Penetrating Keratoplasty (CPT 65730) Reimbursement | OpenPayer

Summary & Overview

CPT 65730: Penetrating Keratoplasty (Corneal Transplant)

CPT code 65730 denotes penetrating keratoplasty, a full-thickness corneal transplant performed in patients without aphakia or pseudophakia. This procedure is the standard surgical approach for restoring vision in patients with corneal opacity, scarring, or other full-thickness corneal disease. It remains a nationally important surgical intervention because corneal disease is a leading cause of vision impairment and keratoplasty outcomes influence access to specialty surgical services and resource utilization across settings.

Key payers included in the analysis are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare and Medicare. Readers will find a concise overview of clinical indications and the typical surgical setting, plus national benchmarking context where available. The publication outlines common billing considerations tied to this procedure, typical sites of service such as hospital operating rooms and ambulatory surgical centers, and potential implications for coverage and surgical scheduling. Where input data is missing, the text notes its absence.

This summary equips clinicians, coding professionals, and policy analysts with a clear description of the code's clinical purpose, the principal payers addressed, and what to expect in the full publication: clinical context for keratoplasty, coding and billing guidance, payer coverage snapshots, and relevant benchmarks or policy updates when available.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicare65730CPTpenetrating-keratoplastycorneal-transplantophthalmologysurgical-procedureambulatory-surgeryhospital-OR

Billing Code Overview

CPT code 65730 describes a penetrating keratoplasty (full-thickness corneal transplant) performed in patients who are neither aphakic nor pseudophakic. The procedure is used to replace diseased or opaque corneal tissue to restore or improve visual acuity when corneal opacity or structural disease compromises vision.

Service type: Surgical — Ophthalmology / Corneal Surgery

Typical site of service: Hospital operating room or ambulatory surgical center

Data not available in the input.

Clinical & Coding Specifications

Clinical Context

A 62-year-old patient with progressive central corneal scarring from Fuchs endothelial dystrophy presents with decreased visual acuity and glare despite maximal medical management. Ophthalmic evaluation confirms stromal opacity with irregular astigmatism and visual acuity reduced to 20/200 in the affected eye. The surgical team schedules a penetrating keratoplasty (full-thickness corneal transplant) under general or monitored anesthesia care. Preoperative workflow includes corneal topography, endothelial cell count, ocular surface optimization, informed consent, donor tissue procurement coordination, and marking of laterality. Intraoperative steps include trephination of the recipient cornea, donor button preparation, sutured placement of donor graft, and intraoperative antibiotics and corticosteroid administration. Postoperative care consists of topical antibiotics and steroids, suture management during clinic visits, intraocular pressure monitoring, and staged suture removal with visual rehabilitation and refraction over months to optimize outcomes.

Coding Specifications

Modifier	Description	When to Use
`26`	Professional component	Use when reporting the surgeon’s professional component separate from a facility or technical component (rare for full-service inpatient/outpatient surgery billing).

CPT 65710: Anterior Lamellar Corneal Transplant

CPT-65750-KERATOPLASTY-CORNEAL-TRANSPLANT-APHAKIC-PATIENT

CPT 65750: Keratoplasty (Corneal Transplant) in Aphakic Patients

CPT-65756-FULL-THICKNESS-CORNEAL-TRANSPLANT-ENDOTHELIAL-REPLACEMENT

CPT 65756: Full‑Thickness Corneal Transplant for Endothelial Replacement

CPT-65755-PENETRATING-KERATOPLASTY-WITH-IOL-IMPLANTATION

CPT 65755: Penetrating Keratoplasty with Intraocular Lens Implantation

CPT-65757-CORNEAL-ENDOTHELIAL-GRAFT-PREPARATION-ADD-ON

CPT 65757: Corneal Endothelial Graft Preparation, Add-on

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Taxonomy Code	Specialty	Notes
`207W00000X`	Ophthalmology	Cornea and external disease specialists most commonly perform keratoplasty.
`207W00000X`	Ophthalmic Surgery	Corneal surgeons with subspecialty training perform transplants and complex reconstructions.
`207K00000X`	Optometry	Co-management for preoperative and postoperative vision testing and refraction (where state law permits).
`2086S0123X`	Anesthesiology	Provides monitored anesthesia care or general anesthesia for the procedure.
`163W00000X`	Eye Bank Technician/Administrator	Involved in donor tissue coordination and processing.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`H18.52`	Interstitial keratitis, left eye	Corneal scarring and opacity from interstitial keratitis can indicate need for penetrating keratoplasty.
`H18.53`	Interstitial keratitis, bilateral	Bilateral severe corneal opacities may necessitate bilateral keratoplasties.
`H18.8`	Other corneal disorders	Includes corneal opacities and scarring not otherwise specified that impair vision and prompt transplant.
`H18.31`	Punctate keratitis, right eye	Surface disease that, when severe and scarring develops, may lead to keratoplasty consideration.
`H18.39`	Other superficial keratitis, bilateral	Chronic epithelial disease leading to stromal compromise and potential transplant.
`H18.5`	Corneal ulcer and corneal opacity	Scarring after ulceration is a common indication for penetrating keratoplasty.
`H18.44`	Bullous keratopathy, left eye	End-stage corneal decompensation with edema and pain; penetrating keratoplasty may be required if other treatments fail.
`H18.43`	Bullous keratopathy, right eye	Same clinical relevance for the right eye when transplant is indicated.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`65730`	Penetrating keratoplasty (corneal transplant)	Primary procedure — full-thickness corneal transplant for patients without aphakia or pseudophakia.
`65710`	Keratoplasty, lamellar, (partial thickness)	Alternative to `65730` when only partial-thickness corneal replacement is indicated; may be selected based on pathology.
`65750`	Keratoplasty, automated lamellar (e.g., automated lamellar therapeutic keratoplasty)	Performed in contexts where automated lamellar techniques are used instead of full-thickness transplant.
`65755`	Keratoplasty, penetrating with removal of host cornea and replacement — for special techniques	Used for complex penetrating grafts or when combined with additional procedures.
`66020`	Anterior chamber paracentesis (diagnostic or therapeutic)	May be performed intraoperatively or postoperatively for management of raised intraocular pressure or fluid sampling.
`66982`	Insertion of glaucoma drainage device, aqueous shunt (e.g., Molteno, Ahmed)	May be performed before, during, or after keratoplasty when coexisting glaucoma requires surgical control; relevant for combined case planning.

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