Summary & Overview
CPT 65420: Pterygium Excision or Transposition Without Graft
CPT code 65420 represents surgical excision or transposition of a pterygium without graft placement. This ophthalmic operation is performed to restore ocular surface anatomy, reduce irritation, and improve visual function when a pterygium encroaches on the cornea. The code matters nationally because pterygium surgery is a common outpatient ophthalmic procedure with implications for facility use, surgical practice patterns, and payer coverage policies.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise clinical and billing context for CPT code 65420, including service type and typical sites of service. The publication outlines benchmarks and reimbursement considerations, summarizes common clinical scenarios prompting use of the code, and highlights relevant policy updates and coding guidance where available. Where input data is incomplete, the summary notes the absence of specific items such as associated taxonomies, ICD-10 diagnoses, or related codes.
This resource is designed for billing professionals, ophthalmology providers, and policy analysts who need a clear, national-level summary of CPT code 65420, its clinical purpose, and the payer landscape that commonly covers the service.
Billing Code Overview
CPT code 65420 describes the surgical excision or transposition of a pterygium performed to improve patient comfort and vision without placement of a graft. This procedure involves removal or repositioning of the conjunctival tissue over the cornea affected by the pterygium.
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Service type: Surgical excision/transposition of pterygium
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Typical site of service: Ambulatory surgery center or hospital outpatient department; may also be performed in an ophthalmology surgical suite
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Clinical & Coding Specifications
Clinical Context
A 58-year-old patient presents to the ophthalmology clinic with a progressively encroaching nasal conjunctival fibrovascular growth on the cornea of the right eye, causing ocular irritation, foreign-body sensation, and induced astigmatism with decreased visual acuity. After topical anesthetic and antisepsis, the surgeon performs pterygium excision/transposition without placement of an autograft or amniotic membrane graft to remove the fibrovascular tissue and restore a smooth corneal surface. The typical clinical workflow includes preoperative assessment (visual acuity, slit-lamp exam, corneal topography if indicated), informed consent, topical or local anesthesia, excision of the pterygium head and body with careful dissection of Tenon capsule where needed, optional cautery for hemostasis, conjunctival closure or advancement/transposition without grafting, application of topical antibiotic and steroid postoperatively, and follow-up visits at day 1, 1 week, and 1 month to monitor healing and recurrence. This procedure is commonly performed in an ambulatory surgical center or ophthalmology outpatient clinic procedure room under local anesthesia with monitored care.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
11 | Normal, preselected surgical procedure | Use when the procedure is performed as planned without complication. |