Summary & Overview
CPT 65140: Ocular Implant Insertion for Anophthalmic Socket
CPT code 65140 identifies the surgical placement of an ocular implant into an anophthalmic socket, generally performed months after eye removal. This procedure restores orbital volume and secures the implant to the extraocular muscles to improve prosthetic motility and cosmesis. Nationally, the code matters for surgical ophthalmology, oculoplastics, and hospital billing workflows because it affects facility and professional claims for reconstructive orbital care.
Key payers covered in this overview include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise clinical context for when 65140 is used, typical sites of service, and the service type for billing purposes. The analysis also summarizes common modifiers and payer considerations where available. This publication is intended to inform payers, clinical coders, and surgical teams about coding expectations, common billing scenarios, and factors that influence claims for orbital implant placement.
The content that follows provides benchmarks, coding guidance context, and policy-related notes relevant to professional and facility billing for ocular implant insertion, and highlights where input data was not available for deeper payer-specific coverage or diagnosis crosswalks.
Billing Code Overview
CPT code 65140 describes the surgical insertion of an ocular implant to fill an empty eye socket, typically performed several months after an enucleation or similar eye removal procedure. The provider attaches the implant to the extraocular muscles to restore socket volume and allow prosthetic motility.
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Service type: Surgical implant placement of an ocular orbital implant
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Typical site of service: Ambulatory surgery center or hospital operating room
Clinical & Coding Specifications
Clinical Context
A typical patient is an adult who previously underwent enucleation or evisceration for a blind, painful eye, ocular malignancy, or severe trauma and now presents several months later for placement of an orbital implant. The patient has completed healing of the conjunctiva and socket tissues, with stable orbital anatomy and no active infection. Preoperative evaluation includes history and physical, review of prior operative reports, assessment of socket depth and motility, and informed consent discussing risks such as infection, extrusion, or motility limitation. The procedure is performed in an ambulatory surgery center or hospital operating room under monitored anesthesia care or general anesthesia. The surgeon creates a conjunctival or scleral pocket as needed, inserts an appropriately sized porous or nonporous orbital implant into the orbit, secures the implant to the extraocular muscle stumps (or surrounding tissues) to improve motility, and closes soft tissues. Postoperative workflow includes short recovery monitoring, postoperative instructions, topical/systemic antibiotics as indicated, follow-up visits for suture removal and prosthetic fitting with an ocularist once healing is complete. Typical payors include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, BUCA, and Medicare.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
11 | Usually denotes the office or outpatient visit | Use if reporting the usual, uncomplicated service; rarely appended to surgical CPT reporting per payer rules |