CPT 67430 Orbital Foreign Body Removal Reimbursement | OpenPayer

Summary & Overview

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

CPT code 67430 denotes an operative orbital procedure to remove an intraorbital foreign body by making an incision through the lateral orbit and removing a bony segment as a flap or window. This is a specialized ophthalmic/orbit surgical service typically performed in an operating room or ambulatory surgical center under general or regional anesthesia. The code matters nationally because it captures a high-acuity, resource-intensive intervention with implications for surgical staffing, facility utilization, and payer coverage policies across both commercial and public plans.

Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise clinical context for when 67430 is used, the typical site of service, and which payers commonly adjudicate claims for this service. The publication outlines benchmarking elements such as expected place-of-service and service intensity, highlights relevant policy and billing considerations, and summarizes common modifiers and associated administrative notes where available. Data not available in the input is clearly noted. The content is intended to inform coding, billing, and policy teams about the clinical scope and payer landscape surrounding CPT code 67430 without providing clinical recommendations.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicare67430CPTorbital surgeryophthalmic procedureforeign body removaloperating roomambulatory surgical centersurgical coding

Billing Code Overview

CPT code 67430 describes a surgical procedure in which the provider makes an incision through the side of the orbit (the bony cavity that holds the eye) and removes a segment of bone, either as a temporary bone flap or as a bone window left open, to access and remove a foreign body. This is an operative procedure addressing intraorbital foreign body removal.

Service type: Surgical procedure, orbital surgery
Typical site of service: Hospital operating room or ambulatory surgical center

Clinical & Coding Specifications

Clinical Context

A 35-year-old male presents to the emergency department after orbital trauma from a metal fragment while using a grinder. He reports acute vision changes, pain, and a palpable irregularity at the lateral orbit. Imaging (CT of the orbits) demonstrates an intraorbital foreign body adjacent to the lateral orbital wall without globe rupture. Ophthalmology and oculoplastic surgery evaluate the patient and decide to remove the foreign body via an external lateral orbitotomy with removal of a bone segment to access the intraorbital space.

The clinical workflow: the patient undergoes preoperative evaluation including focused ophthalmic exam, CT imaging, and anesthesia assessment. In the operating room under general anesthesia, the surgeon makes a lateral orbital incision, performs a lateral orbitotomy with temporary bone flap or bone window to access and retrieve the foreign body, achieves hemostasis, inspects the globe, and closes soft tissues. Postoperative care includes assessment for orbital hematoma, visual function monitoring, pain control, and discharge planning with follow-up for wound check and imaging if indicated.

Coding Specifications

Modifier	Description	When to Use
`22`	Increased procedural services	When work required is substantially greater than typical for `67430` (extensive dissection, prolonged time).

CPT 67415: Orbital Needle Biopsy for Diagnostic Evaluation

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

CPT 67440: Orbitotomy for Drainage of Orbital Cyst or Abscess

CPT-67400-ORBITAL-EXPLORATION-WITH-BIOPSY

CPT 67400: Orbital Exploration and Biopsy

CPT-67413-ORBITAL-FOREIGN-BODY-REMOVAL

CPT 67413: Incision of Orbit for Removal of Foreign Body

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

CPT 67414: Orbital Bony Decompression via Eyelid or Conjunctival Approach

CPT-67405-ORBITAL-INCISION-DRAINAGE-ABSCESS

CPT 67405: Orbital Incision and Drainage for Abscess

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-67412-ORBITAL-INCISION-ORBITAL-TISSUE-REMOVAL

CPT 67412: Orbital Incision for Removal of Diseased Orbital Tissue

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

CPT 67420: Lateral Orbitotomy for Orbital Tumor Resection

Taxonomy Code	Specialty	Notes
207XS0101X	Ophthalmology	Oculoplastic/orbital surgeons commonly perform `67430`.
207K00000X	Otolaryngology	Head and neck surgeons may perform orbitotomy for adjacent skull/orbital pathology.
2080P0206X	Plastic and Reconstructive Surgery	Facial/orbital reconstruction surgeons involved when complex reconstruction is required.
208D00000X	General Surgery	In some trauma settings, general surgeons with orbital experience may assist.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`S07.0XXA`	Crushing injury of head, initial encounter	Orbital trauma with embedded foreign body often occurs with head/orbital crush mechanisms requiring orbitotomy for foreign body removal.
`S05.89XA`	Other injury of eye and orbit, initial encounter	Captures varied orbital injuries including foreign bodies requiring surgical removal via `67430`.
`S01.81XA`	Foreign body in other part of head, initial encounter	Directly relevant for retained foreign bodies in orbital soft tissue or adjacent skull requiring removal.
`H05.403`	Orbital abscess, unspecified eye	Infected retained foreign bodies may lead to orbital abscess necessitating orbitotomy for drainage and removal.
`T15.31A`	Foreign body in right eye, initial encounter	When the foreign body is intraorbital/periocular and requires surgical extraction; laterality specified as applicable.
`T15.32A`	Foreign body in left eye, initial encounter	As above for left-sided involvement.
`S02.12XA`	Fracture of ethmoid bone, initial encounter	Adjacent orbital fractures may coexist and influence the surgical approach for foreign body retrieval.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`21320`	Reconstruction, orbital floor, transantral or transcutaneous, with bone graft (includes obtaining graft)	May be performed after `67430` if orbital wall reconstruction is required following bone window removal or traumatic defect.
`67028`	Removal of intraocular foreign body, external approach	If an intraocular foreign body is encountered or involvement of the globe requires removal via an external approach in conjunction with orbitotomy.
`67141`	Vitrectomy, mechanical, pars plana approach (for removal of retained intraocular foreign body)	Performed by retina specialists when intraocular foreign body requires posterior segment surgery after or concurrent with orbital foreign body removal.
`66140`	Excision or destruction of lesion of lacrimal sac or duct; external approach	Performed when the foreign body or surgery involves the lacrimal apparatus and requires concurrent lacrimal surgery.
`69990`	Unlisted procedure, eyelids, lacrimal system, orbit	Used for atypical or highly specialized orbital procedures not precisely described by existing CPT codes when performed with or instead of `67430`.

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