Summary & Overview
CPT 67550: Orbital Prosthetic (Manmade) Eyeball Implantation
Headline: CPT code 67550: Surgical implantation of prosthetic eyeball outside the extraocular muscle cone
Lead: CPT code 67550 covers surgical implantation of a prosthetic orbital implant placed outside the muscle cone to replace an eye lost to disease or trauma. The code defines a targeted reconstructive ophthalmic procedure with implications for surgical billing, site-of-service planning, and national coverage determinations.
CPT code 67550 represents a definitive surgical procedure used to restore orbital volume after enucleation or evisceration by placing a manmade ocular implant outside the extraocular muscle cone. This code matters nationally because it captures a specialized reconstructive service with specific facility and surgeon resource needs, and it is relevant to coverage policies across public and commercial payers. Key payers referenced in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare.
Readers will find a concise overview of the clinical indication and procedure setting, plus what to expect in payer coverage and coding context. The publication summarizes typical sites of service (hospital operating room or ambulatory surgical center), common billing considerations, and benchmarking and policy elements where available. Data not available in the input will be noted as such. The content is intended to inform coding accuracy, claims preparation, and payer engagement on a national level.
Billing Code Overview
CPT code 67550 describes implantation of a prosthetic (manmade) eyeball placed outside the extraocular muscle cone to replace an eye lost to disease or injury. This procedure involves inserting and securing an orbital implant external to the muscle cone to restore orbital volume after enucleation or evisceration.
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Service type: Surgical orbital implant procedure
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Typical site of service: Hospital operating room or ambulatory surgical center for ophthalmic/orbital surgery
Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A 54-year-old patient with a history of severe ocular trauma to the left eye presents after enucleation for a painful, blind eye. The oculoplastic surgeon schedules implantation of an orbital prosthesis to restore orbital volume and facial cosmesis. Preoperative workflow includes history and physical, informed consent specific to prosthetic orbital implant insertion, pre-op imaging as indicated (orbital CT if complex anatomy), perioperative antibiotics, general anesthesia assessment, and coordination with an ocularist for later external prosthesis fitting. Intraoperative steps include placement of a spherical orbital implant external to the extraocular muscle cone, securement to Tenon’s capsule or conjunctiva, hemostasis, and layered closure. Postoperative care includes pain control, wound checks, topical and/or systemic antibiotics, instructions to avoid heavy lifting or Valsalva, and follow-up visits for suture removal and later referral to an ocularist for final prosthetic eye fitting. Typical site of service is an ambulatory surgery center or hospital outpatient operating room. Service type is surgical, reconstructive, oculoplastic/orbital procedure under general or monitored anesthesia care.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | Use if billing only the physician professional component separate from hospital/facility technical component (rare for this global surgical service). |