Vitrectomy

80.11 - Vitrectomy (Rev. 48, Issued: 03-17-06; Effective/Implementation Dates: 06-19-06) CIM - 35-16 Vitrectomy may be considered reasonable and necessary for the following conditions: vitreous loss incident to cataract surgery, vitreous opacities due to vitreous hemorrhage or other causes, retinal detachments secondary to vitreous strands, proliferative retinopathy, and vitreous retraction. See chapter 23 of the Medicare Claims Processing Manual for how to determine payment for physician vitrectomy services and the Medicare Claims Processing Manual, Chapter 14, “Ambulatory Surgical Centers,” §40, for how to determine payment for ASC facility vitrectomy services. Also, see the Medicare Claims Processing Manual, Chapter 23, “Fee Schedule Administration and Coding Requirements,” §20.9, to identify when, for Medicare payment purposes, certain vitrectomy codes are included in other codes or when codes for other services include vitrectomy codes.