CPT 67412 Orbital Incision Reimbursement | OpenPayer

Summary & Overview

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.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicare67412CPTophthalmologyorbital surgeryambulatory surgeryoperating roomsurgical proceduremedical billingrevenue cycle

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).

Service type: Orbital surgical procedure for removal of diseased or damaged orbital tissue
Typical site of service: Hospital operating room or ambulatory surgery center; procedures may also occur in specialized ophthalmic surgical suites

Clinical & Coding Specifications

Clinical Context

A 62-year-old patient presents to an oculoplastic surgeon with progressive, painful proptosis and decreased extraocular motility due to an orbital mass identified on imaging. After ophthalmic examination and orbital CT/MRI confirming a localized benign tumor within the orbit (e.g., cavernous hemangioma) without need for neurosurgical bone flap, the patient is scheduled for an orbital incision and excision of the lesion. The procedure is performed in an ambulatory surgery center or hospital outpatient department under general anesthesia; the surgeon accesses the orbit via an eyelid crease incision or a transconjunctival approach, dissects to the lesion, excises the diseased tissue, achieves hemostasis, and closes the wound. Postoperative care includes short-term observation in PACU, outpatient follow-up with the oculoplastic surgeon for wound assessment, vision check, and suture removal, with pathology processing if tissue sent.

Coding Specifications

Modifier	Description	When to Use
`26`	Professional component	Use when billing only the physician’s professional work separate from technical facility components if applicable (e.g., in separate billing situations).
`RT`	Right side

CPT 67400: Orbital Exploration and Biopsy

CPT-67413-ORBITAL-FOREIGN-BODY-REMOVAL

CPT 67413: Incision of Orbit for Removal of Foreign Body

CPT-67420-LATERAL-ORBITOTOMY-ORBITAL-TUMOR-RESECTION

CPT 67420: Lateral Orbitotomy for Orbital Tumor Resection

CPT-67445-ORBITAL-BONE-REMOVAL-ORBITAL-DECOMPRESSION

CPT 67445: Orbital Bone Removal for Decompression or Access

CPT-67450-ORBITOTOMY-EXPLORATION-BIOPSY

CPT 67450: Orbitotomy with Exploration and Biopsy

CPT-67405-ORBITAL-INCISION-DRAINAGE-ABSCESS

CPT 67405: Orbital Incision and Drainage for Abscess

CPT-67415-ORBITAL-NEEDLE-BIOPSY-DIAGNOSTIC

CPT 67415: Orbital Needle Biopsy for Diagnostic Evaluation

CPT-67430-ORBITAL-FOREIGN-BODY-REMOVAL-ORBITAL-SURGERY

CPT 67430: Orbital Foreign Body Removal, Bone Window or Flap

CPT-67440-ORBITOTOMY-DRAINAGE-ORBITAL-FLUID-COLLECTION

CPT 67440: Orbitotomy for Drainage of Orbital Cyst or Abscess

CPT-67414-ORBITAL-BONY-DECOMPRESSION-EYELID-CONJUNCTIVAL-APPROACH

CPT 67414: Orbital Bony Decompression via Eyelid or Conjunctival Approach

Taxonomy Code	Specialty	Notes
207K00000X	Ophthalmology	Primary specialty performing orbital incisions and lesion excision.
207P00000X	Ophthalmic Plastic and Reconstructive Surgery (Oculoplastics)	Subspecialty commonly performing orbital surgery and eyelid/conjunctival approaches.
2084P0800X	Neurosurgery	Occasionally involved if lesion extends to skull base or requires cranial collaboration without bone flap.
207L00000X	Ophthalmology - Pediatrics	Pediatric ophthalmologists may perform orbital procedures in children when indicated.
363L00000X	Otolaryngology	Head and neck surgeons may participate for complex orbital-adjacent disease approaches.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`H05.20`	Orbital cellulitis, unspecified eye	Orbital incision and drainage or debridement may be required for severe infections not responding to medical therapy.
`H05.21`	Orbital cellulitis, right eye	Laterality-specific code when surgery is performed on the right orbit.
`H05.22`	Orbital cellulitis, left eye	Laterality-specific code when surgery is performed on the left orbit.
`D18.02`	Hemangioma of other sites, orbit	Common benign vascular tumor that may be excised via an orbital incision.
`C69.8`	Malignant neoplasm of overlapping sites of eye and adnexa	Malignant orbital tumors may require excision of diseased orbital tissue.
`H05.89`	Other disorders of orbit	Catch-all for various orbital pathologies (inflammatory, traumatic) necessitating orbital surgery.
`S05.89XA`	Other specified injury of eye and orbit, initial encounter	Traumatic orbital injuries with retained foreign material or devitalized tissue may be managed surgically.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`67411`	Excision or destruction of lesion of lacrimal sac or duct; external approach	May be performed for concomitant lacrimal system disease or differential procedure when pathology involves lacrimal sac rather than intraorbital tissue.
`67510`	Repair of eyelid ptosis; frontalis suspension	Performed before or after orbital surgery when eyelid position is affected by mass effect or surgical approach.
`67028`	Removal of retained intraocular foreign body, posterior segment; pars plana approach	Related posterior-segment intraocular procedures that may be required if intraocular involvement is present, although distinct from orbital incision.
`67036`	Vitrectomy, pars plana; removal of lens fragments or vitreous opacities	Performed in same operative setting when intraocular intervention is necessary in addition to orbital work.
`69990`	Microsurgical techniques, requiring use of operating microscope (list separately in addition to code for primary procedure)	Billed adjunctively when a microscope is required for delicate orbital dissection.

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