Summary & Overview
CPT 65275: Corneal Laceration Repair
CPT code 65275 represents surgical repair of a corneal laceration, a procedure to close tears in the cornea and remove any foreign material from the wound. This code captures an acute ophthalmic surgical intervention that can be vision-saving and often requires coordinated surgical and perioperative care. Nationally, corneal repair procedures are significant for trauma care pathways, emergency ophthalmology services, and surgical resource planning.
Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find clinical context for when 65275 is used, typical sites of service, and an overview of billing considerations relevant to acute eye trauma. The publication outlines benchmarks and policy-relevant issues affecting coverage and payment for ophthalmic trauma procedures, and provides guidance on documentation elements that support billing for procedural complexity and concurrent foreign body removal. Where specific payer policies are not available in the input, the text notes that data is not available in the input.
This summary is intended for clinicians, billing professionals, and policy analysts seeking a concise national overview of CPT code 65275, its clinical role, and the payer landscape that commonly reimburses for corneal laceration repair.
Billing Code Overview
CPT code 65275 describes surgical repair of a corneal laceration or tear. The procedure involves closure of the corneal wound and includes removal of any foreign body present within the wound. This is an ophthalmic surgical service addressing acute traumatic or iatrogenic injuries to the cornea.
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Service type: Ophthalmic surgical repair of corneal laceration
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Typical site of service: Ambulatory surgery center or hospital operating room (eye surgery suite) depending on injury severity and facility capabilities
Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A typical patient is an adult or child who presents to an emergency department or ophthalmology clinic after sustaining ocular trauma such as a blunt or penetrating injury, animal bite, metal-on-metal work injury, or a lacerating incident involving glass or sharp objects. The patient reports eye pain, decreased vision, tearing, photophobia, or a foreign body sensation. On exam, the provider identifies a corneal laceration or full-thickness corneal tear, often with aqueous leakage, irregular pupil, or an entry wound. Fluorescein staining and slit-lamp exam confirm corneal epithelial disruption or stromal penetration; a visible foreign body may be lodged in the wound.
The clinical workflow includes triage with visual acuity and basic ocular examination, application of topical anesthetic, tetanus status assessment, and imaging if intraocular foreign body is suspected (orbital CT). The provider obtains informed consent and performs procedural irrigation, removal of superficial or embedded foreign material if present, and layered corneal repair using microsurgical instruments and appropriate suture technique under local or general anesthesia as indicated. Post-procedure care includes topical antibiotics, cycloplegics if needed, pain control, and close follow-up with ophthalmology for suture management, infection surveillance, and visual rehabilitation. Documentation includes location and size of laceration, presence/absence of globe perforation, materials removed, anesthesia, and specific repair technique.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 |