What Does CPT Code 00147 Mean?

CPT code 00147 describes anesthesia services provided for procedures on the iris and ciliary body of the eye. This code covers iridectomy, iridotomy, ciliary body destruction (cyclophotocoagulation), and related procedures involving the iris and ciliary body structures. It is a specific code within the ophthalmic anesthesia family (00140-00148) and is used when the surgical procedure is confined to the iris or ciliary body without involvement of the lens, cornea, or posterior segment. Key Code Attributes:

• Billable Status: Fully billable as a standalone anesthesia service
• Base Units (CMS 2026): 4
• Primary Setting: Ambulatory surgery center or hospital outpatient department
• 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)
• Common Procedures: Iridectomy, laser iridotomy, cyclophotocoagulation, iris tumor excision

What Services and Procedures Does CPT Code 00147 Cover?

CPT 00147 covers anesthesia for surgical procedures confined to the iris or ciliary body. These are typically glaucoma-related or tumor-related procedures that require an anesthesia provider due to patient discomfort, surgical complexity, or the need for immobility. Covered Procedures:

• Surgical iridectomy (peripheral or sector)
• Laser iridotomy under anesthesia (when anesthesia provider required)
• Cyclophotocoagulation (ciliary body destruction for glaucoma)
• Iris tumor or cyst excision- Iris repair or reconstruction- Ciliary body biopsy- Goniotomy or trabeculotomy (limited to iris/ciliary approach — congenital glaucoma)
• Surgical management of iris prolapse- Iridodialysis repair- Synechialysis under anesthesia

Exclusions| Excluded | Correct Code | Rationale |

| ----- | | Combined cataract with iridectomy | 00140 | Multiple eye structures involve broader code | | Glaucoma surgery (trabeculectomy, tube shunt) | 00140 | Broader eye code when multiple structures involved | | Corneal transplant | 00144 | Corneal procedure | | Vitreoretinal surgery | 00145 | Posterior segment | | Pediatric eye surgery (under 1 year) | 00148 | Age-specific code | | Laser iridotomy without anesthesia provider | Not billable | No anesthesia code |

When Is CPT Code 00147 the Right Code to Use?

Step-by-Step Code Selection1. Confirm the surgical site is limited to the iris or ciliary body2. If the procedure also involves the lens, cornea, or posterior segment, use 001403. If the patient is under 1 year of age, use 001484. Verify that an anesthesia provider is actually required — laser iridotomy performed by the surgeon with topical anesthesia alone is not billable5. Select the appropriate modifier based on provider type and ASA physical status

Comparison With Related Codes| Code | Anatomic Focus | Base Units (2026) |

| ---- | | 00147 | Iris and ciliary body | 4 | | 00140 | Eye — general | 4 | | 00142 | Lens surgery | 4 | | 00144 | Corneal surgery | 4 | | 00145 | Vitreoretinal surgery | 5 | | 00148 | Eye — under 1 year | 5 |

Documentation Requirements

Preoperative DocumentationComprehensive history and physical with emphasis on ophthalmic history, ASA classification, airway assessment, anticoagulant and antiplatelet medication review, anesthesia plan specifying MAC versus general anesthesia, NPO status, and baseline intraocular pressure if available.

Intraoperative DocumentationAnesthesia start and stop times, vital signs recorded at minimum 5-minute intervals, all anesthetic agents and doses administered, level of sedation monitoring (for MAC cases), oxygen administration method, documentation of any peribulbar or retrobulbar block performed by the anesthesia provider, and any complications such as oculocardiac reflex, hypertension, or hypoxia.

Postoperative DocumentationPACU admission and discharge times, pain scores using appropriate scale, PONV assessment and treatment, Aldrete score or equivalent, and any specific eye-related precautions (eye shield, activity restrictions).

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

Note: Anesthesia services use a unit-based formula, not RVUs. Medicare payment = (Base Units + Time Units + Modifying Units) x Anesthesia Conversion Factor. The 2026 Medicare anesthesia CF is approximately $21.71 (varies by locality). Commercial payer CFs are typically 2-5x higher.

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 |

Payer Considerations- Medicare covers CPT 00147 when the underlying surgical procedure is medically necessary. Laser iridotomy for narrow angles or angle-closure glaucoma is typically covered.- Commercial payers follow the ASA Relative Value Guide for base unit assignment but may apply their own conversion factors.- Some payers require prior authorization for cyclophotocoagulation procedures — verify before scheduling.- Cosmetic iris procedures (e.

g., cosmetic iris implant) are not covered by any payer. Anesthesia for these procedures must be collected directly from the patient.- Always verify with the specific payer whether combined procedures on the iris and other eye structures should use 00147 or the general eye code 00140.

Coding Errors to Avoid

1. Using 00140 when 00147 is more specific — When the procedure is confined to the iris or ciliary body, 00147 is the more specific and appropriate code
2. Combined procedures with other eye structures — When the surgical procedure involves the lens, cornea, or posterior segment in addition to the iris, use 00140
3. **
4. Billing regional block separately — Peribulbar or retrobulbar block performed by the anesthesia provider is bundled into the anesthesia service
5. Billing bilateral procedures separately — A single anesthetic session is reported with one anesthesia code regardless of unilateral or bilateral surgery
6. Using 00147 for pediatric patients — Patients under 1 year require 00148 regardless of the specific eye structure

Real-World Scenario

Scenario 1: Surgical Iridectomy for Plateau Iris SyndromeA 58-year-old female with plateau iris syndrome and elevated intraocular pressure unresponsive to laser iridotomy undergoes surgical peripheral iridectomy under MAC. The anesthesia provider administers conscious sedation with a peribulbar block. Total anesthesia time is 25 minutes. Patient is ASA II.

Coding: CPT 00147 + AA + P2 + QS. Base 4, time 1 (25 min rounds to 1 time unit), total 5 units. Estimated payment at $21.71/unit: ~$108.55.

Scenario 2: Cyclophotocoagulation for Refractory GlaucomaA 72-year-old male with neovascular glaucoma refractory to medical therapy undergoes transscleral cyclophotocoagulation (CPC) under monitored anesthesia care. The patient has a history of hypertension and diabetes. Total anesthesia time is 35 minutes. Patient is ASA III.

Coding: CPT 00147 + AA + P3 + QS. Base 4, time 2 (35 min rounds to 2 time units), P3 adds +1 unit, total 7 units. Estimated payment: ~$151.97.

Frequently Asked Questions

What Is the Difference Between CPT 00147 and CPT 00140?

CPT 00147 is specific to procedures confined to the iris and ciliary body. CPT 00140 is the general eye code used when multiple eye structures are involved or when the specific structure code does not apply. Both have 4 base units.

Can CPT 00147 Be Used for Laser Iridotomy?

Yes, but only when an anesthesia provider is required and the patient cannot tolerate the procedure under topical anesthesia alone. Routine laser iridotomy performed by the surgeon with topical drops does not qualify for an anesthesia code.

Is CPT 00147 Appropriate for Cyclophotocoagulation?

Yes. Cyclophotocoagulation (ciliary body destruction) is a procedure on the ciliary body and is correctly coded with CPT 00147.

What Modifier Is Used for MAC With CPT 00147?

The QS modifier indicates monitored anesthesia care. It is used in addition to the AA modifier (or QX/QZ for CRNAs) when the anesthesia provider is managing sedation while the surgeon performs the procedure under local or topical anesthesia.

Can CPT 00147 Be Billed With 00140 in the Same Session?

No. Only one anesthesia code is reported per anesthetic session. If the procedure involves multiple eye structures, use 00140 for the entire case.

What Physical Status Modifiers Apply to CPT 00147?

P1 through P4 are commonly used. P3 adds +1 base unit and P4 adds +2 base units. P5 and P6 are rare in ophthalmic ambulatory surgery but may apply in hospital settings.

Key Takeaways- CPT 00147 is specific to iris and ciliary body procedures- Base units 4 — same as 00140/00142/00144- Rarely billed compared to cataract and corneal codes- Combined with other eye procedures = use 00140- Single code per anesthetic session- MAC with QS modifier is common for iris procedures- Verify anesthesia provider requirement for laser-based procedures

References- CMS PFS: [cms.gov](https://www.cms.

gov/apps/physician-fee-schedule/)- ASA Relative Value Guide- American Academy of Ophthalmology