Commercial

Medical Policy

Title:

Surgical Correction of Strabismus

Policy #:

11.05.07d

Policy

The Company reserves the right to reimburse only those services that are furnished in the most appropriate and cost-effective setting that is appropriate to the member’s medical needs and condition.

MEDICALLY NECESSARY

Surgical correction of strabismus due to any etiology is considered medically necessary and, therefore, covered to attain or restore normal binocular vision in visually immature children who are 10 years of age or younger.

Surgical correction of strabismus for individuals older than 10 years of age is considered medically necessary and, therefore, covered when any of the following criteria are met:

Diplopia exists secondary to impaired extraocular muscle coordination.
Abnormal head posture is exhibited in an effort to have better clarity of vision.
Visual confusion is present (i.e., two separate images are superimposed).
Ocular malalignment impairs depth perception or three-dimensional vision.
Other therapies, if indicated, have been ineffective or not tolerated (i.e., the use of prism glasses or eye occlusion [patching] trials).
Peripheral vision is impaired due to esotropia (eye deviation inwardly toward the nose).
Psychosocial function or vocational status would improve with ocular alignment.

NOT MEDICALLY NECESSARY

Surgical correction of strabismus is considered not medically necessary when the criteria listed above are not met and for all other indications.

REQUIRED DOCUMENTATION

The individual's medical record must reflect the medical necessity for the care provided. These medical records may include, but are not limited to: records from the professional provider's office, hospital, nursing home, home health agencies, therapies, and test reports.

The Company may conduct reviews and audits of services to our members, regardless of the participation status of the provider. All documentation is to be available to the Company upon request. Failure to produce the requested information may result in a denial for the service.

Guidelines

BENEFIT APPLICATION

Subject to the terms and conditions of the applicable benefit contract, surgical correction of strabismus is covered under the medical benefits of the Company’s products when the medical necessity criteria listed in this medical policy are met.

US FOOD AND DRUG ADMINISTRATION (FDA) STATUS

The surgical correction of strabismus is not regulated by the FDA.

Description

The general term "strabismus" describes an ocular alignment abnormality that can occur in one or both eyes, resulting in an eye deviation or "turn" in any direction. Strabismus can be congenital or acquired, latent or manifest, constant or intermittent, and fixed or variable, depending on the position of the gaze. With all of these possibilities, the degree of disability it creates varies widely. The terms used to describe types of strabismus depend on the direction of the eye deviation, the underlying conditions that facilitate its presence, and whether the condition changes with the position of the eye's gaze. The American Association for Pediatric Ophthalmology and Strabismus (AAPOS) estimates that 4% of the US population is afflicted with strabismus.

Most strabismus results from an abnormality of the neuromuscular system, including the brain and some cranial nerves, that hinders the ability to control eye movement. It can also be a result of difficulties with one or more of the eye muscles that control ocular movement. Strabismus is commonly described by the direction of the eye misalignment: inward (esotropia), outward (exotropia), upward (hypertropia), downward (hypotropia), or torsional (cyclotropia). Additionally, strabismus is described by its etiology; there are three cranial nerves that control eye movement (III [3], IV[4],VI [6]), and a weakness or palsy in any one or combination of these can result in strabismus. Moreover, strabismus can be congenital or acquired, with some acquired as a result of a vision or life-threatening condition, such as retinoblastoma, head trauma, cranial nerve palsies, orbital fractures, myasthenia gravis, Graves' disease, and Guillain-Barré syndrome. A cerebral vascular accident (CVA) or "stroke" is the leading cause of adult-acquired strabismus, while trauma that affects the brain and its control of eye movement, damage to the cranial nerves that control eye movement, or damage to the eye socket either directly or secondarily can lead to strabismus.

Strabismus can occur in children who exhibit a typical pattern of neurological development with expected, on-time developmental milestones, but it is more likely to develop in children with a concurrent abnormality that affects the brain, such as cerebral palsy, hydrocephalus, Down syndrome, or a brain tumor. Young children who are afflicted with strabismus often develop amblyopia (lazy eye). Because the strabismic child with amblyopia is at increased risk of blindness due to loss of vision in the non-amblyopic eye, it is critical that strabismus be identified early and corrective treatment started immediately.

The alignment problems associated with strabismus are classified in different ways:

Onset: Congenital or acquired
Directional: Horizontal, vertical, or cyclotorsional
Accommodation: Accommodative strabismus is able to be fully corrected with glasses. Partially accommodative strabismus is able to be partially corrected with glasses. Finally, non-accommodative strabismus is not able to be corrected with glasses.
Frequency: Constant or intermittent, depending on whether the deviation is the same in all positions of gaze (constant) or the deviation varies depending on the direction of gaze (intermittent).
Laterality: Unilateral or alternating. Individuals will experience strabismus in the right eye, left eye, or alternating both eyes, but never in both eyes simultaneously.
Size: Small, moderate, or large.
Primary, secondary, or consecutive: Most strabismus is primary, while secondary strabismus is the result of vision loss or impaired vision. Consecutive strabismus results from an overcorrection (i.e., exotropia resulting from a correction of esotropia).
Concomitant (non-paralytic) or incomitant (paralytic): With concomitant strabismus, the magnitude of the deviation does not vary with gaze direction, while the gaze direction does affect the size or presence of the deviation with incomitant strabismus.

Strabismus can be seen at any age. Binocularity of vision is usually well developed by 5 years of age, and visual maturity is reached between 8 and 10 years of age; thus, it is important to address strabismus during this period of time so that vision develops properly in both eyes. Before visual maturity is reached, individuals with strabismus focus preferentially with their non-deviating eye and the brain blocks signals from the deviating eye. This may become permanent if not addressed before visual maturity. In individuals with strabismus, sometimes visual correction is first approached medically by the use of prism glasses; if indicated, such glasses may help to relieve diplopia and visual confusion while helping to restore normal depth perception. However, if the size of the deviation is large, prism glasses will distort the vision and, additionally, do not help the wearer with deviation that occurs depending on the position of gaze (incomitant). If any benefit is noted, it can occur only when the user is wearing the glasses; thus, it is a way to compensate for visual problems, not repair them. Most adult strabismus is incomitant and therefore not typically correctable by the use of prism glasses. The use of an eye patch, if indicated, is only a temporizing measure until the condition resolves or, if unresolved, prompts a surgical approach. Sometimes, the use of botulinum toxin agents injected into the rectus muscle may help alleviate the hard muscular pull of one side of the rectus muscle, which is moving the eye out of correct alignment. In addition, visual training exercises (orthoptics/pleoptics) and the use of miotic drops to the eye to manipulate accommodation have been noted to have limited utility.

If the desired result is not obtained or cannot be sustained medically, a variety of procedures can help align the eyes and permit a more optimal visual fusion. Surgical correction of strabismus is variable and depends on the root cause of the problem. Some of the more frequently used surgical corrections are strengthening, weakening, or transpositioning procedures. The most common weakening procedure is recession, in which an outside (extraocular) muscle is detached from the eye and reattached further back on the globe (away from the iris). Weakening procedures can be performed on the afflicted muscle if it is too strong or can be performed on the opposing muscle (antagonist) if the afflicted muscle is too weak. The most common strengthening procedure is resection, typically performed on esotropic eyes, in which a portion of the lateral rectus muscle (ear-side muscle) is removed and then reattached to its original location. Transposition procedures are typically performed on cyclotropic eyes, in which the insertion of the muscle is moved to an entirely new position on the globe. Any combination of these procedures can be used to obtain ocular alignment. A more recent technique involves the use of adjustable sutures. After surgery, the eye is patched and 4 to 24 hours later, the eye is evaluated. The suture can be used to weaken or strengthen the muscle and then can be permanently tied into place. This results in better alignment, but is difficult to perform on young children due to the uncomfortable nature of the adjustment. The exact approach for correction is individualized and contingent on the eye's orientation, the degree of ocular muscle dysfunction, and visual field disturbances.

Surgical correction of strabismus in physically symptomatic, visually mature individuals can also result in improved appearance. Psychosocial function and vocational issues are a large part of the body of literature available on adult strabismus surgery. In a joint position statement, the AAPOS and The American Academy of Ophthalmology (AAO) discuss that successful strabismus surgery can relieve diplopia and visual confusion, expand the visual fields, eliminate an abnormal head posture, and restore or establish depth perception, all of which improve and enhance the quality of life and strengthen functionality in daily living.

The term "strabismus" refers to a wide range of malalignments, from horizontal to vertical, to various subcategories of malalignment based on causation. For complete information and more detailed discussion of the various types of strabismus and a range of etiologies, please refer to the AOA's Optometric Clinical Practice Guidelines: Care of the Patient with Strabismus: Esotropia and Exotropia, available at: https://www.aoa.org/practice/clinical-guidelines/clinical-practice-guidelines?sso=y.

PEER-REVIEWED LITERATURE

With a lack of strong evidence for any treatment of strabismus, as most studies on the subject involve a small number of subjects, Clarke et al. (2015) designed and executed a pilot study to test the feasibility of conducting a full-scale randomized clinical trial. Surgical correction for strabismus has long been accepted as a standard treatment option, but with high rates of reoperation and an unknown amount of spontaneously resolving strabismus, the authors sought to assess the true rate of successful strabismus surgery when compared to active monitoring. Because of the historical acceptance of surgical correction of strabismus, the authors believed that subjects, parents, and physicians might be hesitant to participate in the “active monitoring” arm of the trial, for fear that vision would irreparably deteriorate during this period. Conversely, subjects, parents, and physicians might think that the subject’s case was not severe enough to warrant surgery and refuse to participate in the surgical arm. Of the 138 eligible subjects, 89 (64.5%) refused to participate. Although the authors acknowledge the significant rate of participation refusal, the need for a full-scale trial was confirmed. The pilot study found that active monitoring resulted in neither a decline nor an improvement in visual acuity, whereas strabismus surgery typically resulted in a decrease in visual acuity, with a large rate of overcorrecting, although it was successful in ocular alignment, at least in the short term. The pilot was not powered to prove any of the findings to a statistically significant level, which is why a large, multicenter randomized controlled trial is needed on this matter.

In a retrospective cross-sectional study conducted by Leffler et al. (2016), pediatric reoperation and abnormal binocularity rates were compared for 11,115 children who underwent fixed-suture surgery (n=10,806), adjustable-suture surgery (n=260), or botulinum injection (n=49) for the treatment of strabismus between 2007 and 2013. Younger age (<8 years), esotropia, hyperopia, and botulinum injection were found to be associated with postoperative abnormal binocularity. Younger age (<5 years), botulinum injection, vertical and superior oblique surgeries (compared to horizontal surgery), and three- or four-muscle surgery were all associated with increased risk of reoperation. The data for this study were collected from an insurance claim database, and are therefore lacking in crucial information, especially with regard to surgical success. Advantages to this study include the large sample size, and the inclusion of data across multiple insurance providers.

In a retrospective cohort study conducted by Chang et al. (2015), the quality of life for adults with strabismus (n=41) was compared to the quality of life for adults with other ocular diseases, which included diabetic retinopathy (n=123), age-related macular degeneration (n=108), glaucoma (n=77), cataract (n=93), cytomegalovirus (n=37), and low vision (n=90). Quality of life was evaluated using the standardized and validated 25-item National Eye Institute Visual Functioning Questionnaire. Subjects with strabismus scored worse than any other group in the “ocular pain” subscale and scored the same or worse in almost any other subcategory, which included general health, general vision, near activities, distance activities, vision-specific social functioning, vision-specific mental health, vision-specific role difficulties, vision-specific dependency, driving, color vision, and peripheral vision. This study highlights the effect strabismus has on functional quality of life compared to the effect incurred by other ocular diseases that are widely accepted as detrimental to individual well-being.

References

Abroms AD, Mohney BG, Rush DP, et al. Timely surgery in intermittent and constant exotropia for superior sensory outcome. Am J Ophthalmol. 2001;131(1):111-116.

Albert DM, Jakobiec FA, Azar DT, et al. Principles and Practice of ophthalmology. 2^nd ed. Philadelphia, PA: WB Saunders Co; 2000;4379-4392.

American Academy of Ophthalmology Pediatric Ophthalmology/Strabismus Panel. Preferred Practice Pattern® Guidelines. Amblyopia. San Francisco, CA: American Academy of Ophthalmology; 2024. Also available on the AAO Web site at: https://www.aao.org/education/preferred-practice-pattern/amblyopia-ppp-2022. Accessed July 01, 2026.

American Academy of Ophthalmology Pediatric Ophthalmology/Strabismus Panel. Preferred Practice Pattern® Guidelines. Esotropia and Exotropia. San Francisco, CA: American Academy of Ophthalmology; 2022. Also available on the AAO Web site at: https://www.aao.org/education/preferred-practice-pattern/esotropia-exotropia-ppp. Accessed July 01, 2026.

American Academy of Ophthalmology (AAO). Joint policy statement: Adult strabismus surgery. [AAO Web site]. 2017. Available at: https://www.aao.org/clinical-statement/adult-strabismus-surgery. Accessed July 01, 2026.

American Academy of Ophthalmology. EyeWiki™. Strabismus in Thyroid Eye Disease. Last modified 03/24/2021. Available at: http://eyewiki.aao.org/Strabismus_in_Thyroid_Eye_Disease. Accessed July 01, 2026.

American Academy of Pediatrics (AAP). Policy statement: Visual System Assessment in Infants, Children, and Young Adults by Pediatricians. Pediatrics. 2016;137(1):2015-3596. Available at: https://publications.aap.org/pediatrics/article/137/1/e20153596/52809/Visual-System-Assessment-in-Infants-Children-and. Accessed July 01, 2026.

American Academy of Pediatrics (AAP). Policy statement: Eye examination in infants, children, and young adults by pediatricians. Pediatrics. 2003;111(4 Pt 1):902-907.

AAP Publications Reaffirmed. Pediatrics (2022) 149 (4): e2022056609.

American Optometric Association. Optometric Clinical Practice Guideline. Care of the Patient with Strabismus: Esotropia and Exotropia. Original:1995, Revised 2010. [American Optometric Association Web site.] Available at: https://www.aoa.org/AOA/Documents/Practice Management/Clinical Guidelines/Consensus-based guidelines/Care of Patient with Strabismus Esotropia and Exotropia.pdf. Accessed July 01, 2026.

Asbury T, Fredrick DR. Strabismus. In: Vaughan D, Asbury T, Riordan-Eva P, eds. General Ophthalmology. 15th ed. New York, NY: McGraw-Hill; 1999:216-233.

Baker JD. The value of adult strabismus correction to the patient. J AAPOS. 2002;6(3):136-140.

Basmak H, Sahin A, Yildirim N. Combined cataract and strabismus surgery with adjustable sutures. J AAPOS. 2007;11(1):73.

Beauchamp GR, Black BC, Coats DK, et al. The management of strabismus in adults—I. Clinical characteristics and treatment. J AAPOS. 2003;7(4):233-240.

Beauchamp GR, Black BC, Coats DK, et al. The management of strabismus in adults—II. Patient and provider perspectives on the severity of adult strabismus and on outcome contributors. J AAPOS. 2005;9(2):141-147.

Beauchamp GR, Black BC, Coats DK, et al. The management of strabismus in adults—III. The effects on disability. J AAPOS. 2005;9(5):455-459.

Birch EE, Fawcett S, Stager DR. Why does early surgical alignment improve stereoacuity outcomes in infantile esotropia? J AAPOS. 2000;4(1):10-14.

Black BC, Felius J, Beauchamp GR. Intensity and complexity index of disease for strabismus surgery. J AAPOS.2003;7(1):60-65.

Burke JP, Leach CM, Davis H. Psychosocial implications of strabismus surgery in adults. J Pediatr Ophthalmol Strabismus. 1997;34(3):159-164.

Calhoun JH. Strabismus and amblyopia. In: Quillen DA, ed. Current Concepts in Ophthalmology. Harrisburg, PA: Pennsylvania Academy of Ophthalmology; 2000: 63-65.

Caputo R, Tinelli F, Bancale A, et al. Motor coordination in children with congenital strabismus: effects of late surgery. Eur J Paediatr Neurol. 2007;11(5):285-291.

Catalano JD. Strabismus. Pediatr Ann. 1990;19(5);19:289, 292-297.

Chang MY, Velez FG, Demer JL, et al. Quality of life in adults with strabismus. Am J Ophthalmol. 2015;159(3):539-544.

Chia A, Seenyen L, Long QB. Surgical experiences with two-muscle surgery for the treatment of intermittent exotropia. J AAPOS. 2006;10(3):206-211.

Clarke M, Hogan V, Buck D, et al. An external pilot study to test the feasibility of a randomised controlled trial comparing eye muscle surgery against active monitoring for childhood intermittent exotropia [X(T)]. Health Technol Assess. 2015;19(39):1-144.

Coats DK, Paysse EA. Causes of horizontal strabismus in children. 01/12/2023. Up to Date. [UpToDate Web site]. Available at: http://www.uptodate.com/home/index.html. [via subscription only]. Accessed June 5, 2024.

Coats DK, Paysse EA. Causes of vertical strabismus in children. 09/27/2022. Up to Date. [UpToDate Web site]. Available at: http://www.uptodate.com/home/index.html. [via subscription only]. Accessed July 01, 2026.

Coats, DK, Paysse EA. Evaluation and management of strabismus in children. 02/01/2023. Up to Date. [UpToDate Web site]. Available at: http://www.uptodate.com/home/index.html. [via subscription only]. Accessed July 01, 2026.

Coats DK, Paysse EA, Towler AJ, et al. Impact of large angle horizontal strabismus on ability to obtain employment. Ophthalmology. 2000;107(2):402-405.

Dawson E, Boyle N, Taherian K, Lee JP. Use of the combined recession and resection of a rectus muscle procedure in the management of incomitant strabismus. J AAPOS. 2007;11(2):131-134.

Dotan G, Nelson LB, Mezad-Koursh D, et al. (2014). Surgical outcome of strabismus surgery in patients with unilateral vision loss and horizontal strabismus. J Pediatr Ophthalmol Strabismus. 2014;51(5):294-298.

Drover JR, Stager DR Sr, Morale SE, et al. Improvement in motor development following surgery for infantile esotropia. J AAPOS. 2008;12(2):136-140.

Figueira EC, Hing S. Intermittent exotropia: comparison of treatments. Clin Exp Ophthalmol. 2006;34(3):245-251.

Gill MK, Drummond GT. Indications and outcomes of strabismus repair in visually mature patients. Can J Ophthalmol. 1997;32(7):436-440.

Godts D, Trau R, Tassignon MJ. Effect of refractive surgery on binocular vision and ocular alignment in patients with manifest or intermittent strabismus. Br J Ophthalmol. 2006;90(11):1410-1413.

Guthrie M, Wright KW. Congenital esotropia. Ophthalmol Clin North Am. 2001;14(3):416-424, viii.

Habot-Wilner Z, Spierer A, Glovinsky J, Wygnanski-Jaffe T. Bilateral medial rectus muscle recession: results in children with developmental delay compared with normally developed children. J AAPOS. 2006;10(2):150-154.

Helveston EM, Neely DF, Stidham DB, et al. Results of early alignment of congenital esotropia. Ophthalmology. 1999;106(9):1716-1726.

Hertle RW. Clinical characteristics of surgically treated adult strabismus. J Pediatr Ophthalmol Strabismus. 1998;35(3):138-145.

Hudson HL, Feldon SE. Late Hypercorrection of Hypotropia in Graves'. Ophthalmology: Predictive Factors. Ophthalmology.1992;100:356-360.

Jackson S, Harrad RA, Morris M, Rumsey N. The psychosocial benefits of corrective surgery for adults with strabismus. Br J Ophthalmol. 2006;90(7):883-888.

Jeoung JW, Lee MJ, Hwang JM. Bilateral lateral rectus recession versus unilateral recess-resect procedure for exotropia with a dominant eye. Am J Ophthalmol. 2006;141(4):683-688.

Johnson CA, Keltner JL. Incidence of visual field loss in 20,000 eyes and its relationship to driving performance. Arch Ophthalmol. 1983;101(3):371-375.

Kanski JJ, Bowling B. Clinical Ophthalmology: A Systematic Approach. 7th ed. Edinburgh: Butterworth-Heinemann/Elsevier; 2011; 735-781.

Keltner JL. Strabismus surgery in adults. Functional and psychosocial implications. Arch Ophthalmol. 1994;112(5):599-600.

Keltner JL, Johnson CA. Visual function and driving safety. Arch Ophthalmol. 1992;110(12):1697-1698.

Kim SH, Choi YJ. Effects of unilateral lateral rectus recession according to the tendon width intermittent exotropia. Eye. 2006;20(7):785-788.

Kushner BJ. Binocular field expansion in adults after surgery for esotropia. Arch Ophthalmol. 1994;112(5):639-643.

Kushner BJ, Morton GV. Postoperative binocularity in adults with longstanding strabismus. Ophthalmology. 1992;99(3):316-319.

Leffler CT, Vaziri K, Schwartz SG, et al. Rates of reoperation and abnormal binocularity following strabismus surgery in children. Am J Ophthalmol. 2016;162:159-166.

Leuder GT, Galli M. Comparison of lateral rectus muscle re-recession and medial rectus muscle resection for treatment of postoperative exotropia. Am J Ophthalmol. 2015;159(4):812-815.

Lueder GT, Norman AA. Strabismus surgery for elimination of bifocals in accommodative esotropia. Am J Ophthalmol. 2006;142(4):632-635.

Magramm I, Schlossman A. Strabismus in patients over the age of 60 years. J Pediatr Ophthalmol Strabismus. 1991;28(1):28-31.

Mills MD, Coats DK, Donahue SP, et al. Strabismus surgery for adults: a report by the American Academy of Ophthalmology. Ophthalmology. 2004;111(6):1255-1262.

Mills MD. Fundamental principals of strabismus surgery. In: Albert DM, ed. Ophthalmic Surgery Principles and Techniques. Malden, MA: Blackwell Science, Inc. 1999:810-830.

Mohan K, Sharma A, Pandav SS. Unilateral lateral rectus muscle recession and medial rectus muscle resection with or without advancement for postoperative consecutive exotropia. J AAPOS. 2006;10(3):220-224.

Mojon DS. Comparison of a new, minimally invasive strabismus surgery technique with the usual limbal approach for rectus muscle recession and plication. Br J Ophthalmol. 2007;91(1):76-82.

Mojon-Azzi SM, Potnik W, Mojon DS. Opinions of dating agents about strabismic subjects' ability to find a partner. Br J Ophthalmol. 2008;92(6):765-769.

Morris RJ, Scott WE, Dickey CF. Fusion after surgical alignment of longstanding strabismus in adults. Ophthalmology. 1993;100(1):135-138.

Nabie R, Anvari F, Azadeh M, et al. Evaluation of the effectiveness of anterior transposition of the inferior oblique muscle in dissociated vertical deviation with or without inferior oblique overaction. J Pediatr Ophthalmol Strabismus. 2007;44(3):158-162.

Newell FW. Ophthalmology Principles and Concepts. 8th ed. St. Louis, MO: Mosby; 1996:406-411.

Ogüt MS, Onal S, Demirtas S. Adjustable suture surgery for correction of various types of strabismus. Ophthalmic Surg Lasers Imaging. 2007;38(3):196-202.

Oh JY, Hwang JM. Survival analysis of 365 patients with exotropia after surgery. Eye. 2006;20(11):1268-1272.

Olitsky SE, Nelson LB. Common ophthalmologic concerns in infants and children. Pediatr Clin North Am. 1998;45(4):993-1012.

Olitsky SE, Nelson LB. Strabismus disorders. In: Nelson LB, ed. Harley’s Pediatric Ophthalmology. 4th ed. Philadelphia, PA: WB Saunders Co;1998:146-167.

Parks MM. The monofixation syndrome. Trans Am Ophthalmol Soc. 1969;67:609-657.

Pratt-Johnson JA. Fusion ability lost and regained in visual adults. Graefes Arch Clin Exp Ophthalmol. 1988;226(2):111-112.

Repka MX, Lam GC, Morrison NA. The efficacy of botulinum neurotoxin A for the treatment of complete and partially recovered chronic sixth nerve palsy. J Pediatr Ophthalmol Strabismus. 1994;31(2):79-83; discussion 84.

Rodrigues AC, Nelson LB. Long-term results of hang-back lateral rectus recession. J Pediatr Ophthalmol Strabismus. 2006;43(3):161-164.

Rosenbaum AL. The goal of adult strabismus surgery is not cosmetic. Arch Ophthalmol. 1999;117(2):250.

Rosenbaum AL, Kushner BJ, Kirschen D. Vertical rectus muscle transposition and botulinum toxin (Oculinum) to medial rectus for abducens palsy. Arch Ophthalmol. 1989;107(6):820-823.

Satterfield D, Keltner JL, Morrison TL. Psychosocial aspects of strabismus study. Arch Ophthalmol. 1993;111(8):1100-1105.

Scott WE, Kutschke PJ, Lee WR. 20th annual Frank Costenbader Lecture – adult strabismus. J Pediatr Ophthalmol Strabismus. 1995;32(6):348-352.

Shirabe H, Mori Y, Dogru M, Yamamoto M. Early surgery for infantile esotropia. Br J Ophthalmol. 2000;84(5):536-538.

Son JH, Huh YS, Kim MM. Surgical outcomes of intermittent exotropia as a function of strabismic angle. Korean J Ophthalmol. 2006;20(4):230-233.

Sprunger DT, Helveston EM. Progressive Overcorrection After Inferior Rectus Recession. J Pediatr Ophthalmol Strabismus. 1993;30:145-148.

Szlyk JP, Alexander KR, Severing K, et al. Assessment of driving performance in patients with retinitis pigmentosa. Arch Ophthalmol. 1992;110(12):1709-1713.

Tabbara KF. The eye and ocular adnexa. In: Way LW, ed. Current Surgical Diagnosis and Treatment. East Norwalk, CT: Appleton & Lange; 1994; 894-902.

Ticho BH, Ticho KE, Kaufman LM. Combined strabismus and lens surgery. J AAPOS. 2006;10(5):430-434.

Wang X, Gao X, Xiao M, et al. Effectiveness of strabismus surgery on the health-related quality of life assessment of children with intermittent exotropia and their parents: a randomized clinical trial. J AAPOS. 2015;19(4):298-303.

Wortham E, Greenwald MJ. Expanded binocular peripheral visual fields following surgery for esotropia. J Pediatr Ophthalmol Strabismus. 1989;26(3):109-112.

Wu H, Sun J, Xia X, et al. Binocular status after surgery for constant and intermittent exotropia. Am J Ophthalmol. 2006;142(5):822-826. [published correction appears in Am J Ophthalmol. 2007;143(1):201.].

Coding

CPT Procedure Code Number(s)

67311, 67312, 67314, 67316, 67318, 67320, 67331, 67332, 67334, 67335, 67340, 67343

ICD - 10 Procedure Code Number(s)

N/A

ICD - 10 Diagnosis Code Number(s)

See Attachment A.

HCPCS Level II Code Number(s)

N/A

Revenue Code Number(s)

N/A

MPMiscCodesNarrativesPub

Coding and Billing Requirements

Cross Reference

Policy History

Revisions From 11.05.07d:

07/22/2026	This policy has been reissued in accordance with the Company's annual review process.
10/01/2025	This policy has been reissued in accordance with the Company's annual review process.
06/26/2024	This policy has been reissued in accordance with the Company's annual review process.
04/19/2023	This policy has been reissued in accordance with the Company's annual review process.
05/18/2022	This policy has been reissued in accordance with the Company's annual review process.
06/02/2021	The policy has been reviewed and reissued to communicate the Company’s continuing position on Surgical Correction of Strabismus.
06/03/2020	This policy has been reissued in accordance with the Company's annual review process.
05/22/2019	The policy has been reviewed and reissued to communicate the Company’s continuing position on Surgical Correction of Strabismus.
03/28/2018	This policy has undergone a routine review, and no revisions have been made.

Effective 10/05/2017 this policy has been updated to the new policy template format.

Version Effective Date:

9/7/2016

Version Issued Date: