Summary & Overview
CPT 65780: Multilayer Amniograft Ocular Surface Reconstruction
CPT code 65780 represents multilayer amniograft transplantation for reconstruction of the ocular surface using placental inner membrane. This procedure addresses significant corneal or conjunctival surface damage from trauma, disease, or surgical complications and is clinically important for vision preservation and reducing the need for more extensive interventions. Nationally, use of this procedure carries implications for specialist surgical capacity, tissue sourcing and coverage policy.
Key payers in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. The publication outlines payer coverage patterns and benchmark considerations relevant to ophthalmology and surgical service lines.
Readers will learn clinical context for CPT code 65780 (procedure description, typical settings), the payer landscape and common modifiers in use, and practical billing considerations such as usual site-of-service claims handling and documentation expectations. The report also flags areas where policy updates or prior-authorizations commonly affect access and reimbursement.
Data not available in the input will be identified where applicable; the focus remains national in scope rather than state-specific.
Billing Code Overview
CPT code 65780 describes surgical reconstruction of the ocular surface using the inner membrane of the placenta (amniograft). The procedure involves transplanting multiple layers of amniograft to repair or reconstruct the surface of the eye damaged by injury or disease.
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Service type: Surgical ocular surface reconstruction using amniograft, multilayer transplantation
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Typical site of service: Hospital operating room or ambulatory surgery center, performed by ophthalmic surgeons or corneal specialists
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Clinical & Coding Specifications
Clinical Context
A 58-year-old male presents to an ophthalmic plastic and reconstructive surgery clinic after a chemical burn to the right eye that produced extensive conjunctival and corneal epithelial loss with symblepharon formation and persistent epithelial defect. Prior attempts at medical therapy and bandage contact lens placement failed to achieve epithelialization. The oculoplastic surgeon schedules a multilayer amniotic membrane transplant to reconstruct the ocular surface, restore the conjunctival fornix, and promote healing. The procedure is performed in an ambulatory surgery center under monitored anesthesia care. The surgical workflow includes preoperative consent and allergy check, topical and regional anesthesia, trimming of devitalized tissue, placement and suturing or tissue adhesive fixation of multiple layers of cryopreserved amniograft to the corneal and conjunctival surface, optional conjunctival autograft or symblepharon release, and postoperative topical antibiotics and corticosteroids with close follow-up for epithelialization and graft integration.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | When reporting only the surgeon’s professional service separate from a facility or technical component. |
50 |