2025 CPT code 65426
(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; with graft.
Modifiers may be applicable based on specific circumstances (e.g., 50 for bilateral procedures, 59 for distinct procedural services, 22 for increased procedural services).Refer to the CPT manual for detailed guidance on modifier usage.
Medical necessity is established by the presence of a symptomatic pterygium causing visual impairment, irritation, or discomfort that is not adequately managed by conservative measures.Documentation should support the need for surgical intervention.
The ophthalmologist or appropriately trained surgical specialist is responsible for the pre-operative assessment, surgical procedure, and post-operative care.
In simple words: This surgery removes a growth on the white part of the eye (pterygium) and replaces the removed tissue with a graft. This improves vision and comfort.
This procedure involves the surgical removal (excision) or repositioning (transposition) of a pterygium, a noncancerous growth on the conjunctiva of the eye, followed by the placement of a graft to repair the resulting defect.The procedure begins with separating the pterygium from the underlying sclera. The entire pterygium is then excised, and bleeding is controlled using electrocautery.The conjunctiva is carefully separated from Tenon's capsule, and the size of the wound is assessed. A graft (conjunctival or amniotic) is harvested and placed on the scleral bed.The graft is secured with sutures, while the donor site is left open to heal naturally.
Example 1: A 55-year-old male patient presents with a symptomatic pterygium affecting his right eye, causing blurred vision and irritation.A conjunctival autograft is used to repair the defect after pterygium excision., A 40-year-old female patient has a large pterygium on her left eye that requires excision. Due to the size of the defect, an amniotic membrane transplant is used in addition to a conjunctival autograft for complete coverage., A 60-year-old patient undergoes pterygium excision with an amniotic membrane transplant secured with glue instead of sutures. No conjunctival autograft is used.
Detailed ophthalmologic examination notes documenting the presence and size of the pterygium, visual acuity measurements before and after the procedure, intraoperative photos or videos, type of graft used, and post-operative assessment including visual acuity and any complications.
** Always refer to the most current CPT and payer guidelines for accurate coding and reimbursement.
- Revenue Code: P4E (EYE PROCEDURE - OTHER)
- RVU: Information not available in provided text.Refer to CMS fee schedules or other relevant payer resources for RVU values and reimbursement information.
- Global Days: Information not provided.The global period will depend on payer policies and the specific circumstances of the procedure.
- Payment Status: Active
- Modifier TC rule: Information not provided. The application of a TC modifier depends on payer policies and may vary.
- Fee Schedule: Information not available in provided text. Consult historical CPT fee schedules or payer-specific data for historical fee information.
- Specialties:Ophthalmology
- Place of Service:Ambulatory Surgical Center, Office, Outpatient Hospital