Summary & Overview
CPT 65765: Donor Anterior Corneal Implantation, Surgical Corneal Transplant
CPT code 65765 denotes the surgical implantation of a donor cornea into the patient’s anterior cornea to improve refraction and restore vision. As a corneal transplant procedure focused on the anterior cornea, it is a clinically significant intervention for patients with keratoconus, corneal scarring, thinning, or other anterior corneal pathology that impairs visual acuity. Nationally, this code represents a specialized ophthalmic surgical service with implications for surgical capacity, ophthalmology subspecialty billing, and payer coverage protocols.
Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical context, common sites of service, and the procedural scope captured by the code. The publication provides benchmarks and payment context where available, outlines typical billing modifiers used with this type of surgical service, and summarizes policy and coverage considerations that affect access to corneal transplantation. The content is intended for health policy analysts, billing professionals, and ophthalmology providers seeking a national-level briefing on procedural classification, typical utilization settings, and payer landscape related to anterior corneal donor implantation.
Billing Code Overview
CPT code 65765 describes the surgical implantation of a donor cornea into the patient’s anterior cornea with the objective of improving corneal refraction and enhancing vision. This procedure involves replacing or augmenting the anterior corneal tissue with donor corneal material to address vision-impairing corneal disease or structural abnormality.
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Service type: Surgical corneal transplantation / anterior corneal implant procedure
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Typical site of service: Ambulatory surgical center or hospital operating room
Clinical & Coding Specifications
Clinical Context
A 68-year-old patient with advanced endothelial corneal disease and progressively worsening vision presents to a cornea specialist for evaluation. The patient reports decreased acuity, glare, and difficulty performing daily tasks despite maximal medical therapy and prior cataract extraction. Slit-lamp examination demonstrates central corneal opacity and stromal edema significantly limiting vision. After preoperative assessment including corneal topography, endothelial cell count, and discussion of risks and benefits, the surgeon schedules a penetrating keratoplasty with surgical implantation of a donor cornea to replace the diseased anterior cornea and restore corneal clarity and refraction. On the day of service the patient arrives to an ambulatory surgery center or hospital outpatient surgery unit, consents, undergoes general or monitored regional anesthesia, and receives the donor graft with suturing and postoperative topical antibiotics and corticosteroids. Postoperative follow-up includes day 1, week 1, month 1, and serial visits for suture management and refractive rehabilitation.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | No modifier used in some payer systems | Rarely appended; follow payer instructions |
22 | Increased procedural service | Use when documented work is substantially greater than typical for the procedure