Coding Ahead
CasePilot
Medical Coding Assistant
CaseConsultant
Instant Email Coding Consultant
Case2Code
Search and Code Lookup Tool
CareerCenter
Medical Coding Job Board
Log in Register free account

Need help choosing the right code?

Ask CasePilot about procedures, modifiers, bundling, and coding guidance.

Try CasePilot

Official Description

Backbench preparation of corneal endothelial allograft prior to transplantation (List separately in addition to code for primary procedure)

© Copyright 2026 American Medical Association. All rights reserved.

Common Language Description

The CPT® Code 65757 refers to the backbench preparation of a corneal endothelial allograft prior to transplantation. This procedure is a critical step in the process of corneal transplantation, where the physician meticulously prepares donor corneal tissue for successful implantation into a recipient's eye. The preparation can be performed using two primary techniques: an automated method utilizing a microkeratome or a manual approach without the use of a microkeratome. In the automated technique, the donor tissue is placed in an artificial anterior chamber filled with a preservation solution, and a thin layer of Healon is applied to the endothelium. This setup allows for precise manipulation and evaluation of the donor tissue. The physician marks the horizontal meridian of the donor cornea to ensure proper orientation during the transplantation phase. In contrast, the manual preparation technique involves the use of a diamond knife and a crescent blade to create incisions in the donor tissue, allowing for careful dissection to the desired depth. This method requires a high level of skill and precision to avoid damaging the delicate endothelial layer. Regardless of the technique used, the ultimate goal is to prepare the donor tissue in a manner that preserves its integrity and functionality, ensuring the best possible outcome for the recipient during the subsequent transplantation procedure. The preparation of the corneal endothelial allograft is a separate and distinct service that is reported in addition to the primary procedure of endothelial corneal transplantation.

© Copyright 2026 Coding Ahead. All rights reserved.

1. Indications

The backbench preparation of corneal endothelial allograft (CPT® Code 65757) is indicated for patients requiring corneal transplantation due to various conditions that affect the cornea. These may include:

  • Corneal Edema - A condition characterized by swelling of the cornea, often due to endothelial dysfunction.
  • Fuchs' Dystrophy - A genetic disorder that leads to the gradual loss of endothelial cells, resulting in corneal clouding and vision impairment.
  • Corneal Scarring - Scarring of the cornea due to injury, infection, or previous surgeries that can impair vision.
  • Keratoectasia - A condition where the cornea becomes thin and bulges outward, often associated with conditions like keratoconus.

2. Procedure

The procedure for backbench preparation of the corneal endothelial allograft involves several detailed steps, which can be performed using either an automated microkeratome or manual techniques. Each step is crucial for ensuring the integrity and viability of the donor tissue.

  • Step 1: Preparation of the Artificial Anterior Chamber - The physician fills the artificial anterior chamber with a preservation solution to maintain the health of the donor tissue. This chamber serves as a controlled environment for the preparation process.
  • Step 2: Application of Healon - A thin layer of Healon, a viscoelastic substance, is applied to the endothelium of the donor tissue. This helps protect the delicate endothelial cells during the preparation process.
  • Step 3: Marking the Donor Tissue - The horizontal meridian of the donor cornea is marked to ensure proper orientation during transplantation. This step is vital for the successful integration of the graft.
  • Step 4: Automated Preparation with Microkeratome - The microkeratome head is mounted on the guide ring and positioned for resection. The device is then passed over the donor cornea to create a free cap of anterior tissue, which is held above the blade. The residual stromal bed is dried, and the cut's diameter and smoothness are evaluated.
  • Step 5: Manual Preparation Techniques - If performed manually, a diamond knife is set to the appropriate depth to make a curved incision in the peripheral donor limbal area. Deeper stromal tissue is then cut using a crescent blade until the desired plane is reached. Alternatively, a suction trephine may be used to create a precise cut to the desired depth.
  • Step 6: Inspection and Removal of Donor Tissue - After the desired depth is achieved, the donor tissue is carefully dismounted from the artificial anterior chamber. The endothelium is protected during this process to prevent damage.
  • Step 7: Irrigation and Final Preparation - The donor sclera is irrigated above and below the endothelial surface to remove any residual Healon. The donor tissue is then placed on a standard punch trephine block, ensuring proper positioning using the previously placed central ink mark. The tissue is folded along the horizontal meridian in preparation for transplantation.

3. Post-Procedure

Post-procedure care following the backbench preparation of the corneal endothelial allograft involves ensuring the integrity of the prepared tissue until it is transplanted. The physician must monitor the donor tissue for any signs of damage or compromise. The prepared graft is typically stored in a preservation solution until the transplantation procedure is performed. It is essential to maintain a sterile environment and handle the tissue with care to prevent contamination or injury. The physician will then proceed with the endothelial corneal transplant, which is a separate reportable procedure.

Short Descr PREP CORNEAL ENDO ALLOGRAFT
Medium Descr BACKBENCH PREPJ CORNEAL ENDOTHELIAL ALLOGRAFT
Long Descr Backbench preparation of corneal endothelial allograft prior to transplantation (List separately in addition to code for primary procedure)
Status Code Carriers Price the Code
Global Days ZZZ - Code Related to Another Service
PC/TC Indicator (26, TC) 0 - Physician Service Code
Multiple Procedures (51) 0 - No payment adjustment rules for multiple procedures apply.
Bilateral Surgery (50) 0 - 150% payment adjustment for bilateral procedures does NOT apply.
Physician Supervisions 09 - Concept does not apply.
Assistant Surgeon (80, 82) 0 - Payment restriction for assistants at surgery applies to this procedure...
Co-Surgeons (62) 0 - Co-surgeons not permitted for this procedure.
Team Surgery (66) 0 - Team surgeons not permitted for this procedure.
Diagnostic Imaging Family 99 - Concept Does Not Apply
APC Status Indicator Items and Services Packaged into APC Rates
ASC Payment Indicator Packaged service/item; no separate payment made.
Type of Service (TOS) 2 - Surgery
Berenson-Eggers TOS (BETOS) P4A - Eye procedure - corneal transplant
MUE 1
CCS Clinical Classification 13 - Corneal transplant

This is an add-on code that must be used in conjunction with one of these primary codes.

65756 MPFS Status: Active Code APC J1 ASC G2 CPT Assistant Article Keratoplasty (corneal transplant); endothelial
RT Right side (used to identify procedures performed on the right side of the body)
LT Left side (used to identify procedures performed on the left side of the body)
SG Ambulatory surgical center (asc) facility service
GC This service has been performed in part by a resident under the direction of a teaching physician
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).
52 Reduced services: under certain circumstances a service or procedure is partially reduced or eliminated at the discretion of the physician or other qualified health care professional. under these circumstances the service provided can be identified by its usual procedure number and the addition of modifier 52, signifying that the service is reduced. this provides a means of reporting reduced services without disturbing the identification of the basic service. note: for hospital outpatient reporting of a previously scheduled procedure/service that is partially reduced or cancelled as a result of extenuating circumstances or those that threaten the well-being of the patient prior to or after administration of anesthesia, see modifiers 73 and 74 (see modifiers approved for asc hospital outpatient use).
59 Distinct procedural service: under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-e/m services performed on the same day. modifier 59 is used to identify procedures/services, other than e/m services, that are not normally reported together, but are appropriate under the circumstances. documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. however, when another already established modifier is appropriate it should be used rather than modifier 59. only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. note: modifier 59 should not be appended to an e/m service. to report a separate and distinct e/m service with a non-e/m service performed on the same date, see modifier 25.
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.)
80 Assistant surgeon: surgical assistant services may be identified by adding modifier 80 to the usual procedure number(s).
82 Assistant surgeon (when qualified resident surgeon not available): the unavailability of a qualified resident surgeon is a prerequisite for use of modifier 82 appended to the usual procedure code number(s).
CR Catastrophe/disaster related
Date
Action
Notes
2009-01-01 Added -
Code
Description
Code
Description
Code
Description
Code
Description
Code
Description
CasePilot

Get instant expert-level medical coding assistance.

Ask about:
CPT Codes Guidelines Modifiers Crosswalks NCCI Edits Compliance Medicare Coverage
Example: "What is CPT code 99213?" or "Guidelines for E/M services"