Summary & Overview
CPT 61333: Scalp Incision to Access Eye for Lesion or Tumor Removal
CPT code 61333 represents a specialized surgical procedure in which the provider incises the scalp to access the eye and remove a lesion or tumor. This code denotes a higher-complexity ophthalmic or periocular excision that typically requires operative-team resources, general or regional anesthesia, and an appropriately equipped facility. Nationally, procedures coded with 61333 are significant because they reflect complex surgical management of ocular and periocular neoplasms and can drive facility utilization and specialist surgical work.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find clinical context about the procedure type and typical site of service, plus an overview of billing considerations and common modifiers used with this code where applicable. The publication also outlines benchmarks and policy-relevant topics affecting reimbursement and utilization for complex ophthalmic excisions.
This summary serves clinicians, coding professionals, and payers seeking concise guidance on what CPT code 61333 denotes, why it matters for surgical and facility planning, and what to expect in payer coverage discussions. Data not available in the input is noted where detailed payer-specific rates, associated taxonomies, and ICD-10 pairings would normally appear.
Billing Code Overview
CPT code 61333 describes a surgical procedure in which the provider incises the scalp and accesses the eye to remove a lesion or tumor. This procedure is a surgical excision of an ocular or periocular lesion via a scalp incision, indicating a more invasive approach than simple eyelid or conjunctival excisions.
Service type: Surgical procedure (excision/removal of lesion or tumor).
Typical site of service: Hospital operating room or ambulatory surgical center, where operative access through the scalp is feasible and appropriate.
Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A 62-year-old patient presents with a progressively enlarging, symptomatic eyelid and periocular skin lesion suspicious for malignancy (e.g., basal cell carcinoma or squamous cell carcinoma) that involves the anterior scalp/forehead with extension toward the superior orbital rim. After clinical evaluation and imaging as indicated, the oculoplastic or ophthalmic plastic surgeon schedules the patient for operative excision. In the operating room under monitored anesthesia care or general anesthesia, the surgeon incises the scalp/forehead and gains access to the orbit to excise the lesion with appropriate margins, performing careful hemostasis and reconstructive closure of the scalp and eyelid tissues. Specimens are submitted for pathology. Postoperative workflow includes recovery, wound care instructions, pathology follow-up, and coordination of any adjuvant oncology or radiation referrals as indicated.
Typical site of service: Ambulatory surgical center or hospital operating room
Typical service type: Surgical excision and removal of periocular/scalp lesion with access to the orbit and scalp incision, performed by an ophthalmic plastic surgeon or head and neck surgeon
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
11 | Primary procedure | When this procedure is the primary surgical service on the claim |