2025 CPT code 61330
(Active) Effective Date: N/A Revision Date: N/A Surgery - Surgical Procedures on the Nervous System Surgery Feed
Decompression of the orbit, transcranial approach.
Modifiers may be applicable, such as modifier 50 for bilateral procedures, or other modifiers to specify the surgical approach or additional services rendered.Consult the current CPT manual and NCCI edits for details.
Medical necessity for orbital decompression is established based on the presence of clinically significant proptosis causing functional impairment, such as vision loss, diplopia (double vision), or corneal exposure.The procedure may also be medically necessary to treat traumatic orbital fractures. Documentation should clearly demonstrate the clinical indication for surgery.
The ophthalmologist or neurosurgeon performs the procedure.The ophthalmologist is responsible for pre-operative assessment, intra-operative management, and post-operative care.The neurosurgeon may be involved depending on the surgical approach. Anesthesiologist manages anesthesia.
In simple words: This surgery relieves pressure on the eye by removing some bone from the eye socket. This helps if your eyes bulge out or you have a fracture in the eye socket bone.The surgeon reaches the eye socket through the skull, temporarily removing a small piece of bone. After the procedure, the bone is put back in place.
Orbital decompression is a surgical procedure to alleviate pressure on the eye by removing a portion of the bone from the walls of the eye socket (orbit). This creates more space, allowing the eye to reposition to a more normal position. The procedure is often performed to treat proptosis (bulging eyes) or orbital roof fractures.A transcranial approach involves accessing the orbit through the skull, requiring removal and replacement of a piece of skull bone. The surgeon may also remove and/or repair orbital structures, such as the orbital roof.Post-operatively, the bone flap is secured, and a drain is often used to minimize fluid accumulation. The surgical site is closed with sutures or staples.
Example 1: A patient presents with severe proptosis (bulging eyes) secondary to Graves' ophthalmopathy.The ophthalmologist determines that orbital decompression is necessary to reduce eye protrusion and prevent optic nerve compression. A transcranial approach is used., A patient sustains an orbital roof fracture in a motor vehicle accident. Orbital decompression is performed to repair the fracture and restore orbital anatomy.The approach may vary based on fracture location and severity., A patient with long-standing thyroid eye disease experiences progressive vision loss due to optic nerve compression. The ophthalmologist performs orbital decompression to improve vision and reduce the cosmetic effects of proptosis. A combined approach may be employed.
* Detailed history and physical examination documenting proptosis, visual acuity, visual fields, and extraocular muscle function.* Imaging studies (CT scan or MRI) to evaluate orbital anatomy, identify the extent of bony involvement, and assess the presence of any fractures.* Operative report detailing the surgical approach, extent of bone removal, and any other procedures performed.* Post-operative visual acuity and extraocular muscle function assessments.
** The specific surgical approach (e.g., lateral, medial, or combined wall decompression) is not explicitly coded.Documentation should clearly specify the approach used to justify code selection and appropriate billing.
- Revenue Code: P1G (MAJOR PROCEDURE - OTHER)
- RVU: Refer to the current year's Medicare Physician Fee Schedule for RVU values and payment rates. These values vary by geographic location and may also be subject to other adjustments. Consult the appropriate fee schedule for accurate information.
- Global Days: The global period for this procedure varies depending on the complexity and extent of the surgery. Clarification should be sought from the payer.
- Payment Status: Active
- Modifier TC rule: The technical component (TC) modifier may be applicable depending on the circumstances and the payer's guidelines. Consult your payer for specific instructions.
- Fee Schedule: Historical fee schedule data can be found in archival copies of the Medicare Physician Fee Schedule. Consult this data for past reimbursement amounts.Note that these values are historical and should not be used for current billing purposes.
- Specialties:Ophthalmology, Neurosurgery
- Place of Service:Inpatient Hospital, Ambulatory Surgical Center