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CPT 65426: Pterygium Excision or Transposition with Graft

CPT code 65426 defines surgical management of a pterygium that includes excision or transposition of the lesion combined with a graft. This ophthalmic procedure is performed to restore ocular surface integrity, improve vision, and relieve symptoms caused by pterygium growth. Nationally, the code matters for surgical ophthalmology billing, utilization tracking, and policy design for ocular surface procedures.

Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise clinical context for the procedure, typical sites of service, and an outline of billing considerations. The publication summarizes common modifiers seen with this service, expected service line placement, and how this code aligns with related ophthalmic surgical codes.

The report provides benchmarks where available, highlights relevant policy updates affecting coverage and prior authorization practices, and clarifies coding boundaries to support accurate claim submission. Data not available in the input is noted where applicable.

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Billing Code Overview

CPT code 65426 describes excision or transposition of a pterygium with graft. This procedure involves removal or repositioning of the pterygium tissue on the ocular surface and performing a graft to improve patient comfort and vision.

Service type: Surgical ophthalmic procedure (pterygium excision with graft)
Typical site of service: Ambulatory surgical center or hospital outpatient department

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CPT 65426: Pterygium Excision or Transposition with Graft

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Billing Code Overview

Service type: Surgical ophthalmic procedure (pterygium excision with graft)
Typical site of service: Ambulatory surgical center or hospital outpatient department

Clinical & Coding Specifications

Clinical Context

A 54-year-old patient presents to an ophthalmology clinic with a symptomatic nasal pterygium encroaching on the cornea causing foreign-body sensation, tearing, intermittent blurred vision, and cosmetic concern. After topical anesthesia and periocular sedation as needed, the surgeon performs excision of the pterygium with mobilization/transposition of the fibrovascular tissue and placement of a conjunctival autograft (or amniotic membrane graft) to reduce recurrence. The procedure is typically performed in an outpatient ophthalmic surgical center or hospital ambulatory surgery unit under monitored anesthesia care or local anesthesia with sedation. Preoperative evaluation includes ocular surface assessment, visual acuity, slit-lamp biomicroscopy, and informed consent addressing recurrence risk and graft technique. Postoperative workflow includes topical antibiotic and steroid regimen, scheduled follow-up at day 1, week 1, and subsequent visits to monitor graft viability and healing, with documentation of laterality and any intraoperative complications.

Coding Specifications

Modifier	Description	When to Use
`26`	Professional component	Use when billing only the surgeon’s professional service separate from facility technical charges.
`50`	Bilateral procedure	Use when identical procedure is performed on both eyes during the same operative session and payer requires bilateral modifier instead of modifier 51 or TS.
`51`	Multiple procedures	Use when another unrelated CPT-coded procedure is performed during the same operative session and payer requires modifier 51 for multiple procedures.
`52`	Reduced services	Use when the procedure is partially reduced or not completed as documented (e.g., limited excision due to anatomy or complication).
`53`	Discontinued procedure	Use when the procedure is started but aborted for patient-related or intraoperative reasons and appropriately documented.
`59`	Distinct procedural service	Use to indicate a separate, distinct procedure not normally billed together when documentation supports distinct anatomic or procedural services.
`62`	Two surgeons	Use when two surgeons work together as primary surgeons performing distinct portions requiring separate skills.
`78`	Return to OR for related procedure during global period	Use when the patient returns to the operating room for a related procedure for a complication during the global postoperative period.
`79`	Unrelated procedure during global period	Use when an unrelated procedure is performed during the postoperative global period.
`80`	Assistant surgeon	Use when a qualified assistant surgeon provides assistance at surgery and payer requires modifier to denote assistant involvement.
`81`	Minimum assistant surgeon	Use when a minimum assistant surgeon is used and payer distinguishes from full assistant under modifier `80`.
`62`	Two surgeons	(See above) Applicable when co-surgeon care is required for complex reconstructions or complications.
`22`	Increased procedural services	Use when work required to perform the procedure is substantially greater than usual and documentation supports additional work.
`23`	Unusual anesthesia	Use when procedure is performed under general anesthesia solely due to documented medical condition or unexpected circumstance precluding local/regional anesthesia.
`76`	Repeat procedure by same physician	Data not available in the input.

Taxonomy Code	Specialty	Notes
207W00000X	Ophthalmology	Corneal and external disease specialists commonly perform pterygium excision with grafting.
207WS0100X	Ocular Plastic Surgery (Ophthalmic Plastic & Reconstructive Surgery)	Surgeons with external ocular reconstructive expertise may perform complex grafting or conjunctival reconstruction.
207VP0800X	Cornea and External Disease	Providers focused on corneal surgery frequently manage recurrent or large pterygia and advanced graft techniques.
208100000X	Optometry	In some regions, optometrists with surgical privileges perform minor ocular surface procedures per local scope (where permitted).
207K00000X	Retina/Vitreous	Data not applicable as primary but may be involved if combined posterior segment procedures are performed.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
Data not available in the input.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`65426`	Excision or transposition of pterygium with graft	Primary procedure: removal of pterygium with conjunctival autograft or other graft to reduce recurrence and restore ocular surface.
`65420`	Excision of pterygium, simple; without graft	Alternative/lesser procedure when excision is performed without grafting; may be performed for small, non-recurrent lesions.
`65435`	Excision of recurrent pterygium, complicated, with graft	Used for recurrent or complex pterygia requiring more extensive excision and grafting techniques.
`65778`	Conjunctival autograft for pterygium repair; single graft	Often used to report the graft harvest/placement component when documentation distinguishes graft procedure separate from excision (payer-specific).
`12001`	Simple repair of superficial wounds of face, ears, eyelids (2.5 cm or less)	May be reported if concurrent eyelid or periocular skin repairs are performed during the same operative session (payer rules vary).

CPT 65400: Corneal Surface Lesion Excision, Superficial

CPT-65410-CORNEAL-BIOPSY-TISSUE-SAMPLING

CPT 65410: Corneal Biopsy and Tissue Sampling

CPT-65420-PTERYGIUM-EXCISION-TRANSPOSITION-NO-GRAFT

CPT 65420: Pterygium Excision or Transposition Without Graft

Frequently Asked Questions

References

1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.

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Clinical & Coding Specifications

Clinical Context

Coding Specifications

Modifier	Description	When to Use
`26`	Professional component	Use when billing only the surgeon’s professional service separate from facility technical charges.
`50`	Bilateral procedure	Use when identical procedure is performed on both eyes during the same operative session and payer requires bilateral modifier instead of modifier 51 or TS.
`51`	Multiple procedures	Use when another unrelated CPT-coded procedure is performed during the same operative session and payer requires modifier 51 for multiple procedures.
`52`	Reduced services	Use when the procedure is partially reduced or not completed as documented (e.g., limited excision due to anatomy or complication).
`53`	Discontinued procedure	Use when the procedure is started but aborted for patient-related or intraoperative reasons and appropriately documented.
`59`	Distinct procedural service	Use to indicate a separate, distinct procedure not normally billed together when documentation supports distinct anatomic or procedural services.
`62`	Two surgeons	Use when two surgeons work together as primary surgeons performing distinct portions requiring separate skills.
`78`	Return to OR for related procedure during global period	Use when the patient returns to the operating room for a related procedure for a complication during the global postoperative period.
`79`	Unrelated procedure during global period	Use when an unrelated procedure is performed during the postoperative global period.
`80`	Assistant surgeon	Use when a qualified assistant surgeon provides assistance at surgery and payer requires modifier to denote assistant involvement.
`81`	Minimum assistant surgeon	Use when a minimum assistant surgeon is used and payer distinguishes from full assistant under modifier `80`.
`62`	Two surgeons	(See above) Applicable when co-surgeon care is required for complex reconstructions or complications.
`22`	Increased procedural services	Use when work required to perform the procedure is substantially greater than usual and documentation supports additional work.
`23`	Unusual anesthesia	Use when procedure is performed under general anesthesia solely due to documented medical condition or unexpected circumstance precluding local/regional anesthesia.
`76`	Repeat procedure by same physician	Data not available in the input.

Taxonomy Code	Specialty	Notes
207W00000X	Ophthalmology	Corneal and external disease specialists commonly perform pterygium excision with grafting.
207WS0100X	Ocular Plastic Surgery (Ophthalmic Plastic & Reconstructive Surgery)	Surgeons with external ocular reconstructive expertise may perform complex grafting or conjunctival reconstruction.
207VP0800X	Cornea and External Disease	Providers focused on corneal surgery frequently manage recurrent or large pterygia and advanced graft techniques.
208100000X	Optometry	In some regions, optometrists with surgical privileges perform minor ocular surface procedures per local scope (where permitted).
207K00000X	Retina/Vitreous	Data not applicable as primary but may be involved if combined posterior segment procedures are performed.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
Data not available in the input.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`65426`	Excision or transposition of pterygium with graft	Primary procedure: removal of pterygium with conjunctival autograft or other graft to reduce recurrence and restore ocular surface.
`65420`	Excision of pterygium, simple; without graft	Alternative/lesser procedure when excision is performed without grafting; may be performed for small, non-recurrent lesions.
`65435`	Excision of recurrent pterygium, complicated, with graft	Used for recurrent or complex pterygia requiring more extensive excision and grafting techniques.
`65778`	Conjunctival autograft for pterygium repair; single graft	Often used to report the graft harvest/placement component when documentation distinguishes graft procedure separate from excision (payer-specific).
`12001`	Simple repair of superficial wounds of face, ears, eyelids (2.5 cm or less)	May be reported if concurrent eyelid or periocular skin repairs are performed during the same operative session (payer rules vary).

CPT 65400: Corneal Surface Lesion Excision, Superficial

CPT-65410-CORNEAL-BIOPSY-TISSUE-SAMPLING

CPT 65410: Corneal Biopsy and Tissue Sampling

CPT-65420-PTERYGIUM-EXCISION-TRANSPOSITION-NO-GRAFT

CPT 65420: Pterygium Excision or Transposition Without Graft

Frequently Asked Questions

References

1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.

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Trek Health powers OpenPayer with a leading commercial payer intelligence platform, seamlessly converting fragmented payer data into actionable insights for provider organizations.

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CPT 65426: Pterygium Excision or Transposition with Graft

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Billing Code Overview

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CPT 65426: Pterygium Excision or Transposition with Graft

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Billing Code Overview

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Related Diagnoses

Related CPT Codes

Related Codes

References

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Related Diagnoses

Related CPT Codes

Related Codes

References

CPT 65426: Pterygium Excision or Transposition with Graft

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Billing Code Overview

CPT 65426: Pterygium Excision or Transposition with Graft

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Billing Code Overview

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Related Diagnoses

Related CPT Codes

Related Codes

What does CPT 65426 represent and where is it typically performed?

Which modifiers are commonly used with CPT 65426 and when should they be applied?

What other CPT codes are related to pterygium excision with graft and how do they differ?

What preoperative and postoperative documentation elements are highlighted for this procedure?

Which payers and provider specialties are noted as relevant for CPT 65426?

References

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Related Diagnoses

Related CPT Codes

Related Codes

What does CPT 65426 represent and where is it typically performed?

Which modifiers are commonly used with CPT 65426 and when should they be applied?

What other CPT codes are related to pterygium excision with graft and how do they differ?

What preoperative and postoperative documentation elements are highlighted for this procedure?

Which payers and provider specialties are noted as relevant for CPT 65426?

References