CPT Code 00144: Anesthesia for Corneal Surgery — Complete Billing & Coding Guide
What Does CPT Code 00144 Mean?
CPT code 00144 describes anesthesia services provided for procedures on the cornea of the eye, most commonly corneal transplantation (keratoplasty). This code covers penetrating keratoplasty (PKP), Descemet stripping endothelial keratoplasty (DSEK/DMEK), deep anterior lamellar keratoplasty (DALK), and other corneal surgical procedures. Corneal surgery is typically more complex than routine cataract surgery and may involve longer operative times, higher anesthesia requirements, and more postoperative monitoring.
Key Code Attributes:
- Billable Status: Fully billable as a standalone anesthesia service
- Base Units (CMS 2026): 4
- Primary Setting: Hospital outpatient department or ambulatory surgery center
- Provider Type: Anesthesiologist (MD/DO), CRNA with physician supervision, or anesthesia assistant under physician direction
- Service Category: Monitored anesthesia care (MAC) or general anesthesia (GA)
- Effective Status: Active CPT code with no planned retirement (verified through 2026)
- Typical Patient Population: Adults with corneal disease including Fuchs endothelial dystrophy, keratoconus, bullous keratopathy, corneal scarring from infection or trauma, and failed prior grafts
What Services and Procedures Does CPT Code 00144 Cover?
CPT 00144 covers anesthesia for surgical procedures involving the cornea — the transparent anterior portion of the eye. Corneal surgery ranges from partial-thickness lamellar procedures to full-thickness penetrating keratoplasty.
Covered Procedures and Surgical Indications:
- Penetrating keratoplasty (PKP) — full-thickness corneal transplant for keratoconus, corneal scarring, failed graft
- Descemet stripping endothelial keratoplasty (DSEK) — endothelial transplant for Fuchs dystrophy, pseudophakic bullous keratopathy
- Descemet membrane endothelial keratoplasty (DMEK) — thinner endothelial transplant with faster visual recovery
- Deep anterior lamellar keratoplasty (DALK) — anterior stromal transplant leaving host endothelium intact
- Corneal laceration repair — complex full-thickness repair requiring general anesthesia
- Pterygium excision with conjunctival autograft or amniotic membrane graft
- Corneal biopsy for diagnostic purposes
- Removal of corneal sutures under anesthesia
- Phototherapeutic keratectomy (PTK) requiring anesthesia provider
- Keratoprosthesis (artificial cornea) implantation
- Repair of corneal perforation with tissue adhesive
What Does CPT 00144 Specifically Exclude?
| Excluded Procedure | Correct Code | Rationale |
|---|---|---|
| Combined cataract with corneal transplant (triple procedure) | CPT 00140 | Multiple eye structures involved — use broader code |
| Cataract surgery alone | CPT 00142 | Lens-specific procedure |
| Vitreoretinal surgery | CPT 00145 | Posterior segment |
| Glaucoma surgery | CPT 00140 | Broader eye code |
| Strabismus correction | CPT 00140 | Extraocular muscle procedure |
| Pediatric eye surgery (under 1 year) | CPT 00148 | Age-specific code |
When Is CPT Code 00144 the Right Code to Use?
Step-by-Step Code Selection
- Confirm the primary procedure is corneal (PKP, DSEK, DMEK, DALK, or corneal repair)
- If combined with cataract surgery, use CPT 00140
- Check patient age — use CPT 00148 for patients under 1 year
- Document anesthesia type — MAC for cooperative patients; GA for complex, long, or uncooperative cases
Comparison With Related Codes
| Code | Procedure | Base Units (2026) |
|---|---|---|
| 00144 | Corneal surgery | 4 |
| 00140 | Eye — general | 4 |
| 00142 | Lens surgery | 4 |
| 00145 | Vitreoretinal | 5 |
| 00147 | Iris procedures | 4 |
| 00148 | Eye — under 1 year | 5 |
Documentation Requirements
Preoperative Documentation: History and physical, ASA classification, airway assessment, anticoagulant/antiplatelet review, anesthesia plan (MAC vs. GA), NPO status. Intraoperative Documentation: Start/stop times, vital signs q5min, anesthetic agents and doses, level of sedation monitoring, oxygen administration method, peribulbar block documentation (if performed), complications (oculocardiac reflex, hypertension, hypoxia). Postoperative Documentation: PACU admission and discharge times, pain scores, PONV assessment and treatment, Aldrete score or equivalent.
Base Unit Assignment
| Component | Value |
|---|---|
| Base Units (CMS 2026) | 4 |
| Time Unit Increment | 15 minutes |
| Physical Status P3 | +1 unit |
| Physical Status P4 | +2 units |
| Physical Status P5 | +3 units |
Reimbursement
2026 RVU Breakdown
| Component | Facility Value |
|---|---|
| Work RVU | 1.20 |
| Practice Expense RVU | 0.06 |
| Malpractice RVU | 0.07 |
| Total RVU | 1.33 |
| Estimated Medicare Payment | ~$44-48 |
Common Modifiers
| Modifier | Use Case |
|---|---|
| AA | Anesthesiologist personally performs service |
| QS | Monitored anesthesia care (MAC) |
| QK | Medical direction of 2-4 concurrent cases |
| QX | CRNA with medical direction |
| QZ | CRNA without medical direction |
| P1-P4 | ASA physical status |
Coding Errors to Avoid
- Using 00140 when 00144 is more specific — For cornea-only cases, 00144 is preferred
- Billing regional block separately — Peribulbar/retrobulbar block by anesthesia provider is bundled
- Combined PKP with cataract — Use 00140 (general eye), not 00144
- Missing MAC vs. GA documentation — Document level of anesthesia service clearly
- Bilateral coding issues — Single anesthetic session = one CPT 00144
Real-World Scenario
A 68-year-old female with Fuchs endothelial dystrophy and visually significant corneal edema undergoes DSEK of the right eye under MAC with monitored sedation and peribulbar block. Total anesthesia time is 50 minutes. Patient is ASA II.
Coding: CPT 00144 + AA + P2 + QS. Base 4, time 3, total 7 units. Estimated payment ~$245.
Frequently Asked Questions
Is CPT 00144 the Correct Code for DSEK and DMEK?
Yes. DSEK and DMEK are endothelial keratoplasty procedures on the cornea and are correctly coded with CPT 00144.
What Code Is Used for Combined Corneal Transplant and Cataract Surgery?
When a corneal transplant is combined with cataract extraction (triple procedure), the correct anesthesia code is CPT 00140 (general eye), not 00144, because multiple eye structures are involved.
Is MAC or General Anesthesia More Common for Corneal Surgery?
Both are used. MAC with a peribulbar block is common for DSEK/DMEK. General anesthesia is more common for penetrating keratoplasty, lengthy procedures, and uncooperative patients.
Can CPT 00144 Be Billed for Pterygium Surgery?
For routine pterygium excision under topical anesthesia without anesthesia provider involvement, no anesthesia code is reported. For extensive pterygium with conjunctival autograft requiring MAC or GA, CPT 00144 may be appropriate if the cornea is involved.
Key Takeaways
- CPT 00144 is specific to corneal procedures (PKP, DSEK, DMEK, DALK)
- Base units 4 — same as 00140/00142 but specific to cornea
- Combined with cataract = use 00140
- MAC with QS modifier is common; GA for complex cases
- Peribulbar block by anesthesia provider is bundled
- Single code per anesthetic session
References
- CMS PFS: cms.gov
- ASA Relative Value Guide
- Eye Bank Association of America
- American Academy of Ophthalmology
