65103 Eye removal Medicare reimbursement rates in Illinois

An ophthalmic surgeon removes the globe intact and places an implant in the orbit, attaching the extraocular muscles to the implant. This enucleation may be performed for an intraocular malignancy or a severely damaged, blind, painful eye. The service is generally performed in a hospital or ambulatory surgical setting; Medicare recorded facility services for this code in 2024.

Select this code when the operative report supports enucleation, implant placement, and muscle attachment. Documentation should identify the eye, the reason for removal, and the implant and muscle work performed; use a different code when no implant is placed or when the procedure is evisceration rather than enucleation. The procedure has a 90-day global period, including the day-before preoperative visit and related postoperative care. When multiple procedures are performed in the same session, the highest-valued procedure is paid in full and others at 50%. Bilateral reporting with modifier 50 is paid at 150%. Assistant-at-surgery payment is restricted; co-surgeons require supporting documentation, and team surgery is not permitted.