Summary & Overview
CPT 65285: Repair of Corneal/Scleral Tear with Uveal Manipulation
CPT code 65285 denotes surgical repair of a traumatic tear to the cornea and/or sclera with repositioning or removal of uveal tissue. This code is used for emergent or urgent ocular trauma procedures that restore globe integrity and address potentially vision-threatening intraocular injury. Nationally, accurate coding for these complex eye-trauma procedures matters for clinical documentation, surgical case mix reporting, and appropriate payer adjudication given the high-acuity nature of the service.
Key payers included in the coverage discussion are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of the clinical context for the procedure, expected settings of care (operating room or ambulatory surgery center), and the typical clinical objectives of the operation. The publication also highlights benchmarking and policy-relevant themes such as coding specificity for trauma repairs, scenarios that affect billing complexity, and documentation elements that support medical necessity.
The content is intended to inform clinicians, coding professionals, and policy stakeholders about the clinical and billing implications of CPT code 65285, provide clarity on where the service is typically delivered, and summarize what to expect in payer interactions and national reporting frameworks. Data not available in the input is noted where applicable.
Billing Code Overview
CPT code 65285 describes surgical repair of a traumatic injury to the globe involving a tear wound of the cornea and/or sclera with repositioning or removal of portions of the vascular middle layer of the eye (uveal tissue). This procedure is a form of emergent ocular trauma surgery to restore globe integrity and address intraocular tissue disruption.
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Service type: Surgical ocular trauma repair
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Typical site of service: Operating room or ambulatory surgery center, often performed under ophthalmic surgical conditions for traumatic globe injuries
Clinical & Coding Specifications
Clinical Context
A Thirty-four-year-old male presents to the emergency department after blunt facial trauma from a motor vehicle collision. He reports decreased vision, severe eye pain, and visible laceration of the cornea with an irregular pupil. On ophthalmic exam there is a full-thickness corneal laceration with prolapse of intraocular tissue and concern for open-globe injury. The ophthalmology team performs urgent operative repair under general anesthesia in the operating room. The procedure includes primary closure of the corneal and/or scleral tear, inspection of the anterior chamber, repositioning or removal of prolapsed uveal tissue (iris or ciliary body), and layered wound closure. Postoperative care includes topical antibiotics, intraocular pressure monitoring, tetanus prophylaxis as indicated, and close outpatient follow-up for retina and intraocular infection surveillance.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | No modifier provided (general placeholder) | Rarely used clinically; not typically appended — use specific modifiers instead |
| 22 | Increased procedural services | Use when the repair required substantially greater effort or complexity than usual
| 23 | Unusual anesthesia | Use when general anesthesia is administered for a procedure that is usually performed with local anesthesia