2025 CPT code 65135
(Active) Effective Date: N/A Revision Date: N/A Deletion Date: N/A Surgery - Secondary Implant(s) Procedures on the Eyeball Surgical Procedures on the Eye and Ocular Adnexa Feed
Insertion of an ocular implant after enucleation, without muscle attachment.
Modifiers may be applicable depending on circumstances, such as 50 (bilateral procedure) if implants are placed in both eye sockets, or other relevant modifiers based on the specific details of the procedure and any add-on codes used.
The medical necessity for this procedure usually stems from the need to restore the shape of the eye socket after enucleation for cosmetic reasons or to create a suitable base for a prosthetic eye. This will typically be supported by the patient’s history and a physician’s clinical evaluation.
The ophthalmologist or other qualified surgeon is responsible for the surgical procedure, including pre-operative preparation, the insertion of the ocular implant, and post-operative care. Anesthesiologists may be involved depending on patient needs.
- Surgical Procedures on the Eye and Ocular Adnexa
- Surgical Procedures on the Eye and Ocular Adnexa > Surgical Procedures on the Eyeball > Secondary Implant(s) Procedures on the Eyeball
In simple words: The doctor puts an artificial eye into the empty eye socket after the eye has been removed.The artificial eye isn't connected to the eye muscles.
This CPT code 65135 describes the surgical procedure of inserting a secondary ocular implant into the eye socket following enucleation (removal of the eyeball).The procedure involves preparing the socket, inserting the implant without attaching it to the extraocular muscles, closing Tenon's capsule and conjunctiva, and placing an orbital conformer.The implant permanently fills the empty socket, and a prosthetic eye may be later fitted over the conjunctiva.
Example 1: A patient undergoes enucleation due to a traumatic eye injury. Several months later, an ocular implant is inserted using code 65135 to restore the shape of the eye socket.No muscle attachment is required., A patient has an eye removed due to cancer. After the healing process, code 65135 is used for insertion of an ocular implant to improve cosmetic appearance. The implant is not attached to the muscles., A patient with a severely damaged eye undergoes enucleation. Following appropriate healing, an ocular implant is placed (65135) to provide a foundation for a custom-fitted prosthetic eye, without muscle reattachment.
* Pre-operative assessment and consent* Surgical report detailing the procedure performed, including the type of implant used, and confirmation that the implant was not attached to the muscles.* Post-operative instructions and follow-up care.* Images (if applicable) to demonstrate the location and type of implant used.
** Always cross-reference this code with other relevant codes to ensure accurate billing.Be mindful of payer specific guidelines and local regulations that influence reimbursement.
- Revenue Code: P4E (EYE PROCEDURE - OTHER)
- RVU: RVUs vary based on geographic location, facility type, and other factors. Consult your local fee schedule for current RVU values and reimbursement rates.
- Global Days: The global period for this procedure is not explicitly defined in the provided data. Further research may be necessary to determine the specific global period applicable to this code based on payer guidelines and local regulations.
- Payment Status: Active
- Modifier TC rule: A technical component (TC) modifier would not typically apply to this code, as it represents the entire procedure of implant insertion.Additional procedural codes should be considered for any services beyond the primary procedure.
- Fee Schedule: Historical fee schedules vary significantly by payer and location.Consult historical fee schedules from your payer for specific data.
- Specialties:Ophthalmology
- Place of Service:Ambulatory Surgical Center, Office, Inpatient Hospital