Summary & Overview
CPT 65101: Enucleation of Eye, Globe Removed Intact
CPT code 65101 represents the surgical enucleation of an eyeball, removing a diseased or damaged globe with its contents intact and without placement of an ocular implant. This procedure is clinically significant for treating severe ocular trauma, untreatable ocular disease, or blind painful eyes and has implications for surgical planning, post-operative care, prosthetic rehabilitation, and payer coverage determinations nationwide. Key payers in analyses typically include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare.
Readers will find a concise national overview of clinical context and service delivery for 65101, including common sites of service and how the procedure fits into surgical and prosthetic care pathways. The publication summarizes expected billing practice elements, common modifiers when reported (input provided), and identifies where input data is unavailable. It also outlines the types of benchmarks and policy topics commonly reviewed for this code, such as coverage scope, payment variation across major payers, and implications for facility versus ambulatory settings. Data not available in the input is explicitly noted where applicable.
Billing Code Overview
CPT code 65101 describes the surgical removal of a diseased or damaged eyeball (enucleation) with the globe removed intact. The procedure specifies that an ocular implant is not inserted to fill the empty eye socket.
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Service type: Surgical procedure (enucleation of the eye)
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Typical site of service: Operating room or ambulatory surgical center, depending on clinical circumstances and facility resources.
Clinical & Coding Specifications
Clinical Context
A typical patient is an adult with a blind, painful, or severely damaged eye from trauma, end-stage glaucoma, chronic endophthalmitis, or intraocular malignancy (for example, advanced retinoblastoma in pediatric patients or a painful blind eye in adults). The clinical workflow begins with initial ophthalmology evaluation documenting vision status, pain, and examination findings. Imaging (orbital ultrasound or CT) and laboratory studies are obtained as indicated to assess intraocular disease and orbital anatomy. Informed consent is obtained covering enucleation without primary implant placement, risks (bleeding, infection, sympathetic ophthalmia), and postoperative expectations. Preoperative clearance and anesthesia evaluation occur the day of surgery. The surgeon performs 65101 (enucleation without placement of an ocular implant) in an operating room or ambulatory surgery center under general or monitored anesthesia care. Postoperative care includes wound checks, pain management, topical and/or systemic antibiotics or steroids as indicated, suture removal, and referral to ocular prosthetics for delayed prosthesis fitting once healing is complete.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | No modifier; standard reporting | Use when no additional modifier applies and the service is billed as rendered |