CPT 68328 Conjunctival Excision Reimbursement

CPT code 68328 denotes an ophthalmic reconstructive procedure that removes diseased conjunctival tissue and uses tissue adhesive to graft a replacement membrane, commonly used to treat conditions such as conjunctival chalasis. This procedure is clinically significant for preserving ocular surface integrity and improving patient comfort and vision. Nationally, the code captures a specialized outpatient surgical intervention performed in ambulatory surgical centers and hospital outpatient departments.

Payers addressed in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise review of coverage considerations across major commercial carriers and Medicare, common billing practices, and the clinical context that supports use of the code. The report highlights benchmarks and utilization patterns where available, summarizes pertinent coding and billing nuances, and outlines typical sites of service and clinical indications tied to 68328.

This summary is intended for administrators, coding professionals, and clinicians seeking a national overview of the procedure represented by 68328, its clinical role, and the payer landscape relevant to billing and coverage decisions. Data not available in the input is noted where applicable.

Billing Code Overview

CPT code 68328 describes a surgical procedure in which a provider excises diseased conjunctival tissue and uses tissue adhesive to graft a new membrane to the eye. The procedure is performed to treat ocular surface disorders such as conjunctival chalasis by removing dysfunctional conjunctiva and securing replacement membrane tissue with adhesive.

Service type: Ophthalmic reconstructive surgical procedure
Typical site of service: Ambulatory surgical center or hospital outpatient surgical suite

Clinical Context

A 68-year-old patient presents to an ophthalmology ambulatory surgical center with symptomatic conjunctival chalasis of the right eye causing ocular irritation, tearing, and interference with tear distribution. The provider conducts a preoperative evaluation including ocular surface examination, review of medications (notably anticoagulants), and informed consent. In the procedure suite under local or monitored anesthesia care, the surgeon excises the redundant or diseased conjunctival tissue and prepares the bed. A conjunctival autograft or amniotic membrane is affixed using a tissue adhesive rather than sutures to re-establish a smooth ocular surface and reduce postoperative inflammation and discomfort. Immediate postoperative care includes topical antibiotic and steroid drops, instructions for activity restriction, and a follow-up visit within 1 week to assess graft adherence and healing. Typical settings are outpatient ophthalmic surgery centers or hospital outpatient departments. The typical service type is minor ophthalmic reconstructive surgery on the conjunctiva, and the typical site of service is an ambulatory surgery center or hospital outpatient department.

Coding Specifications

Modifier	Description	When to Use
`25`	Data not available in the input.	Data not available in the input.
`26`

Taxonomy Code	Specialty	Notes
`207W00000X`	Ophthalmology	Corneal and external disease surgeons commonly perform conjunctival procedures.
`207K00000X`	Otolaryngology - Head & Neck Surgery	Rarely involved for complex external eye or periocular procedures in multidisciplinary care.
`2080P0227X`	Optometry	Pre- and post-operative ocular surface evaluations and co-management in some practices.
`363L00000X`	Anesthesiology	Provides monitored anesthesia care or general anesthesia for patients with comorbidities.
`193200000X`	Registered Nurse Practitioner	Performs preoperative assessment and postoperative management in some ambulatory settings.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`H11.023`	Conjunctival chalasis, right eye	Direct indication for conjunctival tissue excision and grafting to restore ocular surface anatomy.
`H11.024`	Conjunctival chalasis, left eye	Direct indication when the left eye is affected; bilateral disease may require separate procedures.
`H11.029`	Conjunctival chalasis, unspecified eye	Used when laterality is not specified in documentation.
`H11.1`	Conjunctival degenerations and deposits	Includes other conjunctival surface disorders that may necessitate excision and grafting.
`H10.33`	Chronic conjunctivitis, bilateral	Chronic ocular surface inflammation that can be associated with conjunctival redundancy and symptomatic disease.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`66984`	Cataract surgery with intraocular lens (complex or standard)	May be performed separately; not typically concurrent but relevant if combined anterior segment pathology is addressed in the same operative session.
`65778`	Conjunctival autograft for pterygium repair, with subconjunctival injection; with or without fibrin glue	A related conjunctival graft technique; the use of tissue adhesive in `68328` is analogous to adhesives used in pterygium grafting.
`67840`	Repair of ectropion; horizontal lid shortening with lateral tarsal strip	Periocular reconstructive codes that may be performed in the same surgical setting for coexisting eyelid malposition contributing to conjunctival disease.
`66999`	Unlisted procedure, anterior segment of eye	Use for anterior segment procedures not specifically described elsewhere when additional unique services are provided in the same operative session.
`99024`	Postoperative follow-up visit, postoperative global period	Used for reporting postoperative follow-up services related to the surgical procedure when billing exceptions apply.

OpenPayer

Summary & Overview

CPT 68328: Conjunctival Excision with Tissue Adhesive Graft