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Official Description

Strabismus surgery, recession or resection procedure; 2 horizontal muscles

© Copyright 2026 American Medical Association. All rights reserved.

Common Language Description

Strabismus surgery is a specialized procedure aimed at correcting misalignment of the eyes, which can occur due to imbalances in the strength of the extraocular muscles that control eye movement. The human eye is equipped with six extraocular muscles, each playing a crucial role in coordinating eye movements. When one of these muscles is excessively strong, it can lead to conditions where the eye turns inward, outward, or experiences abnormal vertical positioning. Conversely, if a muscle is too weak, it can result in misalignment of the eyes, causing issues such as double vision or difficulty focusing. To address these imbalances, two primary surgical techniques are employed: recession and resection. In a recession procedure, the affected muscle is detached from its original position on the eye and reattached further back, effectively weakening its pull and allowing the opposing muscle to exert more influence. This technique is particularly useful for muscles that are too strong. On the other hand, a resection procedure is utilized to strengthen a weak muscle by detaching it and reattaching it in a new position closer to the front of the eye. This adjustment increases the muscle's effectiveness in aligning the eyes properly. The surgery typically involves making a small incision in the conjunctiva, the membrane covering the eye, to access the extraocular muscles. After the necessary adjustments are made, the incision is closed, completing the procedure. The specific coding for these surgeries varies based on the muscles involved, with CPT® Code 67312 specifically indicating a recession or resection procedure performed on two horizontal muscles, typically the lateral and medial rectus muscles of the same eye.

© Copyright 2026 Coding Ahead. All rights reserved.

1. Indications

The strabismus surgery, specifically the recession or resection procedure, is indicated for patients exhibiting misalignment of the eyes due to imbalances in the strength of the extraocular muscles. The following conditions may warrant this surgical intervention:

  • Strabismus Misalignment of the eyes, which can manifest as esotropia (inward turning), exotropia (outward turning), or vertical misalignment.
  • Excessive Muscle Strength Conditions where one or more extraocular muscles are too strong, leading to abnormal eye positioning.
  • Weak Muscle Strength Situations where opposing muscles are too weak, contributing to misalignment and visual disturbances.

2. Procedure

The strabismus surgery involves several key procedural steps to effectively correct the misalignment of the eyes. The following outlines the detailed steps involved in the recession or resection procedure:

  • Step 1: Anesthesia Administration The procedure begins with the administration of local anesthesia to ensure the patient is comfortable and pain-free during the surgery. In some cases, general anesthesia may be used, particularly in pediatric patients.
  • Step 2: Incision Creation A small incision is made in the conjunctiva, the thin membrane covering the white part of the eye, over the targeted extraocular muscle. This incision allows access to the muscle without causing significant trauma to the surrounding tissues.
  • Step 3: Muscle Detachment The surgeon carefully detaches the extraocular muscle from its original attachment point on the globe of the eye. This step is critical as it prepares the muscle for repositioning, whether for recession or resection.
  • Step 4: Muscle Reattachment Depending on the specific procedure being performed, the muscle is either reattached farther back on the globe (in the case of recession) to weaken its effect or reattached in a new location closer to the front of the eye (in the case of resection) to strengthen its pull. This adjustment is essential for correcting the misalignment.
  • Step 5: Closure of Incision After the muscle has been repositioned, the surgeon closes the incision in the conjunctiva with sutures. This step ensures that the surgical site is secure and promotes healing.

3. Post-Procedure

Following the strabismus surgery, patients are typically monitored for a short period to ensure there are no immediate complications. Post-procedure care may include the use of prescribed eye drops to prevent infection and reduce inflammation. Patients are advised to avoid strenuous activities and to follow up with their healthcare provider for assessments of healing and alignment. Recovery times can vary, but many patients experience significant improvement in eye alignment shortly after the procedure, with full recovery and stabilization of vision occurring over several weeks. It is important for patients to adhere to follow-up appointments to monitor their progress and address any concerns that may arise during the healing process.

Short Descr REVISE TWO EYE MUSCLES
Medium Descr STRABISMUS RECESSION/RESCJ 2 HRZNTL MUSC
Long Descr Strabismus surgery, recession or resection procedure; 2 horizontal muscles
Status Code Active Code
Global Days 090 - Major Surgery
PC/TC Indicator (26, TC) 0 - Physician Service Code
Multiple Procedures (51) 2 - Standard payment adjustment rules for multiple procedures apply.
Bilateral Surgery (50) 1 - 150% payment adjustment for bilateral procedures applies.
Physician Supervisions 09 - Concept does not apply.
Assistant Surgeon (80, 82) 1 - Statutory payment restriction for assistants at surgery applies to this procedure...
Co-Surgeons (62) 1 - Co-surgeons could be paid, though supporting documentation is required...
Team Surgery (66) 0 - Team surgeons not permitted for this procedure.
Diagnostic Imaging Family 99 - Concept Does Not Apply
APC Status Indicator Hospital Part B services paid through a comprehensive APC
ASC Payment Indicator Surgical procedure on ASC list in CY 2007; payment based on OPPS relative payment weight.
Type of Service (TOS) 2 - Surgery
Berenson-Eggers TOS (BETOS) P4E - Eye procedure - other
MUE 1
CCS Clinical Classification 21 - Other extraocular muscle and orbit therapeutic procedures

This is a primary code that can be used with these additional add-on codes.

67320 Addon Code MPFS Status: Active Code APC N ASC N1 CPT Assistant Article Illustration for Code Transposition procedure (eg, for paretic extraocular muscle), any extraocular muscle (specify) (List separately in addition to code for primary procedure)
67331 Add-on Code MPFS Status: Active Code APC N ASC N1 CPT Assistant Article Illustration for Code Strabismus surgery on patient with previous eye surgery or injury that did not involve the extraocular muscles (List separately in addition to code for primary procedure)
67332 Addon Code MPFS Status: Active Code APC N ASC N1 CPT Assistant Article Strabismus surgery on patient with scarring of extraocular muscles (eg, prior ocular injury, strabismus or retinal detachment surgery) or restrictive myopathy (eg, dysthyroid ophthalmopathy) (List separately in addition to code for primary procedure)
67334 Addon Code MPFS Status: Active Code APC N ASC N1 CPT Assistant Article Illustration for Code Strabismus surgery by posterior fixation suture technique, with or without muscle recession (List separately in addition to code for primary procedure)
67335 Addon Code MPFS Status: Active Code APC N ASC N1 CPT Assistant Article Illustration for Code Placement of adjustable suture(s) during strabismus surgery, including postoperative adjustment(s) of suture(s) (List separately in addition to code for specific strabismus surgery)
67340 Addon Code MPFS Status: Active Code APC N ASC N1 CPT Assistant Article Illustration for Code Strabismus surgery involving exploration and/or repair of detached extraocular muscle(s) (List separately in addition to code for primary procedure)
LT Left side (used to identify procedures performed on the left side of the body)
RT Right side (used to identify procedures performed on the right side of the body)
GC This service has been performed in part by a resident under the direction of a teaching physician
50 Bilateral procedure: unless otherwise identified in the listings, bilateral procedures that are performed at the same session, should be identified by adding modifier 50 to the appropriate 5 digit code. note: this modifier should not be appended to designated "add-on" codes (see appendix d).
51 Multiple procedures: when multiple procedures, other than e/m services, physical medicine and rehabilitation services or provision of supplies (eg, vaccines), are performed at the same session by the same individual, the primary procedure or service may be reported as listed. the additional procedure(s) or service(s) may be identified by appending modifier 51 to the additional procedure or service code(s). note: this modifier should not be appended to designated "add-on" codes (see appendix d).
54 Surgical care only: when 1 physician or other qualified health care professional performs a surgical procedure and another provides preoperative and/or postoperative management, surgical services may be identified by adding modifier 54 to the usual procedure number.
59 Distinct procedural service: under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-e/m services performed on the same day. modifier 59 is used to identify procedures/services, other than e/m services, that are not normally reported together, but are appropriate under the circumstances. documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. however, when another already established modifier is appropriate it should be used rather than modifier 59. only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. note: modifier 59 should not be appended to an e/m service. to report a separate and distinct e/m service with a non-e/m service performed on the same date, see modifier 25.
76 Repeat procedure or service by same physician or other qualified health care professional: it may be necessary to indicate that a procedure or service was repeated by the same physician or other qualified health care professional subsequent to the original procedure or service. this circumstance may be reported by adding modifier 76 to the repeated procedure or service. note: this modifier should not be appended to an e/m service.
78 Unplanned return to the operating/procedure room by the same physician or other qualified health care professional following initial procedure for a related procedure during the postoperative period: it may be necessary to indicate that another procedure was performed during the postoperative period of the initial procedure (unplanned procedure following initial procedure). when this procedure is related to the first, and requires the use of an operating/procedure room, it may be reported by adding modifier 78 to the related procedure. (for repeat procedures, see modifier 76.)
79 Unrelated procedure or service by the same physician or other qualified health care professional during the postoperative period: the individual may need to indicate that the performance of a procedure or service during the postoperative period was unrelated to the original procedure. this circumstance may be reported by using modifier 79. (for repeat procedures on the same day, see modifier 76.)
82 Assistant surgeon (when qualified resident surgeon not available): the unavailability of a qualified resident surgeon is a prerequisite for use of modifier 82 appended to the usual procedure code number(s).
CR Catastrophe/disaster related
GW Service not related to the hospice patient's terminal condition
SG Ambulatory surgical center (asc) facility service
XU Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service
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2009-01-01 Changed Code description changed
Pre-1990 Added Code added.
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