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Official Description

Strabismus surgery, any procedure, superior oblique muscle

© Copyright 2026 American Medical Association. All rights reserved.

Common Language Description

The CPT® Code 67318 refers to strabismus surgery involving any procedure on the superior oblique muscle of the eye. The superior oblique muscle plays a crucial role in eye movement and is located at the superolateral aspect of the globe. It passes through a specialized tendon known as the trochlea, which is situated at the medial or nasal side of the orbit, and ultimately attaches to the posterior aspect of the orbit. This code encompasses various surgical interventions targeting the superior oblique muscle, with the specific procedure performed being contingent upon the underlying condition being addressed. For instance, one notable surgical technique associated with this code is the Harada-Ito procedure, which is specifically designed to correct eye misalignment resulting from cranial nerve IV palsy. During this procedure, an incision is made in the conjunctiva directly over the superior oblique muscle, allowing access to the muscle and its tendon. The tendon is then split, and the anterior fibers are repositioned in an anterior and lateral direction before being reattached to the globe. Finally, the conjunctival incision is meticulously closed with sutures, ensuring proper healing and alignment of the eye.

© Copyright 2026 Coding Ahead. All rights reserved.

1. Indications

The procedure associated with CPT® Code 67318 is indicated for various conditions that involve misalignment of the eye, particularly those affecting the superior oblique muscle. The following are specific indications for performing this surgery:

  • Cranial Nerve IV Palsy - This condition results in weakness or paralysis of the superior oblique muscle, leading to vertical misalignment of the eye.
  • Strabismus - General misalignment of the eyes, which may require surgical intervention to improve ocular alignment and binocular vision.
  • Other Muscle Imbalances - Conditions that involve dysfunction or imbalance of the extraocular muscles, necessitating surgical correction.

2. Procedure

The surgical procedure associated with CPT® Code 67318 involves several critical steps to effectively address the condition affecting the superior oblique muscle. The following outlines the procedural steps:

  • Step 1: Anesthesia Administration - The procedure begins with the administration of appropriate anesthesia to ensure patient comfort during the surgery. This may involve local anesthesia or general anesthesia, depending on the patient's needs and the complexity of the procedure.
  • Step 2: Incision Creation - A careful incision is made in the conjunctiva, which is the thin membrane covering the white part of the eye, directly over the superior oblique muscle. This incision allows the surgeon to access the muscle and its tendon.
  • Step 3: Tendon Manipulation - The superior oblique tendon is then split to facilitate the surgical correction. The anterior fibers of the tendon are repositioned in an anterior and lateral direction, which is crucial for correcting the misalignment of the eye.
  • Step 4: Reattachment - After repositioning the tendon, the anterior fibers are securely reattached to the globe of the eye. This step is vital for restoring proper function and alignment of the eye.
  • Step 5: Closure of Incision - Finally, the conjunctival incision is closed using sutures. This ensures that the surgical site is properly sealed, promoting healing and minimizing the risk of complications.

3. Post-Procedure

Post-procedure care following strabismus surgery involving the superior oblique muscle is essential for optimal recovery. Patients are typically monitored for any immediate complications following the surgery. It is common for patients to experience some degree of discomfort, swelling, or redness in the eye, which can be managed with prescribed medications. Follow-up appointments are crucial to assess the alignment of the eyes and the overall healing process. Patients may also receive specific instructions regarding activity restrictions, eye care, and the use of any prescribed eye drops or medications to prevent infection and promote healing. The expected recovery time can vary based on the individual and the complexity of the procedure, but most patients can anticipate gradual improvement in eye alignment and function over the weeks following surgery.

Short Descr REVISE EYE MUSCLE(S)
Medium Descr STRABISMUS ANY SUPERIOR OBLIQUE MUSCLE
Long Descr Strabismus surgery, any procedure, superior oblique muscle
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)
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).
62 Two surgeons: when 2 surgeons work together as primary surgeons performing distinct part(s) of a procedure, each surgeon should report his/her distinct operative work by adding modifier 62 to the procedure code and any associated add-on code(s) for that procedure as long as both surgeons continue to work together as primary surgeons. each surgeon should report the co-surgery once using the same procedure code. if additional procedure(s) (including add-on procedure(s) are performed during the same surgical session, separate code(s) may also be reported with modifier 62 added. note: if a co-surgeon acts as an assistant in the performance of additional procedure(s), other than those reported with the modifier 62, during the same surgical session, those services may be reported using separate procedure code(s) with modifier 80 or modifier 82 added, as appropriate.
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.)
80 Assistant surgeon: surgical assistant services may be identified by adding modifier 80 to the usual procedure number(s).
GC This service has been performed in part by a resident under the direction of a teaching physician
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)
SG Ambulatory surgical center (asc) facility service
Date
Action
Notes
1991-01-01 Added First appearance in code book in 1991.
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