Summary & Overview
CPT 65920: Removal of Anterior Segment Implanted Material
CPT code 65920 covers surgical removal of previously implanted material from the anterior segment of the eye, such as explantation of an artificial lens. This code is clinically important because explantation procedures address complications like implant dislocation, infection, or visual disturbance and can have significant implications for surgical planning, resource use, and patient outcomes across the country.
Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna, UnitedHealthcare, and Medicare. The publication provides a national perspective on billing and clinical context for anterior segment implant removals, highlighting coding definitions, typical sites of service, and the clinical scenarios that most commonly prompt explantation.
Readers will learn practical benchmarks and reimbursement context where available, common billing considerations tied to the procedure, and relevant clinical context to understand when 65920 is used. The report also summarizes typical service settings and the procedural scope captured by the code. Data not available in the input will be clearly noted when specific payer policies, utilization metrics, or diagnosis mapping are absent.
Billing Code Overview
CPT code 65920 describes the surgical removal of previously implanted material from the anterior segment of the eye, such as an explantation of an intraocular lens or other implanted device. This procedure involves surgical extraction of implanted ocular material that is located in or affecting the anterior chamber, cornea, iris, or lens plane.
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Service type: Surgical ophthalmic procedure (implant removal)
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Typical site of service: Hospital outpatient department or ambulatory surgical center, and in some cases, hospital inpatient if medically indicated
Clinical & Coding Specifications
Clinical Context
A 72-year-old patient with a previously implanted anterior chamber intraocular lens presents with progressive corneal edema and recurrent uveitis attributed to malpositioned or opacified lens material. After clinical evaluation including slit-lamp exam and ocular imaging, the ophthalmologist schedules removal of the previously implanted anterior segment material under monitored anesthesia care in an ambulatory surgery center. The workflow includes preoperative assessment, informed consent, topical and/or local anesthesia with possible sedation, operative removal of the lens and any adhesions or viscoelastic material, intraoperative irrigation/aspiration as needed, placement of a new prosthesis if indicated or planned secondary procedure, and postoperative recovery with topical antibiotics and anti-inflammatory therapy. Typical documentation includes indication for explantation, details of the implanted device removed, anesthesia type, intraoperative findings, any complications, and follow-up plan for visual rehabilitation.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | Use when reporting only the physician's professional component separate from technical services when applicable (rare for this CPT). |
50 |