Summary & Overview
CPT 65135: Ocular Implant Insertion for Anophthalmic Socket
CPT code 65135 covers surgical insertion of an ocular implant to fill an empty eye socket, usually performed months after an eye removal procedure. The defining feature of this code is that the implant is placed without attaching it to the extraocular muscles. This procedure restores orbital volume and supports prosthetic eyes; it is clinically important for cosmesis and socket health and has implications for surgical scheduling, device selection, and outpatient facility utilization nationwide.
Key payers in the national landscape include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical context, typical sites of service, and payer relevance. The publication also summarizes common billing practices for this procedure, coding nuances affecting claim submissions, and benchmarks where available.
The report is intended to help billing managers, surgical teams, and policy analysts understand how CPT code 65135 is used, what clinical scenario it represents, and which payers commonly cover or process claims for this outpatient ophthalmic prosthetic service. Data not available in the input is noted where applicable.
Billing Code Overview
CPT code 65135 describes the insertion of an ocular implant into an anophthalmic socket to replace volume after eye removal. The procedure typically occurs several months after enucleation or evisceration and does not include attachment of the implant to the extraocular muscles.
Service Type: Ophthalmic surgical prosthetic implantation
Typical Site of Service: Outpatient ambulatory surgery center or hospital outpatient department
Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A typical patient is an adult who underwent enucleation or evisceration months earlier for trauma, uncontrolled ocular malignancy, or a painful blind eye and now presents for primary insertion of a spherical orbital implant to restore orbital volume. The patient has healed conjunctival and socket tissues, no active infection, and stable systemic status for elective surgery. Preoperative evaluation includes history, ophthalmic and socket examination, review of prior operative notes, informed consent, and assessment for anesthesia. In the operating room or ambulatory surgical center, the oculoplastic or ophthalmic plastic surgeon places a nonmotility ocular implant into the anophthalmic socket without attaching extraocular muscles, achieves hemostasis, and closes the conjunctiva. Postoperative workflow includes local wound care instructions, topical antibiotics and anti-inflammatory drops as indicated, pain control, and short-term follow-up to monitor healing and prosthesis fitting by an ocularist typically several weeks after epithelialization is complete. Typical site of service is an ambulatory surgical center or hospital outpatient department for an elective, non-emergent procedure.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | No modifier (default) | Use when no special circumstances apply. |
11 |