How often should an ocular prosthesis be cleaned?

It is recommended to have the prosthesis cleaned and polished semiannually or annually by a professional.

Can an ocular prosthesis be adjusted?

Yes, adjustments may be necessary over time to ensure a proper fit with the tissue bed.

Is a glass eye the same as an ocular prosthesis?

While historically referred to as a glass eye, modern ocular prostheses are rarely made of glass and are instead crafted from more durable materials.

Does insurance cover ocular prostheses?

Coverage varies by insurance plan, so it's important to verify benefits and obtain pre-authorization when necessary.

D5916

Ocular Prosthesis - CDT Code Guide

Maxillofacial Prosthetics/Other Removable Prosthetic Services

Overview

CDT code D5916 refers to the provision of an ocular prosthesis, commonly known as an artificial eye or glass eye. This prosthesis is used to replace an eye that is missing due to trauma, surgery, or congenital absence. It is important to note that the ocular prosthesis does not replace missing eyelids or surrounding tissues such as skin, mucosa, or muscle. Regular maintenance, including semiannual or annual cleaning and polishing, is necessary to ensure the prosthesis remains in good condition. Additionally, revisions may be needed over time to ensure the prosthesis fits well with the tissue bed. While historically made of glass, modern ocular prostheses are typically crafted from more adaptable materials.

When to Use This Code

Patient has lost an eye due to traumatic injury.
Eye removal following surgical procedures for tumors.
Congenital absence of an eye requiring prosthetic replacement.
Replacement of an existing ocular prosthesis due to wear.
Adjustment of a prosthesis to better fit the tissue bed.

Documentation Requirements

Detailed patient history and reason for eye loss.
Clinical notes documenting the need for prosthesis.
Description of the prosthesis provided including materials used.
Record of patient consent for prosthesis placement.
Follow-up care plan including cleaning and maintenance schedule.

Billing Considerations

When billing for D5916, it's crucial to document the medical necessity and the specific circumstances leading to the need for an ocular prosthesis. Frequency limitations may apply, particularly regarding the replacement of the prosthesis. Common modifiers include those indicating bilateral procedures if applicable. Insurance coverage can vary, so verifying benefits and obtaining pre-authorization is recommended.

Related CDT Codes

D5982 D5983 D5984 D5985 D5986

Frequently Asked Questions

Modern ocular prostheses are typically made from acrylic or medical-grade polymers, offering durability and adaptability.

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