The American Academy of Ophthalmology has issued a fact sheet1 defining goniotomy with billing guidelines for the procedure. It states that CPT 65850 is used to report trabeculotomy ab externo and 65820 is used to report trabeculotomy ab interno, also known as goniotomy, adding that the trabecular meshwork is opened for at least 3 clock hours.
The billing guidelines note that goniotomy should not be coded in addition to other angle surgeries, stent insertion, or Schlemm canal implants, if the incision into the trabecular meshwork is minimal or incidental to another procedure. Additionally, guidance states that if the procedure consists of several punctures, injection of a small amount of viscoelastic, or other limited interventions, unlisted CPT code 66999 should be used. When multiple incisions are performed opening the trabecular meshwork over an area of at least 90 degrees, CPT 65820 should be used. Of note, the fact sheet references 2 Medicare Administrative Contractors with published Local Coverage Determinations and Local Coverage Articles relevant to goniotomy procedures.
Reference
- American Academy of Ophthalmology. Fact sheet: goniotomy. https://www.aao.org/Assets/c1c5ad6a-f611-4c41-988c-991514f68602/637896975656770000/goniotomy-fs-pdf?inline=1
