQUEOUS SHUNT TO EXTRAOCULAR RESERVIOR

(MOLTENO)
INSERTION OF ANTERIOR SEGMENT AQUEOUS
DRAINAGE DEVICE, WITHOUT EXTRAOCULAR
RESERVIOR, EXTERNAL APPROACH

723.63

592.43

66185

REVISION OF AQUEOUS SHUNT EXTRAOCULAR

RESERVIOR

455.39

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

REPAIR OR REVISION

IRIS, CILIARY BODY

66500

IRIDOTOMY BY STAB INCISION, EXCEPT

TRANSFIXION

214.55

66505

IRIDOTOMY WITH TRANSFIXION AS FOR IRIS BOMBE

234.92

66600

IRIDECTOMY, WITH CORNEOSCLERAL OR CORNEAL

SECTION; FOR REMOVAL OF LESION

500.01

IRIDECTOMY; WITH CYCLECTOMY

DESCRIPTION OF SERVICES

651.48
FEE

EXCISION

66605
CPT
CODE

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

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

DESTRUCTION

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

LENS - REMOVAL

FEE

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

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)

INTRAOCULAR LEN PROCEDURES

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

CPT
CODE

DESCRIPTION OF SERVICES

440.12

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

67113

REPAIR OF COMPLEX RETINAL DETACHMENT

1,086.28

67115

RELEASE ENCIRCLING MATERIAL (POSTERIOR

SEGMENT)
DESCRIPTION OF SERVICES

300.20

CPT
CODE

824.09

FEE

RETINA OR CHOROID - REPAIR

67120

REMOVAL OF IMPLANTED MATERIAL, EXTRAOCULAR

397.11

67121

REMOVAL OF IMPLANTED MATERIAL, INTRAOCULAR

558.07

67141

PROPHYLAXIS RETINAL DETACHMENT

DIATHERMY/CRYOTHERAP

316.06

67145

PROPHYSAXIS PHOTOCOAGULATION LASER

318.93

PROPHYLAXIS

DESTRUCTION
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
67221

PHOTODYNAMIC THERAPY (INCLUDES

184.95

INTRAVENOUS INFUSION)

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
CPT
CODE

ORBITOTOMY WITHOUT BONE FLAP (FRONTAL OR

TRANSCONJUNTIVAL APPROACH); FOR
EXPLORATION, WITH OR WITHOUT BIOPSY
DESCRIPTION OF SERVICES

573.32
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

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

68.23
1,018.21

67445

ORBITOTOMY WITH REMOVAL OF BONE FOR

DECOMPRESSION

877.80

67450

ORBITOTOMY FOR EXPLORATION, WITH OR

WITHOUT BIOPSY

772.08

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

67800

EXCISION OF CHALAZION; SINGLE

77.70

67801
CPT
CODE

EXCISION OF CHALAZION; MULTIPLE, SAME LID

DESCRIPTION OF SERVICES

99.92
FEE

EYELIDS EXCISION, DESTRUCTION

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

68200

SUBCONJUCTIVAL INJECTIONS

96.28

INJECTION
13.14

CONJUNCTIVOPLASTY
68320

CONJUNCTIVOPLASTY W/GRAFT OR
REARRANGEMENT

434.59

68325

CONJUNCTIVOPLASTY W/BUCCAL MUCOUS

MEMBRANE GRAFT

404.77

68326

CONJUNCTIVOPLASTY/ RECONSTRUCTION CUL-DESAC 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

CPT

DIVISION OF SYMBLEPHARON, WITH OR WITHOUT

INSERTION OF CONFORMER OF CONTACT LENS

DESCRIPTION OF SERVICES

328.68

FEE

CODE

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

68500

EXCISION, LACRIMAL BLAND; TOTAL EXCEPT FOR

TUMOR

65.10
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)

469.54

W/O TUBE
68750

CPT
CODE

CONJUNCTIVORHINOSTOMY (FIST CONJUNCTIVA)

W/TUBE
DESCRIPTION OF SERVICES

482.88

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

76510

OPHTHALMIC ULTRASOUND, DIAGNOSTIC; B-SCAN

AND QUANTITATIVE A-SCAN PERFORMED DURING
THE SAME PATIENT ENCOUNTER
INTREPRETATION

DIAGNOSTIC ULTRASOUND - SCANS

26

106.80
60.04

76511
26

QUANTITATIVE A-SCAN ONLY

INTREPRETATION

69.24
36.25

76512
26

B-SCAN (W-W/O SUPERIMPOSED NONQUANTITATIVE A-SCAN)

INTREPRETATION

64.90
36.38

76513

ANTERIOR SEGMENT ULTRASOUND, IMMERSION

(WATER BATH) B-SCAN OR HIGHER RESOLUTION
BIOMICROSCOPY0
INTREPRETATION

59.33

26
76514
26

CORNEAL PACHYMETRY, UNILATERIAL OR

BILATERAL
INTREPRETATION

24.94
9.11
6.69

76516
26

OPHTHALMIC BIOMETRY BY ULTRASOUND

ECHOGRAPHY, A-SCAN
INTREPRETATION

47.57
20.67

76519
26

OPTHALMIC BIOMETRY ULTRASD EGRAPHY A-SCAN

W/ LENS
INTREPRETATION

50.86
20.93

OPHTHALMOLOGY NEW PATIENT

92002

INTERMEDIATE EYE EXAM NEW PATIENT

49.48

92004
CPT
CODE

COMPREHENSIVE EYE EXAM NEW PATIENT

DESCRIPTION OF SERVICES

93.50
FEE

92005

LOW VISION EXAMINATION (SCCB CLINIC)

LOW VISION EXAM

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

COMPUTERIZED CORNEAL TOPOGRAPHY,

UNILATERAL OR BILATERAL,
INTERPRETATION AND REPORT

22.59

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

26

SERIAL TONOMETRY (SEPARATE PROCEDURE) WITH

13.28

92100

MULTIPLE MEASUREMENTS OF INTRAOCULAR

PRESSURE

59.01

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
DESCRIPTION OF SERVICES

53.91

26
CPT
CODE

20.93
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

REMOTE IMAGING FOR DETECTION OF RETINAL

DISEASE
REMOTE IMAGING FOR MONITORING AND
MANAGEMENT OF ACTIVE RETINAL DISEASE

92228

6.79
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

92340

FITTING, SPECTACLES EXCEPT FOR APHAKIA,

MONOFOCAL

60.03

FITTING FOR GLASSES

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
CPT
CODE

INITIAL OFFICE CONSULTATION

DESCRIPTION OF SERVICE

136.16
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

J9035

AVASTIN USE IN CONJUNCTION WITH 67028

INJECTION

CPT
CODE

DESCRIPTION OF SERVICE

64.62

FEE

ASSESSMENT SERVICES
PSYCHIATRIC SERVICES
90791

PSYCHIATRIC DIAGNOSTIC EVALUATION

115.38

90792

PSYCHIATRIC DIAGNOSTIC EVALUATION WITH

MEDICAL SERVICES

115.38

90832

90833

90834

PSYCHOTHERAPHY, 30 MINUTES WITH PATIENT

AND/OR FAMILY MEMBER
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)
PSYCHOTHERAPHY, 45 MINTUES WITH PATIENT
AND/OR FAMILY MEMBER

33.87

22.60

43.95

90836

90837

90838
96101

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)
PSYCHOTHERAPHY, 60 MINUTES WITH PATIENT
AND/OR FAMILY MEMBER
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)
PHYCHOLOGICAL TESTING PER HOUR

36.73

64.37

59.13
63.91

MOST FREGUENTLY USED OUTPATIENT

FACILITY FEES

Outpatient Facility Fees

65103
65105

65420

Enucleation w/Implant muscle not

attached to implant

1,585.73

Enucleation of eye w/implant,

muscle
Attached to eye

1,585.73

Cornea, Excision or transposition of

Pterygium; without graft

822.23

65710

Keratoplasty (Cornea Transplant

Lamellar)

2,936.54

65730

Keratoplasty; Penetrating (non-

2,936.54

aphakia)
65755

Keratoplasty; Penetrating

(in

2,936.54

pseudoaphakia)

65850

Trabeculectomy

65855

Trabeculoplasty Laser (one or

more sessions)

822.23

Trabeculectomy ab externo in
absence of previous surgery

1.339.05

66170

66172

66174
66175

Trabeculectomy ab externo
w/scarring from previous ocular
surgery or trauma (includes
injection of antifibrotic agents)

1,339.05

1,339.05

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

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

Cataract Extraction with Primary

975.00

66984

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 preretinal cellular membrane

67042

Vitrectomy, with removal of internal

limiting membrane

67043

Vitrectomy, with removal of subretinal membrane

67107

Repair of retinal detachment

sclera bucking w/without implant

1,339.05

1,339.05

1,339.05

1,339.05

Outpatient Facility Fees

67108

Repair retinal detachment with

vitrectomy any method

67110

Repair of retinal detachment by

injection of air or other gas

1,339.05

1,339.05

67112
67113

67228

Repair of retinal detachment by

sclera buckling or vitrectomy
Repair of complex retinal
detachment
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 doctors
office

1,339.05
1,339.05

125.00