Extraocular Procedures Except Orbit: Inpatient Reimbursement Overview

DRG 115 encompasses inpatient extraocular procedures except those involving the orbit, including eyelid, lacrimal, and extraocular muscle operations; it defines the clinical scope for payment grouping. This grouping matters for inpatient reimbursement because it determines the bundled payment for expected resources and affects coding specificity and case mix classification under Medicare.

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DRG 115 Overview

DRG 115 covers inpatient cases involving extraocular procedures that do not involve the orbital contents, including surgical interventions on the eyelids, lacrimal apparatus, and extraocular muscles. This Diagnosis-Related Group captures procedures that are often performed for functional or corrective reasons rather than for treatment of orbital disease. It matters for Medicare payment because the grouped payment reflects expected resource use for these procedure-focused admissions and influences hospital coding and billing for inpatient ophthalmic surgical care.

Clinical Trials

Acute perioperative pain management trials testing non-opioid analgesic protocols or regional anesthesia techniques for patients undergoing extraocular procedures (eg, strabismus surgery, eyelid repair excluding orbital surgery). These studies enroll pediatric and adult patients scheduled for short-duration ocular surgeries to evaluate immediate postoperative pain scores, opioid consumption, nausea/vomiting, and time to discharge. Results inform clinicians and payers about pathways that reduce inpatient analgesic use, shorten recovery room stays, and lower complication-related costs in this DRG.
Comparative effectiveness studies evaluating different surgical techniques or adjunctive perioperative approaches (for example, minimally invasive eyelid or lacrimal procedures versus traditional open techniques, or use of antifibrotic agents during corrective extraocular muscle surgery). These trials focus on functional outcomes (ocular motility, eyelid position), reoperation rates, and complication profiles in both pediatric and adult cohorts over weeks to months. Evidence from these studies helps providers choose procedures with better long-term outcomes and helps payers assess value and long-term resource utilization associated with initial procedure selection.
Post-discharge outcomes and health services research assessing readmission rates, wound-related complications, visual function recovery, and patient-reported outcomes after extraocular procedures, including surveillance of infection, diplopia persistence, or eyelid malposition. These observational cohort studies and quality-improvement trials often involve risk stratification of medically complex patients (eg, diabetics, immunosuppressed) to identify predictors of complications and to test care pathways (eg, follow-up timing, outpatient support). Findings are relevant to hospital administrators and payers for designing discharge planning, reducing preventable readmissions, and aligning post-acute care resources with patient risk.

Related Codes

113-ORBITAL-PROCEDURES-WITH-CC-MCC

Orbital Procedures with CC/MCC: Inpatient Reimbursement Overview

114-ORBITAL-PROCEDURES-WITHOUT-CC-MCC

Orbital Procedures without CC/MCC: Inpatient Reimbursement Overview

116-INTRAOCULAR-PROCEDURES-WITH-CC-MCC

Intraocular Procedures with CC/MCC: Inpatient Reimbursement Overview

117-INTRAOCULAR-PROCEDURES-WITHOUT-CC-MCC

Intraocular Procedures without CC/MCC: Inpatient Reimbursement Overview

121-ACUTE-MAJOR-EYE-INFECTIONS-WITH-CC-MCC

Acute Major Eye Infections with CC/MCC: Inpatient Reimbursement Overview

122-ACUTE-MAJOR-EYE-INFECTIONS-WITHOUT-CC-MCC

Acute Major Eye Infections without CC/MCC: Inpatient Reimbursement Overview

123-NEUROLOGICAL-EYE-DISORDERS

Neurological Eye Disorders: Inpatient Reimbursement Overview

124-OTHER-DISORDERS-OF-THE-EYE-WITH-MCC-OR-THROMBOLYTIC-AGENT

Other Disorders of the Eye with MCC or Thrombolytic Agent: Inpatient Reimbursement Overview

125-OTHER-DISORDERS-OF-THE-EYE-WITHOUT-MCC

Other Disorders of the Eye without MCC: Inpatient Reimbursement Overview

References

1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.

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Clinical Trials

Acute perioperative pain management trials testing non-opioid analgesic protocols or regional anesthesia techniques for patients undergoing extraocular procedures (eg, strabismus surgery, eyelid repair excluding orbital surgery). These studies enroll pediatric and adult patients scheduled for short-duration ocular surgeries to evaluate immediate postoperative pain scores, opioid consumption, nausea/vomiting, and time to discharge. Results inform clinicians and payers about pathways that reduce inpatient analgesic use, shorten recovery room stays, and lower complication-related costs in this DRG.
Comparative effectiveness studies evaluating different surgical techniques or adjunctive perioperative approaches (for example, minimally invasive eyelid or lacrimal procedures versus traditional open techniques, or use of antifibrotic agents during corrective extraocular muscle surgery). These trials focus on functional outcomes (ocular motility, eyelid position), reoperation rates, and complication profiles in both pediatric and adult cohorts over weeks to months. Evidence from these studies helps providers choose procedures with better long-term outcomes and helps payers assess value and long-term resource utilization associated with initial procedure selection.
Post-discharge outcomes and health services research assessing readmission rates, wound-related complications, visual function recovery, and patient-reported outcomes after extraocular procedures, including surveillance of infection, diplopia persistence, or eyelid malposition. These observational cohort studies and quality-improvement trials often involve risk stratification of medically complex patients (eg, diabetics, immunosuppressed) to identify predictors of complications and to test care pathways (eg, follow-up timing, outpatient support). Findings are relevant to hospital administrators and payers for designing discharge planning, reducing preventable readmissions, and aligning post-acute care resources with patient risk.

Related Codes

113-ORBITAL-PROCEDURES-WITH-CC-MCC

Orbital Procedures with CC/MCC: Inpatient Reimbursement Overview

114-ORBITAL-PROCEDURES-WITHOUT-CC-MCC

Orbital Procedures without CC/MCC: Inpatient Reimbursement Overview

116-INTRAOCULAR-PROCEDURES-WITH-CC-MCC

Intraocular Procedures with CC/MCC: Inpatient Reimbursement Overview

117-INTRAOCULAR-PROCEDURES-WITHOUT-CC-MCC

Intraocular Procedures without CC/MCC: Inpatient Reimbursement Overview

121-ACUTE-MAJOR-EYE-INFECTIONS-WITH-CC-MCC

Acute Major Eye Infections with CC/MCC: Inpatient Reimbursement Overview

122-ACUTE-MAJOR-EYE-INFECTIONS-WITHOUT-CC-MCC

Acute Major Eye Infections without CC/MCC: Inpatient Reimbursement Overview

123-NEUROLOGICAL-EYE-DISORDERS

Neurological Eye Disorders: Inpatient Reimbursement Overview

124-OTHER-DISORDERS-OF-THE-EYE-WITH-MCC-OR-THROMBOLYTIC-AGENT

Other Disorders of the Eye with MCC or Thrombolytic Agent: Inpatient Reimbursement Overview

125-OTHER-DISORDERS-OF-THE-EYE-WITHOUT-MCC

Other Disorders of the Eye without MCC: Inpatient Reimbursement Overview

References

1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.

Published by

Trek Health powers OpenPayer with a leading commercial payer intelligence platform, seamlessly converting fragmented payer data into actionable insights for provider organizations.