Summary & Overview
CPT 65105: Enucleation with Ocular Implant and Muscle Attachment
CPT code 65105 represents enucleation: surgical removal of a diseased or damaged eyeball with insertion of an ocular implant and attachment to the extraocular muscles. Nationally, this ophthalmic surgical code is important for clinical management of severe ocular trauma, intraocular malignancy, or end-stage ocular disease when globe removal is indicated. It also affects facility and surgeon billing, prosthetic planning, and postoperative rehabilitation pathways.
Key payers commonly involved in coverage for this procedure include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Payer policies vary on medical necessity criteria, documentation requirements, and coverage of the implant and subsequent prosthetic services.
Readers will learn the clinical context of the procedure, typical sites of service, and the elements that drive coding and billing for enucleation with implant placement. The publication provides benchmarks and policy-relevant considerations for payers, facilities, and clinicians, including how coverage and claims processing can differ across major commercial insurers and Medicare. Data not available in the input is noted where applicable.
Billing Code Overview
CPT code 65105 describes enucleation with insertion of an ocular implant and attachment of the implant to the extraocular muscles. This procedure involves removal of a diseased or damaged eyeball with its contents intact, placement of an implant to fill the orbital socket, and securing the implant to the ocular muscles to maintain orbital volume and support prosthetic rehabilitation.
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Service type: Surgical procedure — ophthalmic/orbital surgery
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Typical site of service: Hospital operating room or ambulatory surgery center
Clinical & Coding Specifications
Clinical Context
A 68-year-old patient with a blind, painful eye secondary to severe end-stage glaucoma and recurrent intraocular infection is scheduled for surgical removal of the eyeball (enucleation) with placement of an intraorbital ocular implant and extraocular muscle attachment. Preoperative evaluation includes history and physical, ophthalmic exam, informed consent, and anesthesia assessment. In the operating room under general anesthesia, the ophthalmic surgeon performs 65105: removal of the globe with its contents intact, insertion of an appropriately sized porous or nonporous orbital implant to restore orbital volume, and attachment of the extraocular muscles to the implant to improve prosthetic motility. Postoperative workflow includes orbital dressing application, pain control, antibiotics as indicated, wound care instructions, scheduling of ocular prosthesis fitting once healing permits, and follow-up visits for suture and socket assessment. Typical sites of service are hospital operating room or ambulatory surgery center depending on patient comorbidities and complexity.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services | Use when the procedure requires significantly greater work than typical due to severe scarring, prior radiation, or extensive reconstruction of the socket. |