2025 CPT code 65420
(Active) Effective Date: N/A Revision Date: N/A Surgery - Surgical Procedures on the Eye and Ocular Adnexa Surgery Feed
Excision or transposition of pterygium without a graft.
Modifier 22 (Increased Procedural Services) may be used if both nasal and temporal pterygium excisions are performed in the same eye.
Medical necessity for pterygium excision is established when the pterygium affects vision, causes significant discomfort, or is cosmetically unacceptable to the patient.Documentation should demonstrate that conservative treatments have failed.
The ophthalmologist or qualified surgeon is responsible for prepping the patient, administering anesthesia, excising the pterygium, controlling bleeding, and ensuring proper wound closure.
In simple words: The doctor removes or moves a non-cancerous growth on the white part of the eye without using a replacement tissue patch.
This procedure involves the surgical removal or repositioning of a pterygium (a non-cancerous growth on the conjunctiva of the eye) without the use of a graft.The pterygium is separated from the underlying scleral scar tissue.The entire pterygium is then excised.Bleeding is controlled using electrocautery, and the sclera is allowed to heal naturally.
Example 1: A 55-year-old patient presents with a pterygium encroaching on their visual axis, causing blurry vision and discomfort.The surgeon performs a pterygium excision without a graft. , A 60-year-old patient has a small pterygium that doesn't affect vision but causes significant irritation and redness. The surgeon excises the pterygium without a graft., A 40-year-old patient with a history of recurrent pterygium undergoes a second excision, with no graft used.
* Detailed operative report including the technique used.* Preoperative and postoperative visual acuity assessments.* Documentation of patient symptoms and medical necessity.* Photographs of the pterygium before and after surgery (if applicable).
** If mitomycin C is used to prevent recurrence, the cost is typically included in the procedure fee.Off-label use requires payer-specific approval.
- Revenue Code: P4E (EYE PROCEDURE - OTHER)
- RVU: This information is not available in the provided text.Refer to the current year's CPT codebook or a relevant medical billing resource for RVU values.
- Global Days: This information is not provided.The global period will depend on payer specific guidelines.
- Payment Status: Active
- Modifier TC rule: This information is not available in the provided text. Refer to the current year's CPT codebook or a relevant medical billing resource.
- Fee Schedule: This information is not available in the provided text.Refer to a relevant medical billing resource for historical fee schedule data.
- Specialties:Ophthalmology
- Place of Service:Office, Ambulatory Surgical Center, Inpatient Hospital