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CPT 67412: Orbital Incision for Removal of Diseased Orbital Tissue
CPT code 67412 represents an orbital incision procedure performed to remove diseased or damaged orbital tissue through an eyelid or conjunctival approach without creation of a bone flap. This code captures a subset of ophthalmic orbital surgeries that preserve bony integrity and is relevant for surgical providers, hospital billing departments, and payers because it defines procedural intent, operative approach, and billing specificity for orbital soft-tissue interventions. Key national payers commonly involved in coverage and payment of this procedure include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise clinical context for the procedure, typical sites of service, and which payers are relevant to reimbursement discussions. The publication also outlines common modifier usage and related administrative considerations where available. The content is intended to inform clinical coders, revenue cycle professionals, and policy analysts about the procedural definition and billing context for 67412, along with benchmarks, coverage considerations, and policy updates where applicable. Data not provided in the input — including specific ICD-10 pairings, associated taxonomies, and payer-specific reimbursement rates — is noted as unavailable.
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Billing Code Overview
CPT code 67412 describes a surgical procedure in which the surgeon incises the orbit, the bony cavity that houses the eye, via an incision in the eyelid or through the conjunctival membrane to remove diseased or damaged tissue. The procedure specifically does not include creation of a bone flap (no temporary removal of a bone segment).
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Service type: Orbital surgical procedure for removal of diseased or damaged orbital tissue
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Typical site of service: Hospital operating room or ambulatory surgery center; procedures may also occur in specialized ophthalmic surgical suites