67040 Retinal vitrectomy Medicare reimbursement rates in California

A retinal surgeon removes vitreous through a pars plana approach and applies endolaser across the retina for panretinal photocoagulation. A common setting is surgery for proliferative diabetic retinopathy complicated by vitreous hemorrhage, when clearing the vitreous permits treatment of the retinal neovascular disease. The service is generally performed in an operating room or ambulatory surgery center.

Select this code when the operative report supports both mechanical pars plana vitrectomy and endolaser panretinal photocoagulation. The laser treatment is part of the coded service; do not separately report it merely because the surgeon documents endolaser during the same operation. Medicare assigns a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. When multiple procedures are performed in one session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% multiple-procedure reduction. For bilateral surgery, modifier 50 is paid at 150%. An assistant at surgery may be paid; co-surgeon payment requires supporting documentation, and team surgery is not permitted.