CPT CODE LIST CPT CODE LIST – 2014- 2015

CPT CODE DESCRIPTION OF SERVICE FEEEYEBALL – 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

65155WITH USE OF FOREIGN MATERIAL FOR REINFORCEMENT AND/OR ATTACHMENT OF MUSCLES TO IMPLANT 520.71

65175 REMOVAL OCULAR IMPLANT 400.19REMOVAL OF FOREIGN BODY

65205 REMOVAL FOREING BODY EXTERNAL EYE CONJUNCTIVA 35.39

CPT DESCRIPTION OF SERVICES FEEREMOVAL OF FOREIGN BODY

65210REMOVAL 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 663.29REPAIR 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 301.30CORNEA- Excision

65400 EXCISION LESION, CORNEA EXCEPT PTERYGIUM 407.34

65410 BIOPSY, CORNEA 88.37

65420 EXCISION OR TRANSPOSITION OF PTERYGIUM WITHOUT GRAFT 311.02

CPT CODE DESCRIPTION OF SERVICE FEECORNEA- 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)

M

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 FEEANTERIOR CHAMBER - INCISION

65800 PARACENTESIS, ANTERIOR CHAMBER W/DIAGNOSTIC ASP 94.11

65810PARACENTESIS 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

ANTERIOR CHAMBER - REMOVAL

65900REMOVAL 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 99.69ANTERIOR 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 FEEANTERIOR 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

65175 WITH RETENTION OF DEVICE OR STENT 623.72

AQUEOUS SHUNT66180 AQUEOUS SHUNT TO EXTRAOCULAR RESERVIOR (MOLTENO) 723.63

66183INSERTION OF ANTERIOR SEGMENT AQUEOUS DRAINAGE DEVICE, WITHOUT EXTRAOCULAR RESERVIOR, EXTERNAL APPROACH

592.43

66185 REVISION OF AQUEOUS SHUNT – EXTRAOCULAR RESERVIOR 455.39REPAIR 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 BODY66500 IRIDOTOMY BY STAB INCISION, EXCEPT TRANSFIXION 214.55

66505 IRIDOTOMY WITH TRANSFIXION AS FOR IRIS BOMBE 234.92EXCISION

66600IRIDECTOMY, WITH CORNEOSCLERAL OR CORNEAL SECTION; FOR REMOVAL OF LESION 500.01

66605 IRIDECTOMY; WITH CYCLECTOMY 651.48

CPT CODE DESCRIPTION OF SERVICES FEEEXCISION

66625 IRIDECTOMY; PERIPHERAL FOR GLAUCOMA 262.69

66630 IRIDECTOMY; SECTOR FOR GLAUCOMA 346.36

66635 IRIDECTOMY; “OPTICAL” 349.91

REPAIR66680 REPAIR OF IRIS, CILIARY BODY (IRIDODIALYSIS) 312.74

66682 SUTURE OF IRIS CILIARY BODY (SEPERATE PROCEDURE) 379.84

DESTRUCTION66700 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 – INCISION66820 DISCUSSION – SECONDARY MEMBRANOUS CATARACT (KNIFE) 240.38

66821 LASER SURGRY (YAG LASER) (1 OR MORE STAGES) 195.71

66825REPOSITIONING OF INTRAOCULAR LENS PROTHESIS, REQUIRING AN INCISION (SEPARATE PROCEDURE) 464.44

CPT CODE DESCRIPTION OF SERVICES FEELENS - 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 PROCEDURES66982 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

66990USE OF OPHTHALMIC ENDOSCOPE (LIST SEPARETLY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) 59.16

VITREOUS67005 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 FEEVITREOUS

67027IMPLANTATION 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 - REPAIR67101 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

67112REPAIR BY SCLERAL BUCKLING OR VITRECTOMY, ON PATIENT HAVING HAD PREVIOUS DETACHMENT REPAIR 824.09

67113 REPAIR OF COMPLEX RETINAL DETACHMENT 1,086.28

67115 RELEASE ENCIRCLING MATERIAL (POSTERIOR SEGMENT) 300.20

CPT CODE DESCRIPTION OF SERVICES FEERETINA OR CHOROID - REPAIR

67120 REMOVAL OF IMPLANTED MATERIAL, EXTRAOCULAR 397.11

67121 REMOVAL OF IMPLANTED MATERIAL, INTRAOCULAR 558.07

PROPHYLAXIS67141 PROPHYLAXIS RETINAL DETACHMENT

DIATHERMY/CRYOTHERAP316.06

67145 PROPHYSAXIS PHOTOCOAGULATION LASER 318.93

DESTRUCTION67208 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

DESTRUCTION67221 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 - REPAIR67250 SCLERAL REINFORCEMENT; WITHOUT GRAFT 482.55

67255 SCLERAL REINFORCEMENT; WITH GRAFT 515.89ORBIT – 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 FEEORBIT – 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

1,018.21

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

ORBIT – OTHER PROCEDURES

67500RETROBULBAR 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, DESTRUCTION67800 EXCISION OF CHALAZION; SINGLE 77.70

67801 EXCISION OF CHALAZION; MULTIPLE, SAME LID 99.92

CPT CODE DESCRIPTION OF SERVICES FEEEYELIDS – 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

TARSORRHAPHY67875 TEMPORARY CLOSURE OF EYELIDS BY SUTURE (FROST) 105.89

67880 CONSTRUCTION, INTERMARGINAL ADHESIONS, MEDIAN 276.21

67882 WITH TRANSPOSITION OF TRASAL PLATE 341.59REPAIR (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 FEEREPAIR (BROW PTOSIS, BLEPHAROPTOSIS, LID

RETRACTION)

67904(TARSO) LEVATOR RESECTION OR ADVANCEMENT, EXTERNAL APPROCAH 589.37

CONJUNCTIVA – INCISION AND DRAINAGE68020 INCISION OF CONJUNCTIVA, DRAINAGE OF CYST 73.24

68040 EXPRESSION CONJUNCTIVAL FOLLICLES F/TRACHOMA 40.98

EXCISION AND/OR DESTRUCTION68100 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 96.28INJECTION

68200 SUBCONJUCTIVAL INJECTIONS 13.14

CONJUNCTIVOPLASTY68320 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

68340DIVISION OF SYMBLEPHARON, WITH OR WITHOUT INSERTION OF CONFORMER OF CONTACT LENS 328.68

CPT CODE DESCRIPTION OF SERVICES FEEOTHER PROCEDURES

68360 CONJUNCTIVAL FLAP; BRIDGE OR PARTIAL 321.17

68362 CONJUNCTIVAL FLAP; TOTAL 401.17

LACRIMAL SYSTEM - INCISION68400 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 - INCISION68505 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 -REPAIR68700 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 FEELACRIMAL 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 - SCANS76510

26

OPHTHALMIC ULTRASOUND, DIAGNOSTIC; B-SCAN AND QUANTITATIVE A-SCAN PERFORMED DURING THE SAME PATIENT ENCOUNTERINTREPRETATION

106.80

60.04

7651126

QUANTITATIVE A-SCAN ONLYINTREPRETATION

69.2436.25

7651226

B-SCAN (W-W/O SUPERIMPOSED NON-QUANTITATIVE A-SCAN)INTREPRETATION

64.9036.38

76513

26

ANTERIOR SEGMENT ULTRASOUND, IMMERSION (WATER BATH) B-SCAN OR HIGHER RESOLUTION BIOMICROSCOPY0INTREPRETATION

59.33

24.94

7651426

CORNEAL PACHYMETRY, UNILATERIAL OR BILATERALINTREPRETATION

9.116.69

7651626

OPHTHALMIC BIOMETRY BY ULTRASOUND ECHOGRAPHY, A-SCAN

INTREPRETATION

47.5720.67

7651926

OPTHALMIC BIOMETRY ULTRASD E’GRAPHY A-SCAN W/ LENSINTREPRETATION

50.8620.93

OPHTHALMOLOGY – NEW PATIENT92002 INTERMEDIATE EYE EXAM – NEW PATIENT 49.48

92004 COMPREHENSIVE EYE EXAM – NEW PATIENT 93.50

CPT CODE DESCRIPTION OF SERVICES FEELOW VISION EXAM

92005 LOW VISION EXAMINATION (SCCB CLINIC) 95.00ESTABLISHED PATIENT

92012 INTERMEDIATE/RE-EXAM ESTABLISHED PATIENT 52.13

92014 DILATED/INTERMEDIATE EXAM ESTABLISHED PATIENT 76.26

SPECIAL OPHTHALMOLOGICAL SERVICES92015 DETERMINATION OF REFRACTIVE STATE 24.65

92020 GONIOSCOPY, NOT PART OF COMPLETE EYE EXAM 17.67

92025

26

COMPUTERIZED CORNEAL TOPOGRAPHY, UNILATERAL OR BILATERAL, INTERPRETATION AND REPORT

22.59

13.28

9208126

VISUAL FIELDS EXAMINATION, UNILATERAL OR BILATERIALINTREPRETATION

34.5913.56

9208226

HUMPHREY VISUAL FIELDS EXAMINATION, INTERMEDIATEINTREPRETATION

45.7616.58

9208326

GOLDMANN VISUAL FIELDS EXTENDED EXAM INTREPRETATION

52.2919.03

92100SERIAL TONOMETRY (SEPARATE PROCEDURE) WITH MULTIPLE MEASUREMENTS OF INTRAOCULAR PRESSURE 59.01

9213226

SCANNING COMPUTERIZED OPHTHALMIC DIAGNOSTIC IMAGINGINTERPRETATION

21.4712.45

9213326

SCANNING COMPUTERIZED OPHTHALMIC DIAGNOSTIC (OCT)INTREPRETATION

26.4117.38

9213426

SCANNING COMPUTERIZED OPHTHALMIC (OCT)INTREPRETATION

26.4117.38

92136

26

OPHTHALMIC BIOMETRY BY PARTIAL COHERENCE INTERFEROMETRY WITH IOL POWER CALCULATIONINTREPRETATION

53.91

20.93

CPT CODE DESCRIPTION OF SERVICES FEESPECIAL OPHTHALMOLOGICAL SERVICES

92140 PROVOCATIVE TESTS FOR GLAUCOMA, WITH INTREPRETATION AND REPORT, WITHOUT TONOGRAPHY 37.89

OPHTHALMOSCOPY92225 OPHTHALMOSCOPY, EXTENDED W/RETINAL DRAWING 16.93

92226 OPHTHALMOSCOPY - SUBSEQUENT 15.70

92227 REMOTE IMAGING FOR DETECTION OF RETINAL DISEASE 6.79

92228REMOTE IMAGING FOR MONITORING AND MANAGEMENT OF ACTIVE RETINAL DISEASE 17.79

92230 FLRORESCEIN ANGIOSCOPY W/INTERPRETATION AND REPORT 40.07

9223526

FLUROESCEIN ANGIOGRAPHY INTREPRETATION

83.6931.45

9225026

FUNDUS PHOTO INTREPRETATION

47.0316.58

9228526

EXTERNAL OCULAR PHOTOGRAPHYINTERPRETATION

27.287.79

9228626

ANTERIOR SEGMENT IMAGING INTERPRETATION

78.2025.19

CONTACT LENS FITTING

92071FITTING OF CONTACT LENS FOR TREATMENT OF OCULAR SURFACE DISEASE 19.80

92072INITIAL FITTING OF CONTACT LENS – FOR MANAGEMENT OF KERATOCONUS; INITIAL FITTING 87.00

92310PRESCRIPTION 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 FEECONTACT LENS FITTING

92313 CORNEOSCLERAL LENS 60.03

FITTING FOR GLASSES92340 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 150.00OFFICE 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 PATIENT99211 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 92.44INITIAL 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 FEEAUDIOLOGICAL 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

ANESTHESIAANESTHEISA – ESTIMATION ONLY(once invoice has been received actual amount will be calculated)

150.00

CORNEA TISSUEV2785 CORNEA TISSUE 2,880.00

INJECTIONJ9035 AVASTIN USE IN CONJUNCTION WITH 67028 64.62

CPT CODE DESCRIPTION OF SERVICE FEEASSESSMENT SERVICESPSYCHIATRIC SERVICES

90791 PSYCHIATRIC DIAGNOSTIC EVALUATION 115.38

90792 PSYCHIATRIC DIAGNOSTIC EVALUATION WITH MEDICAL SERVICES

115.38

90832PSYCHOTHERAPHY, 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

90834PSYCHOTHERAPHY, 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

90837PSYCHOTHERAPHY, 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

65103Enucleation w/Implant muscle not attached to implant

1,585.73

65105Enucleation of eye w/implant, muscleAttached to eye 1,585.73

65420Cornea, Excision or transposition of Pterygium; without graft 822.23

65710 Keratoplasty (Cornea Transplant Lamellar) 2,936.54

65730 Keratoplasty; Penetrating (non-aphakia) 2,936.54

65755 Keratoplasty; Penetrating (in pseudoaphakia) 2,936.54

65850 Trabeculectomy 1,339.05

65855 Trabeculoplasty Laser (one or more sessions)

822.23

66170Trabeculectomy 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

66174Transluminal dilation of aqueous outflow canal; without retention of device or stent 1,339.05

66175 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 975.00

66984Cataract 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

67040Vitrectomy, with endolaser panretinalphotocoagulation 1,339.05

67041Vitrectomy, with removal of pre-retinal cellular membrane 1,339.05

67042Vitrectomy, with removal of internal limiting membrane 1,339.05

67043Vitrectomy, with removal of sub-retinal membrane 1,339.05

67107Repair of retinal detachment – sclera bucking w/without implant 1,339.05

Outpatient Facility Fees

67108Repair retinal detachment with vitrectomy – any method 1,339.05

67110Repair of retinal detachment by injection of air or other gas 1,339.05

67112Repair 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