Summary & Overview
CPT 67560: Removal or Revision of Orbital Prosthetic Eyeball
CPT code 67560 denotes surgical removal or revision of a previously placed prosthetic eyeball located outside the extraocular muscle cone, performed because of poor fit or malfunction. This procedure is a focused orbital surgery addressing complications or dissatisfaction with an external ocular implant. Nationally, procedural coding for orbital implant removal affects surgical scheduling, device management, and reimbursement pathways for ophthalmic and oculoplastic specialists.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise explanation of the clinical purpose of the code, typical sites of service, and the service type. The publication provides benchmarks where available, summarizes relevant policy and coverage considerations, and places the procedure in clinical context for surgical teams and billing professionals.
This resource is intended to clarify what CPT code 67560 represents, who typically manages these services, and what operational and coding topics stakeholders should expect to review, including coverage variability, documentation needs, and alignment with related surgical services. Data not available in the input will be noted where applicable.
Billing Code Overview
CPT code 67560 describes the removal or revision of a previously placed prosthetic (manmade) eyeball located outside the extraocular muscle cone. The procedure addresses poor fit or function of an orbital implant that rests anterior to the muscle cone.
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Service type: Surgical removal or revision of an orbital prosthetic implant
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Typical site of service: Ambulatory surgical center or hospital operating room
Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A 62-year-old patient with a history of ocular trauma and chronic orbital inflammation presents with an ill-fitting, painful orbital implant placed months earlier. The prosthetic globe is positioned outside the muscle cone and causes irritation, recurrent discharge, and poor cosmetic fit. After clinical evaluation by an oculoplastic surgeon, conservative options are exhausted and the decision is made to remove or revise the extraocular (anophthalmic) prosthetic. The procedure is performed in an ambulatory surgical center under monitored anesthesia care or general anesthesia, with preoperative marking and sterile prep of the orbit. Intraoperative steps include removal of the existing implant, inspection of the socket and surrounding tissues, possible revision of the implant pocket or sizing, and placement of a new implant or custom fitting. Postoperative workflow includes pain control, topical and/or systemic antibiotics, instructions for socket care, follow-up visits for prosthesis refitting, and coordination with an ocularist for custom prosthesis fabrication. Typical providers include oculoplastic surgeons or ophthalmologists with orbital reconstruction expertise; services are commonly billed from the ambulatory surgical center or hospital outpatient department depending on facility use.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | Default/unspecified (not typically reported) | Rarely used; included in raw list but not typically appended clinically |