CPT Code 00145: Anesthesia for Vitreoretinal Surgery — Complete Billing & Coding Guide
What Does CPT Code 00145 Mean?
CPT code 00145 describes anesthesia services provided for vitreoretinal surgery — procedures involving the vitreous humor, retina, and posterior segment of the eye. This code covers pars plana vitrectomy, retinal detachment repair, epiretinal membrane peel, macular hole repair, and other complex posterior segment surgeries. With base units of 5, this code reflects the higher complexity, longer operative times, and greater anesthesia requirements compared to anterior segment procedures.
Key Code Attributes:
- Billable Status: Fully billable as a standalone anesthesia service
- Base Units (CMS 2026): 5 — higher than other eye codes (00140-00144 at 4)
- Primary Setting: Hospital outpatient department or ambulatory surgery center
- Provider Type: Anesthesiologist (MD/DO), CRNA with physician supervision
- Service Category: Monitored anesthesia care (MAC) or general anesthesia
- Effective Status: Active CPT code with no planned retirement (verified through 2026)
- Typical Patient Population: Adults with retinal detachment, macular hole, epiretinal membrane, vitreous hemorrhage, diabetic retinopathy complications, or retained lens fragments
What Services and Procedures Does CPT Code 00145 Cover?
CPT 00145 covers anesthesia for surgical procedures involving the vitreous and retina — the posterior segment of the eye. These procedures are typically more complex, longer in duration, and require more intensive anesthesia management than anterior segment surgery.
Covered Procedures and Surgical Indications:
- Pars plana vitrectomy (PPV) — 23-gauge, 25-gauge, or 27-gauge
- Retinal detachment repair — pneumatic retinopexy, scleral buckle, or vitrectomy with gas or silicone oil tamponade
- Epiretinal membrane peel
- Macular hole repair
- Vitreous hemorrhage clearance (diabetic, traumatic)
- Retained lens fragment removal (posterior segment)
- Endophthalmitis treatment — vitrectomy with intravitreal antibiotics
- Intraocular foreign body removal (posterior segment)
- Subretinal injection or gene therapy delivery
- Retinectomy or retinotomy
- Choroidal biopsy or tumor resection
- Vitreous biopsy for diagnostic purposes
What Does CPT 00145 Specifically Exclude?
| Excluded Procedure | Correct Code | Rationale |
|---|---|---|
| Corneal transplant alone | CPT 00144 | Anterior segment procedure |
| Cataract surgery alone | CPT 00142 | Anterior segment |
| Combined vitrectomy with cataract | CPT 00145 | Primary procedure determines code |
| 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 00145 the Right Code to Use?
Step-by-Step Code Selection
- Confirm the primary procedure involves the vitreous or retina (posterior segment)
- Vitrectomy with membrane peel or retinal detachment repair are the most common indications
- If combined with cataract extraction, CPT 00145 remains correct as the primary posterior segment procedure
- Document anesthesia type — GA is common for longer cases; MAC for shorter vitrectomies
Comparison With Related Codes
| Code | Procedure | Base Units (2026) |
|---|---|---|
| 00145 | Vitreoretinal surgery | 5 |
| 00140 | Eye — general | 4 |
| 00142 | Lens surgery | 4 |
| 00144 | Corneal surgery | 4 |
| 00147 | Iris procedures | 4 |
| 00148 | Eye — under 1 year | 5 |
Documentation Requirements
Preoperative: History and physical, ASA classification, airway assessment, anticoagulant/antiplatelet review (critical — may affect surgical approach), anesthesia plan (MAC vs. GA), NPO status. Diabetic and hypertensive patients are common — document disease control status.
Intraoperative: Start/stop times, vital signs q5min, anesthetic agents and doses, level of sedation monitoring, airway management, oculocardiac reflex monitoring (common during retinal detachment repair), fluid management, blood pressure control (avoid hypertension to reduce intraocular bleeding).
Postoperative: PACU admission and discharge times, pain scores, PONV assessment, Aldrete score, visual acuity check.
Base Unit Assignment
| Component | Value |
|---|---|
| Base Units (CMS 2026) | 5 |
| Time Unit Increment | 15 minutes |
| P3 | +1 unit |
| P4 | +2 units |
| P5 | +3 units |
Reimbursement
2026 RVU Breakdown
| Component | Facility Value |
|---|---|
| Work RVU | 1.50 |
| Practice Expense RVU | 0.08 |
| Malpractice RVU | 0.09 |
| Total RVU | 1.67 |
| Estimated Medicare Payment | ~$55-60 |
Common Modifiers
| Modifier | Use |
|---|---|
| AA | Personally performed |
| QS | MAC service |
| QX/QZ | CRNA |
| P1-P4 | ASA status |
Coding Errors to Avoid
- Using 00140 instead of 00145 — Vitreoretinal surgery has higher base units (5 vs. 4)
- Billing regional block separately — Peribulbar/retrobulbar block by anesthesia is bundled
- Missing MAC vs. GA documentation — GA is more common for longer cases
- Combined vitrectomy with cataract — Use 00145 (primary posterior segment code)
Real-World Scenario
A 55-year-old diabetic male with tractional retinal detachment and vitreous hemorrhage undergoes 25-gauge pars plana vitrectomy with endolaser and gas tamponade under general anesthesia. Total anesthesia time is 75 minutes. Patient is ASA III (diabetes with end-organ damage).
Coding: CPT 00145 + AA + P3. Base 5, time 5, P3 +1, total 11 units. Estimated payment ~$385.
Frequently Asked Questions
Why Does CPT 00145 Have Higher Base Units?
CPT 00145 has base units of 5 (vs. 4 for 00140-00144) because vitreoretinal surgery typically involves longer operative times, higher complexity, greater potential for complications (oculocardiac reflex, bleeding, hypotony), and more intensive anesthesia requirements.
Is General Anesthesia Required for Vitreoretinal Surgery?
General anesthesia is common for longer vitreoretinal cases (retinal detachment repair, complex vitrectomy) to ensure patient immobility and controlled ventilation. MAC may be appropriate for shorter procedures in cooperative patients.
What Is the Oculocardiac Reflex in Vitreoretinal Surgery?
The oculocardiac reflex (bradycardia, hypotension) is triggered by traction on the extraocular muscles or pressure on the globe — common during scleral buckle placement and retinal detachment repair. Anesthesia providers must monitor for OCR and be prepared to intervene.
Can CPT 00145 Be Billed for Intravitreal Injections?
No. Intravitreal injections (anti-VEGF, steroids) are office-based procedures typically performed under topical anesthesia without anesthesia provider involvement. No anesthesia code is reported.
Key Takeaways
- CPT 00145 is specific to vitreoretinal surgery (posterior segment)
- Base units 5 — higher than other eye codes (4) due to complexity
- GA is common; MAC for select shorter cases
- OCR monitoring is essential — document any interventions
- Combined with cataract = still 00145 (primary code)
- Single code per anesthetic session
References
- CMS PFS: cms.gov
- ASA Relative Value Guide
- American Society of Retina Specialists
- American Academy of Ophthalmology
