2025 CPT code 65130
(Active) Effective Date: N/A Revision Date: N/A Surgery - Surgical Procedures on the Eye and Ocular Adnexa Surgery Feed
Insertion of an ocular implant after evisceration, with the implant encased in a scleral shell.
Modifiers may apply depending on the specific circumstances of the procedure. Consult the CPT manual and payer guidelines for appropriate modifier usage.
Medical necessity is established by the presence of a blind, painful eye, or an eye with severe pathology requiring removal of the intraocular contents.The insertion of the implant is for cosmetic purposes and to restore orbital volume.
The ophthalmologist or oculoplastic surgeon is responsible for performing the procedure. This involves prepping the patient, cleansing and preparing the socket, inserting the implant (possibly wrapped in scleral membrane), suturing the muscles to the implant (if applicable), closing Tenon's capsule and the conjunctiva, and placing an orbital conformer.
In simple words: The doctor inserts a special implant into the empty eye socket after removing the inside of the eye. The implant is wrapped in a protective layer and placed to fill the socket, improving the appearance of the eye area. A temporary shell is also used to help maintain the shape of the eyelids.
This procedure involves the insertion of an ocular implant into the scleral shell following the removal of the intraocular contents (evisceration).The implant is typically wrapped in a scleral membrane before insertion.The extraocular muscles may or may not be attached to the implant.An orbital conformer is placed to maintain the shape of the eyelids.This is usually performed several months after the initial evisceration.
Example 1: A patient presents with a blind, painful eye due to trauma.Evisceration with secondary implantation using code 65130 is performed to remove the painful eye contents and restore the orbital volume and cosmetic appearance., A patient undergoes evisceration for endophthalmitis (eye infection). After the infection is controlled, a secondary procedure is performed using code 65130 to insert an ocular implant, improving the cosmetic outcome., A patient has previously undergone an evisceration, but the resulting socket is too shallow. Code 65130 is used for a secondary procedure to insert a larger implant and improve cosmetic appearance.
* Preoperative diagnosis and documentation of the need for evisceration.* Detailed surgical report describing the procedure, including type of implant used, whether or not muscles were attached, and the use of a scleral shell.* Postoperative care instructions.* Imaging (if relevant).
** The choice of implant material and size will vary depending on the individual patient's anatomy and the surgeon's preference.The procedure may be performed under general or local anesthesia. Post-operative care typically includes the use of an orbital conformer and pain management.
- Revenue Code: P4E (EYE PROCEDURE - OTHER)
- RVU: Not specified in provided text.Consult the current year's CPT codebook for RVU values.
- Global Days: Not specified in provided text.The global period will depend on payer policies and local practices.
- Payment Status: Active
- Modifier TC rule: The application of a technical component (TC) modifier is not explicitly defined for this code in the provided data.Consult payer policies and local practices for clarification.
- Fee Schedule: Fee schedule information is not available in the provided text. This data varies by payer and geographic location.
- Specialties:Ophthalmology, Oculoplastic surgery
- Place of Service:Ambulatory Surgical Center, Hospital (Inpatient or Outpatient), Office