Summary & Overview
CPT 65930: Anterior Segment Blood Clot Evacuation
CPT code 65930 identifies a surgical procedure to remove a blood clot from the anterior segment of the eye (anterior chamber) to prevent vision loss. This procedure is clinically significant because timely evacuation of anterior chamber hemorrhage can reduce intraocular pressure, limit corneal blood staining, and preserve visual function. Nationally, use of this code reflects management of traumatic or spontaneous hyphema and related complications in ophthalmology practice.
Key payers in the analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of clinical context and service expectations, common payer coverage considerations, and the types of service sites where the procedure is typically performed. The publication also outlines benchmarks and policy-relevant updates that affect reimbursement and utilization for this ophthalmic surgical service.
The content is designed for clinicians, billing professionals, and policy analysts seeking a concise reference on coding, site-of-service patterns, and payer engagement for anterior segment blood clot evacuation. Data not available in the input are noted where applicable.
Billing Code Overview
CPT code 65930 describes a surgical procedure to remove a blood clot from the anterior segment of the eye to prevent vision loss. This is an ophthalmic surgical service focused on clearing intraocular hemorrhage within the anterior chamber.
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Service type: Ophthalmic surgical procedure to evacuate an anterior chamber (anterior segment) hyphema or blood clot.
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Typical site of service: Ambulatory surgical center or hospital operating room; may also be performed in a specialized ophthalmology procedure suite depending on clinical setting.
Clinical & Coding Specifications
Clinical Context
A 68-year-old patient presents to the ophthalmology clinic with sudden visual disturbance and a dense hyphema (anterior chamber blood clot) after blunt ocular trauma. Initial evaluation includes visual acuity testing, intraocular pressure (IOP) measurement, slit-lamp examination, and anterior segment photography. Medical management (topical cycloplegics, IOP-lowering agents, and observation) is attempted. With increasing IOP, persistent layered blood obstructing the visual axis, or risk of corneal blood staining, the ophthalmologist schedules an anterior chamber washout with clot evacuation to restore optical clarity and prevent vision loss. The procedure is performed in an ambulatory surgery center or hospital operating room under monitored anesthesia care or general anesthesia depending on patient cooperation and comorbidities. Intraoperative steps include sterile prep, paracentesis, irrigation/aspiration of the clot, possible injection of viscoelastic, and closure. Postoperative workflow includes IOP monitoring, topical antibiotics and steroids, activity restrictions, and timely follow-up within 24–72 hours to assess corneal clarity and inflammation.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | When reporting only the physician professional portion if technical component billed separately |