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CPT 65103: Enucleation with Ocular Implant, No Muscle Attachment
CPT code 65103 represents surgical enucleation in which a diseased or damaged eyeball is removed intact and an ocular implant is placed without attaching the extraocular muscles. This procedure is clinically significant for management of blind, painful eyes, extensive globe trauma, or intraocular malignancy, and has implications for surgical resource utilization and postoperative prosthetic rehabilitation. Nationally, enucleation with implant placement is an important procedure for both acute trauma care and elective oncologic or refractory pain management.
Key payers addressed in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise review of clinical context, common sites of service, and the service type associated with the code. The publication summarizes typical billing considerations and the landscape of coverage policies across major national payers, highlights common modifiers used with this surgical service, and outlines where more detailed coding or diagnosis linkage may be required. It also provides benchmarks and policy update summaries relevant to facilities and surgeons who perform enucleations and manage postoperative prosthetic fitting and follow-up care. Data not available in the input is noted where applicable.
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Billing Code Overview
CPT code 65103 describes removal of a diseased or damaged eyeball (enucleation) with the globe removed intact and insertion of an ocular implant to fill the socket without attachment of the extraocular muscles. This procedure is a surgical orbital procedure performed by ophthalmic or oculoplastic surgeons.
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Service type: Surgical enucleation with implant placement (no muscle attachment)
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Typical site of service: Hospital operating room or ambulatory surgery center