65210_DF

This Medicare carrier does not have a local coverage determination (LCD) for conjunctival foreign body removal.  The policy presented is to serve as a sample and is provided as a reference guide only and should not be construed as policy for your current Medicare carrier.  

Medical record documentation should indicate the medical necessity for performing the procedure.  In addition, documentation that the service was performed including the results should be available.

If the provider of the service is other than the ordering/referring physician, the provider of the service should maintain hard copy documentation of procedure results.  The optometrist/ophthalmologist should state the clinical indication/medical necessity for the study in this order for the procedure. 

Report a conjunctival foreign body removal with CPT code 65210. 

This Medicare carrier has no utilization guidelines for conjunctival foreign body removal.  It is expected that these services would be performed as indicated by current medical literature and/or current standards of ophthalmologic practice.

In the absence of specific utilization guidelines, optometrists/ophthalmologists should adhere to CMS Ruling 95-1 (V) which states that utilization of these services should be consistent with locally acceptable standards of ophthalmic practice.