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CPT 66130: Excision of Abnormal Conjunctival/Scleral Tissue

CPT code 66130 denotes surgical excision of abnormal tissue from the white of the eye, typically involving removal of conjunctival or scleral lesions. This ophthalmic procedure addresses lesions, localized inflammatory tissue, and other abnormal growths on the ocular surface. Nationally, accurate coding for this procedure affects surgical claims, provider reimbursement, and quality reporting for eye care services.

Key payers addressed in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. The publication provides a concise overview of clinical context for the procedure, typical sites of service, and payer coverage considerations. Readers will find benchmarks for coding and billing practices where available, summaries of relevant policy and coverage themes, and clinical context to aid correct claim submission. Data not available in the input is clearly noted where applicable. The content is intended for a national audience of clinicians, coding professionals, and policy analysts seeking a focused reference on CPT code 66130 and its role in ophthalmic surgical billing.

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Billing Code Overview

CPT code 66130 describes a surgical procedure in which the provider excises abnormal tissue from the white of the eye. This procedure involves removal of problematic conjunctival or scleral tissue and is performed to treat lesions, recurrent inflammation, or other localized abnormal growths on the ocular surface.

Service type: Ophthalmic surgical excision of conjunctival/scleral tissue
Typical site of service: Ambulatory surgical center or hospital outpatient department

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CPT 66130: Excision of Abnormal Conjunctival/Scleral Tissue

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Billing Code Overview

Service type: Ophthalmic surgical excision of conjunctival/scleral tissue
Typical site of service: Ambulatory surgical center or hospital outpatient department

Clinical & Coding Specifications

Clinical Context

A 62-year-old patient presents to an ophthalmology clinic with a progressively enlarging, raised, and erythematous lesion on the sclera noted near the limbus that is symptomatic with irritation and cosmetic concern. After slit-lamp examination, the clinician documents a localized area of abnormal conjunctival and episcleral tissue suspicious for a conjunctival nevus or small squamous neoplasia. The patient is scheduled for an outpatient surgical excision of the abnormal tissue from the white of the eye under local anesthesia with monitored anesthesia care available if needed. The typical clinical workflow includes preoperative informed consent, topical and/or local injection anesthesia, surgical excision with careful hemostasis and tissue handling, specimen labeling and submission to pathology, and postoperative topical antibiotic and anti-inflammatory therapy. The procedure is performed in an ambulatory surgery center or ophthalmology office procedure room equipped for minor ophthalmic surgery, and the patient is discharged the same day with postoperative instructions and a follow-up visit for wound check and pathology review.

Coding Specifications

Modifier	Description	When to Use
`11`	Provider's usual/primary service	Use when the surgeon performs the procedure as the primary service.
`52`	Reduced services	Use when the procedure is partially reduced or not completed as originally planned.
`53`	Discontinued procedure	Use when the procedure is started but halted due to extenuating circumstances.
`54`	Surgical care only	Use when the surgeon provides only the intraoperative surgical portion and another physician provides pre/postoperative care.
`55`	Postoperative management only	Use when the surgeon provides only postoperative management.
`62`	Two surgeons	Use when two surgeons of different specialties work together as primary surgeons.
`80`	Assistant surgeon	Use when an assistant surgeon performs assistance during the procedure.
`26`	Professional component	Use when reporting only the professional interpretation or services separate from technical component (rare for this procedure).
`22`	Unusual procedural services	Use when the work required to perform the procedure is substantially greater than typically required.
`50`	Bilateral procedure	Use when the same procedure is performed bilaterally during the same operative session.
`51`	Multiple procedures	Use to indicate multiple procedures were performed during the same session.
`73`	Discontinued outpatient hospital/ASC procedure prior to anesthesia	Use when procedure is discontinued before anesthesia administration.
`78`	Return to OR for related procedure during postoperative period	Use when the patient returns to the operating room for a related procedure during the global period.
`26`	Professional component	Use when billing only the physician professional component separate from the facility/technical component.

Taxonomy Code	Specialty	Notes
207W00000X	Ophthalmology	Primary specialty performing scleral/conjunctival excision procedures.
207K00000X	Optometry	May perform minor ocular surface procedures in some jurisdictions with appropriate credentials.
2080P0226X	Ophthalmic Plastic and Reconstructive Surgery	Performs periocular and scleral excisions when complex reconstruction is required.
363L00000X	General Surgery	Rarely involved; included when oculoplastic/ENT surgeons collaborate for complex resections.
207L00000X	Pediatric Ophthalmology & Strabismus	Performs similar procedures in pediatric populations when indicated.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`D22.9`	Melanocytic nevus of skin, unspecified	Conjunctival or scleral nevus may present as a pigmented lesion requiring excision for diagnosis or cosmesis.
`D03.9`	Melanoma in situ, unspecified	Suspicious pigmented ocular surface lesions may require excision for histopathologic evaluation.
`H11.039`	Conjunctival vascular malformation, unspecified eye	Vascular lesions on the sclera/conjunctiva can cause irritation and may be excised for symptoms or diagnosis.
`H11.129`	Conjunctival cyst, unspecified eye	Epidermoid or retention cysts on the conjunctiva/sclera are commonly excised when symptomatic.
`H11.29`	Other conjunctival degenerations and deposits	Includes lesions such as pinguecula or localized degenerative tissue that may be excised if symptomatic or atypical.
`D04.9`	Carcinoma in situ of skin, unspecified	Ocular surface squamous neoplasia in situ may present on the scleral/conjunctival surface and require excision.
`H11.019`	Conjunctival nevus, unspecified eye	Directly relevant for excision of benign-appearing scleral/conjunctival nevi.
`C69.9`	Malignant neoplasm of eye, unspecified	In cases where a malignant ocular surface tumor is suspected, excision is performed for diagnosis and treatment.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`67840`	Excision of lesion of conjunctiva, including simple suture; single lesion	May be used for excision of conjunctival lesions near the sclera when the lesion is primarily conjunctival rather than scleral.
`67810`	Excision of lesion of eyelid, including simple suture; single lesion	Performed for adjacent eyelid lesions that may require concurrent removal in the same operative session.
`67020`	Removal of retained subretinal fluid; therapeutic drainage (limited)	Not commonly paired but listed when posterior segment access or related maneuvers are required in complex cases.
`12052`	Repair, intermediate, wounds of scalp, arms, and/or legs; 2.6 cm to 7.5 cm (Note: integumentary repair codes)	May be reported for complex closure of conjunctival or periocular soft-tissue defects when integumentary repair coding is required.
`88305`	Level IV pathology (surgical pathology)	Commonly billed by the pathology lab for histologic examination of the excised scleral/conjunctival specimen.

CPT 66150: Iris Trephination and Fistula Formation for Glaucoma

CPT-66155-THERMOCAUTERIZATION-FISTULA-CREATION-GLAUCOMA

CPT 66155: Thermocauterization Fistula Creation for Glaucoma

CPT-66160-GLAUCOMA-FISTULA-SCLERA-IRIS-EXCISION

CPT 66160: Glaucoma Fistula with Sclera and Iris Excision

CPT-66170-TRABECULOSTOMY-FISTULA-CREATION-FOR-GLAUCOMA

CPT 66170: Trabeculostomy and Trabecular Meshwork Excision for Glaucoma

CPT-66172-TRABECULAR-MESHWORK-EXCISION-FISTULA-REVISION-GLAUCOMA

CPT 66172: Trabecular Meshwork Excision and Fistula Revision for Glaucoma

CPT-66174-EXPANSION-OF-AQUEOUS-OUTFLOW-CANAL-NO-STENT

CPT 66174: Expansion of Aqueous Outflow Canal Without Stent

CPT-66175-AQUEOUS-OUTFLOW-CANAL-EXPANSION-WITH-STENT

CPT 66175: Aqueous Outflow Canal Expansion with Stent

References

1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.

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Clinical & Coding Specifications

Clinical Context

Coding Specifications

Modifier	Description	When to Use
`11`	Provider's usual/primary service	Use when the surgeon performs the procedure as the primary service.
`52`	Reduced services	Use when the procedure is partially reduced or not completed as originally planned.
`53`	Discontinued procedure	Use when the procedure is started but halted due to extenuating circumstances.
`54`	Surgical care only	Use when the surgeon provides only the intraoperative surgical portion and another physician provides pre/postoperative care.
`55`	Postoperative management only	Use when the surgeon provides only postoperative management.
`62`	Two surgeons	Use when two surgeons of different specialties work together as primary surgeons.
`80`	Assistant surgeon	Use when an assistant surgeon performs assistance during the procedure.
`26`	Professional component	Use when reporting only the professional interpretation or services separate from technical component (rare for this procedure).
`22`	Unusual procedural services	Use when the work required to perform the procedure is substantially greater than typically required.
`50`	Bilateral procedure	Use when the same procedure is performed bilaterally during the same operative session.
`51`	Multiple procedures	Use to indicate multiple procedures were performed during the same session.
`73`	Discontinued outpatient hospital/ASC procedure prior to anesthesia	Use when procedure is discontinued before anesthesia administration.
`78`	Return to OR for related procedure during postoperative period	Use when the patient returns to the operating room for a related procedure during the global period.
`26`	Professional component	Use when billing only the physician professional component separate from the facility/technical component.

Taxonomy Code	Specialty	Notes
207W00000X	Ophthalmology	Primary specialty performing scleral/conjunctival excision procedures.
207K00000X	Optometry	May perform minor ocular surface procedures in some jurisdictions with appropriate credentials.
2080P0226X	Ophthalmic Plastic and Reconstructive Surgery	Performs periocular and scleral excisions when complex reconstruction is required.
363L00000X	General Surgery	Rarely involved; included when oculoplastic/ENT surgeons collaborate for complex resections.
207L00000X	Pediatric Ophthalmology & Strabismus	Performs similar procedures in pediatric populations when indicated.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`D22.9`	Melanocytic nevus of skin, unspecified	Conjunctival or scleral nevus may present as a pigmented lesion requiring excision for diagnosis or cosmesis.
`D03.9`	Melanoma in situ, unspecified	Suspicious pigmented ocular surface lesions may require excision for histopathologic evaluation.
`H11.039`	Conjunctival vascular malformation, unspecified eye	Vascular lesions on the sclera/conjunctiva can cause irritation and may be excised for symptoms or diagnosis.
`H11.129`	Conjunctival cyst, unspecified eye	Epidermoid or retention cysts on the conjunctiva/sclera are commonly excised when symptomatic.
`H11.29`	Other conjunctival degenerations and deposits	Includes lesions such as pinguecula or localized degenerative tissue that may be excised if symptomatic or atypical.
`D04.9`	Carcinoma in situ of skin, unspecified	Ocular surface squamous neoplasia in situ may present on the scleral/conjunctival surface and require excision.
`H11.019`	Conjunctival nevus, unspecified eye	Directly relevant for excision of benign-appearing scleral/conjunctival nevi.
`C69.9`	Malignant neoplasm of eye, unspecified	In cases where a malignant ocular surface tumor is suspected, excision is performed for diagnosis and treatment.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`67840`	Excision of lesion of conjunctiva, including simple suture; single lesion	May be used for excision of conjunctival lesions near the sclera when the lesion is primarily conjunctival rather than scleral.
`67810`	Excision of lesion of eyelid, including simple suture; single lesion	Performed for adjacent eyelid lesions that may require concurrent removal in the same operative session.
`67020`	Removal of retained subretinal fluid; therapeutic drainage (limited)	Not commonly paired but listed when posterior segment access or related maneuvers are required in complex cases.
`12052`	Repair, intermediate, wounds of scalp, arms, and/or legs; 2.6 cm to 7.5 cm (Note: integumentary repair codes)	May be reported for complex closure of conjunctival or periocular soft-tissue defects when integumentary repair coding is required.
`88305`	Level IV pathology (surgical pathology)	Commonly billed by the pathology lab for histologic examination of the excised scleral/conjunctival specimen.

CPT 66150: Iris Trephination and Fistula Formation for Glaucoma

CPT-66155-THERMOCAUTERIZATION-FISTULA-CREATION-GLAUCOMA

CPT 66155: Thermocauterization Fistula Creation for Glaucoma

CPT-66160-GLAUCOMA-FISTULA-SCLERA-IRIS-EXCISION

CPT 66160: Glaucoma Fistula with Sclera and Iris Excision

CPT-66170-TRABECULOSTOMY-FISTULA-CREATION-FOR-GLAUCOMA

CPT 66170: Trabeculostomy and Trabecular Meshwork Excision for Glaucoma

CPT-66172-TRABECULAR-MESHWORK-EXCISION-FISTULA-REVISION-GLAUCOMA

CPT 66172: Trabecular Meshwork Excision and Fistula Revision for Glaucoma

CPT-66174-EXPANSION-OF-AQUEOUS-OUTFLOW-CANAL-NO-STENT

CPT 66174: Expansion of Aqueous Outflow Canal Without Stent

CPT-66175-AQUEOUS-OUTFLOW-CANAL-EXPANSION-WITH-STENT

CPT 66175: Aqueous Outflow Canal Expansion with Stent

References

1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.

Published by

Trek Health powers OpenPayer with a leading commercial payer intelligence platform, seamlessly converting fragmented payer data into actionable insights for provider organizations.

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CPT 66130: Excision of Abnormal Conjunctival/Scleral Tissue

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Billing Code Overview

OpenPayer

CPT 66130: Excision of Abnormal Conjunctival/Scleral Tissue

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Billing Code Overview

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Related Diagnoses

Related CPT Codes

Related Codes

References

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Related Diagnoses

Related CPT Codes

Related Codes

References