What Does CPT Code 00148 Mean?

CPT code 00148 describes anesthesia services provided for procedures on the eye in patients under 1 year of age. This age-specific code covers all ophthalmic procedures in infants — including congenital cataract extraction, congenital glaucoma surgery, retinopathy of prematurity (ROP) treatment, nasolacrimal duct probing, and strabismus correction. With base units of 5, this code reflects the higher complexity, increased risk, and specialized expertise required for providing anesthesia to neonatal and infant patients. Key Code Attributes:

• Billable Status: Fully billable as a standalone anesthesia service
• Base Units (CMS 2026): 4 — higher than standard eye codes (4) due to age
• Patient Population: Infants under 1 year of age (neonates and infants)
• Primary Setting: Hospital outpatient department or pediatric ambulatory surgery center
• Provider Type: Pediatric anesthesiologist or general anesthesiologist with pediatric expertise
• Service Category: General anesthesia (standard for infant eye surgery)
• Effective Status: Active CPT code with no planned retirement (verified through 2026)

What Services and Procedures Does CPT 00148 Cover?

CPT 00148 covers anesthesia for any eye procedure — including anterior segment, posterior segment, and adnexal procedures — when the patient is under 1 year of age. This is a comprehensive code that applies regardless of the specific ophthalmic procedure, as the age of the patient is the primary coding determinant. Covered Procedures:

• Congenital cataract extraction with or without IOL implantation- Congenital glaucoma surgery (goniotomy, trabeculotomy, trabeculectomy)
• Retinopathy of prematurity (ROP) laser photocoagulation or anti-VEGF injection- Nasolacrimal duct probing, irrigation, or intubation- Strabismus surgery in infants under 1 year- Corneal transplant or repair in infants- Iris or ciliary body procedures in infants- Eyelid or orbital procedures in infants- Enucleation or evisceration for congenital conditions

Exclusions| Excluded | Correct Code | Rationale |

| ----- | | Eye surgery in patients 1 year or older | Appropriate eye-specific code | Age criterion not met | | Procedures performed without anesthesia provider | Not billable | No anesthesia service rendered | | Diagnostic eye exams under anesthesia | 00140 | Diagnostic EUA without therapeutic procedure |

When Is CPT Code 00148 the Right Code to Use?

Step-by-Step Code Selection1. Confirm patient age is under 1 year at the time of the procedure (use chronological age, not corrected gestational age)2. Identify the ophthalmic procedure — for infants, all eye procedures map to 00148 regardless of specific eye structure3. If the patient is 1 year or older, use the structure-specific code (00140-00147)4. Document weight-based dosing, temperature management, and gestational history5. Select appropriate modifiers for provider type and ASA physical status

Comparison With Related Codes| Code | Procedure | Base Units (2026) |

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

Documentation Requirements

Preoperative DocumentationPatient weight in kilograms, age in months (and weeks for neonates), gestational age at birth, history of prematurity including any history of bronchopulmonary dysplasia or apnea of prematurity, fasting status and NPO duration, airway assessment with special attention to potentially difficult pediatric airway, ASA classification, and preoperative hemoglobin or hematocrit if indicated.

Intraoperative DocumentationAnesthesia start and stop times, vital signs recorded at minimum 5-minute intervals including temperature monitoring, all anesthetic agents and doses in weight-based calculations, fluid management with crystalloid and dextrose-containing solutions, glucose monitoring in prolonged cases or neonates, temperature management methods (warming blanket, warmed fluids), and any complications such as laryngospasm, bronchospasm, or oculocardiac reflex.

Postoperative DocumentationPACU admission and discharge times, pain scores using age-appropriate scale (FLACC, NIPS, or CHEOPS), PONV assessment, Aldrete score or modified pediatric Aldrete score, and discharge criteria including ability to tolerate feeds and stable vital signs.

Base Unit Assignment| Component | Value |

| ---- | | Base Units (CMS 2026) | 5 | | 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 | | QK | Medical direction of 2-4 concurrent cases | | QX | CRNA with medical direction | | QZ | CRNA without medical direction | | P1-P4 | ASA physical status | | 23 | Unusual anesthesia — may apply for extreme prematurity or complex congenital conditions |

Payer Considerations- Medicare covers CPT 00148 for medically necessary eye surgery in infants, though Medicare beneficiaries under 1 year are rare (typically ESRD or disability cases)- Medicaid is the primary payer for most infant eye surgery — verify state-specific Medicaid policies for anesthesia payment- Commercial payers often follow the ASA Relative Value Guide but may require prior authorization for certain procedures like ROP treatment- Some payers may request documentation of gestational age, birth weight, and medical necessity for ROP screening or treatment- Verify coverage for congenital cataract surgery — some plans have specific medical necessity criteria- For bilateral procedures in infants, a single anesthesia code is reported (not two units)

Coding Errors to Avoid

1. Using a structure-specific code for infants — Do not use 00142 for congenital cataract or 00147 for iris procedures in infants under 1 year; 00148 is the correct code
2. Using 00148 for patients 1 year or older — The age cutoff is strict; document date of birth and date of service
3. Billing qualifying circumstances codes (99100) separately — Extreme age is already reflected in the base units for 00148
4. **
5. Bilateral procedures billed separately — Single anesthesia code per session regardless of unilateral or bilateral surgery
6. Missing temperature management documentation — Infants are at high risk for hypothermia; document active warming measures

Real-World Scenario

Scenario 1: Congenital Cataract ExtractionA 3-month-old female with congenital cataract undergoes lens extraction with anterior vitrectomy under general anesthesia via endotracheal tube. Weight is 5.

2 kg. Total anesthesia time is 45 minutes. Patient is ASA II. Coding: CPT 00148 + AA + P2. Base 5, time 3 (45 min), total 8 units. Estimated payment at $21.71/unit: ~$173.68.

Scenario 2: ROP Laser PhotocoagulationA 6-week-old former 26-week premature infant weighing 1.

8 kg undergoes laser photocoagulation for threshold retinopathy of prematurity under general anesthesia. The patient has a history of bronchopulmonary dysplasia and requires careful ventilator management. Total anesthesia time is 60 minutes. Patient is ASA III due to prematurity and respiratory history. Coding: CPT 00148 + AA + P3. Base 5, time 4 (60 min), P3 adds +1 unit, total 10 units. Estimated payment: ~$217.10.

Frequently Asked Questions

Does CPT 00148 Apply to All Eye Procedures in Infants?

Yes. CPT 00148 is used for any eye procedure — anterior segment, posterior segment, or adnexal — when the patient is under 1 year of age. Do not use structure-specific codes (00142, 00144, 00147, etc.) for this age group.

What Is the Base Unit Value for CPT 00148?

The base unit value is 5 under the 2026 CMS Physician Fee Schedule. This is one unit higher than most adult eye codes (base 4), reflecting the increased complexity and risk of pediatric anesthesia.

Can CPT 00148 Be Used for Nasolacrimal Duct Probing?

Yes. Nasolacrimal duct probing, irrigation, or intubation in an infant under 1 year is covered by CPT 00148 when performed under general anesthesia.

What Documentation Is Critical for Pediatric Eye Anesthesia?

Documentation should include weight in kilograms, age in months (and weeks for neonates), gestational age, airway assessment, temperature management, weight-based medication dosing, and any complications related to prematurity.

Is General Anesthesia Required for CPT 00148?

General anesthesia is standard for infant eye surgery. MAC is rarely appropriate for infants due to the need for immobility, airway protection, and the inability of infants to cooperate with sedation alone.

How Are Time Units Calculated for CPT 00148?Time units are calculated by dividing total anesthesia minutes by 15 and rounding to the nearest tenth. For example, a 50-minute case yields 3 time units (50 / 15 = 3.

33, rounded to 3). Accurate start and stop times must be documented.

Does CPT 00148 Cover Bilateral Eye Surgery in Infants?

Yes. A single CPT 00148 code covers the entire anesthetic session, regardless of whether one or both eyes are operated on. Do not report 00148 with modifier 50 or bill two units.

Key Takeaways- CPT 00148 is age-specific for patients under 1 year- Base units 5 — higher complexity and risk than other eye codes- General anesthesia is standard for infant eye surgery- Document weight, age in months, and gestational history- Single code per anesthetic session regardless of bilateral procedures- Do not use structure-specific codes for infants- Temperature management documentation is essential

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

gov/apps/physician-fee-schedule/)- ASA Relative Value Guide- American Academy of Pediatrics- AAPOS clinical guidelines