2025 CPT code 65155
(Active) Effective Date: N/A Revision Date: N/A Deletion Date: N/A Surgery - Surgical Procedures on the Eye and Ocular Adnexa Surgery Feed
Reinsertion of an ocular implant using foreign material to reinforce and/or attach muscles.
Modifiers may be applicable depending on the circumstances. For example, modifier -78 may be used for an unplanned return to the operating room.Always consult the most current CPT guidelines and modifier guidelines before applying any modifier.
Medical necessity must be established for this procedure; for example, if the implant has become dislodged, causing discomfort or cosmetic issues, or if the implant has been extruded.
The ophthalmologist or a qualified surgeon is responsible for performing this procedure.This involves prepping the patient, administering anesthesia, surgically opening the scleral shell, reinserting the implant, using sutures/grafts for reinforcement and/or muscle attachment, and closing the conjunctival membrane. Post-operative care is also the responsibility of the physician.
In simple words: The doctor puts back an implant that fills an empty eye socket.They use stitches or other material to hold it in place and attach the eye muscles.
This CPT code, 65155, describes the surgical procedure of reinserting an ocular implant into an empty eye socket.The procedure involves opening the scleral shell (previously closed during evisceration or enucleation), reinserting the implant, and using foreign materials such as sutures or grafts to reinforce the implant and/or attach the muscles. The conjunctival membrane is then closed over the implant. This differs from 65150, which does not specify the use of foreign material for reinforcement and/or muscle attachment.
Example 1: A patient had an enucleation procedure several years ago. The ocular implant has become dislodged, requiring reinsertion. The surgeon uses a conjunctival graft to secure the implant, and sutures to attach the muscles., A patient underwent an evisceration procedure. During post-operative recovery, the ocular implant was partially extruded. The ophthalmologist reinserts the implant and uses a synthetic material for reinforcement., Following a previous ocular implant surgery, the patient experiences pain and discomfort due to muscle imbalance.Reinsertion of the implant with adjustments and strengthening of muscle attachments using sutures is necessary.
** Always refer to the most recent CPT codebook and payer guidelines for the most up-to-date information on coding, reimbursement, and modifiers.This information is for guidance only and should not be considered a substitute for professional medical coding advice.The use of foreign material is a key differentiating factor between this code (65155) and the similar code 65150.
- Revenue Code: P4E (EYE PROCEDURE - OTHER)
- RVU: This information is not available in the provided text.Consult the current year's Medicare Physician Fee Schedule for RVU values and reimbursement rates.RVUs vary based on geographic location and other factors.
- Global Days: The global period for this procedure is not specified in the provided text.The global period would vary depending on payer and local policies.
- Payment Status: Active
- Modifier TC rule: This information is not available in the source.Whether a TC modifier is applicable will depend on the specific details of the service.
- Fee Schedule: Historical fee schedule data is not available in the provided text.Check with your payer or fee schedule databases for historical information.
- Specialties:Ophthalmology, ophthalmic surgery
- Place of Service:Ambulatory Surgical Center, Outpatient Hospital, Inpatient Hospital