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Official Description

Enucleation of eye; with implant, muscles not attached to implant

© Copyright 2026 American Medical Association. All rights reserved.

Common Language Description

Enucleation of the eye is a surgical procedure that involves the complete removal of the eyeball (globe) from its socket (orbit). This procedure is typically indicated for the treatment of serious conditions such as tumors of the eye, including intraocular melanoma and retinoblastoma, as well as for cases of severe trauma that compromise the integrity of the eye. During the enucleation process, the surgeon carefully measures the globe and determines the length of the optic nerve to ensure proper technique and placement of any subsequent implants. The procedure is performed under magnification using a dissecting microscope, which aids in visualizing the intricate orbital structures and assessing the extent of any lesions or trauma present. A limbal incision is made around the conjunctiva and Tenon's capsule to access the eye. The extraocular muscles, which control eye movement, are then exposed and divided to facilitate the removal of the globe. Following the division of the optic nerve, the globe is extracted from the orbit. In the context of CPT® coding, this specific code, 65103, refers to enucleation with the placement of an implant that is not attached to the extraocular muscles, distinguishing it from other related codes that involve different techniques and implant configurations.

© Copyright 2026 Coding Ahead. All rights reserved.

1. Indications

Enucleation of the eye is performed for several critical medical indications, primarily related to severe ocular conditions. The following are the explicitly provided indications for this procedure:

  • Intraocular Melanoma - A type of cancer that develops in the melanocytes of the eye, necessitating removal to prevent further spread.
  • Retinoblastoma - A malignant tumor of the retina that typically occurs in children, requiring enucleation to eliminate the cancerous tissue.
  • Severe Trauma - Significant injury to the eye that compromises its structure and function, making enucleation necessary to alleviate pain and prevent complications.

2. Procedure

The enucleation procedure involves several critical steps, each performed with precision to ensure the safety and effectiveness of the surgery. The following procedural steps are outlined:

  • Step 1: Measurement and Assessment - The surgeon begins by measuring the globe of the eye and determining the length of the optic nerve. This assessment is crucial for planning the surgical approach and ensuring the appropriate size of the implant to be used later.
  • Step 2: Illumination and Visualization - The globe is illuminated, and a dissecting microscope is utilized to enhance visualization of the orbital structures. This step is essential for identifying the extent of any lesions or trauma that may be present, allowing for careful dissection during the procedure.
  • Step 3: Limbal Incision - A limbal incision is made around the conjunctiva and Tenon's capsule, providing access to the eye and surrounding tissues. This incision is strategically placed to minimize trauma to adjacent structures.
  • Step 4: Division of Extraocular Muscles - The extraocular muscles, which are responsible for eye movement, are exposed and carefully divided. This step is necessary to free the globe from its attachments, facilitating its removal.
  • Step 5: Division of the Optic Nerve - The optic nerve is located and divided, which is a critical step in the enucleation process as it disconnects the eye from the central nervous system.
  • Step 6: Removal of the Globe - The globe is then removed from the orbit, completing the enucleation process. This step must be performed with care to avoid damaging surrounding structures.
  • Step 7: Implant Placement - Following the removal of the globe, an appropriately sized implant is placed in the muscle cone. Importantly, in this procedure, the implant is not attached to the extraocular muscles, distinguishing it from other enucleation procedures that may involve muscle attachment.

3. Post-Procedure

After the enucleation procedure, patients typically require careful monitoring and post-operative care to ensure proper healing. The expected recovery period may vary depending on individual circumstances, but patients are generally advised to follow specific guidelines provided by their healthcare team. This may include managing pain, monitoring for signs of infection, and attending follow-up appointments to assess healing and the integration of the implant. Additional considerations may involve counseling and support for the psychological impact of losing an eye, as well as discussions regarding prosthetic options if desired.

Short Descr REMOVE EYE/INSERT IMPLANT
Medium Descr ENUCLEATION EYE IMPLT MUSC X ATTACHED IMPLT
Long Descr Enucleation of eye; with implant, muscles not attached to implant
Status Code Active Code
Global Days 090 - Major Surgery
PC/TC Indicator (26, TC) 0 - Physician Service Code
Multiple Procedures (51) 2 - Standard payment adjustment rules for multiple procedures apply.
Bilateral Surgery (50) 1 - 150% payment adjustment for bilateral procedures applies.
Physician Supervisions 09 - Concept does not apply.
Assistant Surgeon (80, 82) 1 - Statutory payment restriction for assistants at surgery applies to this procedure...
Co-Surgeons (62) 1 - Co-surgeons could be paid, though supporting documentation is required...
Team Surgery (66) 0 - Team surgeons not permitted for this procedure.
Diagnostic Imaging Family 99 - Concept Does Not Apply
APC Status Indicator Hospital Part B services paid through a comprehensive APC
ASC Payment Indicator Surgical procedure on ASC list in CY 2007; payment based on OPPS relative payment weight.
Type of Service (TOS) 2 - Surgery
Berenson-Eggers TOS (BETOS) P4E - Eye procedure - other
MUE 1
CCS Clinical Classification 21 - Other extraocular muscle and orbit therapeutic procedures
50 Bilateral procedure: unless otherwise identified in the listings, bilateral procedures that are performed at the same session, should be identified by adding modifier 50 to the appropriate 5 digit code. note: this modifier should not be appended to designated "add-on" codes (see appendix d).
51 Multiple procedures: when multiple procedures, other than e/m services, physical medicine and rehabilitation services or provision of supplies (eg, vaccines), are performed at the same session by the same individual, the primary procedure or service may be reported as listed. the additional procedure(s) or service(s) may be identified by appending modifier 51 to the additional procedure or service code(s). note: this modifier should not be appended to designated "add-on" codes (see appendix d).
78 Unplanned return to the operating/procedure room by the same physician or other qualified health care professional following initial procedure for a related procedure during the postoperative period: it may be necessary to indicate that another procedure was performed during the postoperative period of the initial procedure (unplanned procedure following initial procedure). when this procedure is related to the first, and requires the use of an operating/procedure room, it may be reported by adding modifier 78 to the related procedure. (for repeat procedures, see modifier 76.)
79 Unrelated procedure or service by the same physician or other qualified health care professional during the postoperative period: the individual may need to indicate that the performance of a procedure or service during the postoperative period was unrelated to the original procedure. this circumstance may be reported by using modifier 79. (for repeat procedures on the same day, see modifier 76.)
GC This service has been performed in part by a resident under the direction of a teaching physician
GW Service not related to the hospice patient's terminal condition
LT Left side (used to identify procedures performed on the left side of the body)
RT Right side (used to identify procedures performed on the right side of the body)
SG Ambulatory surgical center (asc) facility service
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