CCSD code C8654 – Radioactive plaque insertion into the eye

Key takeaways

CCSD Code C8654 covers insertion and later removal of a radioactive ocular plaque as one billable episode, not two separate codes.

Primary indications include choroidal and ciliary body melanoma (ICD-10 C69.3 and C69.4), retinoblastoma (C69.2), and other intraocular tumours.

Iodine-125 and ruthenium-106 plaques both bill under C8654, so the isotope changes the documentation but never the code.

UK private medical insurers list C8654 in Chapter 4, section 4.12 General, as a Major complexity procedure.

Pabau, the practice software we build, keeps insurer-specific price lists, checks authorisation codes are in place, and submits C8654 claims through Healthcode.

CCSD Code C8654: definition and procedure scope

The Clinical Coding and Schedule Development (CCSD) Group defines CCSD Code C8654 as “Insertion of radioactive plaque into eye (including later removal).” That parenthetical decides how often the code is billed per treatment episode. In short, the answer is once, whether removal follows insertion by days or by weeks.

The code sits in Chapter 4 (Eye and orbital contents) of the schedule of CCSD codes, under section 4.12 General. In addition, insurers band it as Major complexity. However, it applies only to UK private medical insurance (PMI) billing. Trusts code NHS activity in OPCS-4 and group it into HRGs for payment, so CCSD codes never go on NHS-funded episodes.

The procedure sutures a small, dome-shaped radioactive plaque to the episclera, the outer surface of the eye, directly over the tumour. The plaque delivers a prescribed radiation dose over a dwell period, and the surgeon then removes it. Both stages need theatre time and anaesthesia, which is why the CCSD bundles them into one code. Moreover, the anaesthetist claims a separate fee, which insurer schedules list as its own line against C8654.

What the procedure involves: radioactive plaque insertion and removal

The surgical sequence shows coders exactly what one episode of C8654 covers and what falls outside it.

1. Conjunctival peritomy: the surgeon opens the conjunctiva to expose the episcleral surface overlying the tumour.
2. Tumour localisation: the ophthalmologist or ocular oncologist marks the tumour margins using indirect ophthalmoscopy or intraoperative ultrasound.
3. Plaque positioning and suturing: the surgeon sutures the radioactive plaque (loaded with sealed I-125 seeds or a Ru-106 beta-emitting source) to the episclera with non-absorbable sutures. Precise positioning covers the tumour apex and limits dose to adjacent structures.
4. Dwell period: the plaque stays in situ for a calculated period, typically several days, until the prescribed dose has been delivered. Staff admit the patient, or manage them in a shielded environment, under IRMER 2017 radiation protection requirements.
5. Plaque removal: the surgeon releases the sutures under general or local anaesthesia, removes the plaque and closes the conjunctiva. The plaque then goes back to the medical physics department for safe storage or disposal.

Steps 1 through 3 are the insertion stage, and step 5 is the removal stage. The diagram below shows how both sit inside a single C8654 claim, while the dwell period between them creates no separate billable episode.

Clinical indications for ocular plaque brachytherapy

Uveal melanoma, the most common primary intraocular malignancy in adults, is the leading diagnosis behind C8654. The Collaborative Ocular Melanoma Study (COMS) found plaque brachytherapy equivalent to enucleation for survival in medium-sized choroidal melanoma. As a result, that evidence made the technique standard of care at UK specialist centres.

The table below maps the principal indications to their WHO ICD-10 codes, the edition UK insurers use rather than the US ICD-10-CM. First, selecting the correct diagnosis is a must for claim acceptance. Submitting C8654 against an inaccurate or non-specific ICD-10 code is a common cause of insurer rejection.

Isotopes used in ocular plaque brachytherapy

C8654 works with any isotope. The same code covers iodine-125 (I-125) and ruthenium-106 (Ru-106) plaques. The ocular oncologist and medical physicist choose the isotope based on tumour thickness, tumour location, and what the treating centre has available.

From a billing perspective, the isotope changes neither the code nor the claim. Therefore, coders never select a different code for I-125 versus Ru-106 procedures. However, the operative note and dosimetry record should still name the isotope, plaque model and source activity. Insurers may ask for that detail during claim review.

What C8654 includes and excludes

Clear bundling boundaries stop avoidable errors on C8654 claims. The table below separates what the code covers from services billed separately and from services never billed alongside C8654.

In practice, separate billing of dosimetry planning depends on each insurer’s provider agreement. Some UK private medical insurers bundle physics planning into the surgical fee, while others allow a separate medical physics charge. Therefore, check the relevant provider manual before billing.

Neighbouring CCSD codes and common coding errors

Several Chapter 4 codes cover the treatment of intraocular tumours. Choosing the wrong one typically leads to rejection or, where the error inflates the claim, a compliance audit. The table below lists the codes that sit closest to C8654.

For example, one possible mix-up is billing laser photocoagulation when the treatment was plaque brachytherapy. However, the two are clinically distinct. Laser is typically used for smaller choroidal haemangiomas or as follow-up therapy, while C8654 applies to the full plaque insertion and removal sequence. Verify the operative note before assigning the code.

When the eye is removed instead, the claim moves to C0122 if an implant goes in, or to C0120 if it does not. Likewise, when the surgeon excises a ciliary body tumour rather than irradiating it, the claim bills as C5910.

Also, radiotherapy to a surface lesion of the conjunctiva is a different procedure from plaque treatment of an intraocular tumour. It has its own code, C3950.

Required clinical documentation to support a C8654 claim

Missing or incomplete documentation is a frequent reason C8654 claims are rejected. UK private medical insurers increasingly request supporting records at the point of claim for high-value oncology procedures. Preparing these documents in advance shortens the wait between procedure and payment.

• Operative note (insertion stage): names the procedure, the plaque isotope and model, the tumour localisation method, the suture technique and the plaque position.
• Operative note (removal stage): confirms the plaque was removed, records the dwell period, and notes any findings during surgery.
• Dosimetry record: the medical physicist’s calculation sheet showing prescribed dose, dose rate, dwell time and plaque coordinates. Even where dosimetry is billed separately, the record supports the surgical claim.
• Tumour measurement: pre-treatment ultrasound (A/B-scan) or fundus photography showing tumour dimensions and location. This links the clinical indication to the procedure performed.
• MDT discussion record: most UK specialist centres require multidisciplinary team (MDT) sign-off before ocular oncology procedures. The MDT note confirms the treatment decision, and insurers routinely request it for oncology claims.
• Pre-authorisation reference number: every claim submission must include the insurer’s authorisation reference. Insurers are likely to reject claims submitted without it.

Therefore, store each document in the patient record at the time of the procedure, not afterwards. Pabau’s digital forms capture operative notes and supporting documents straight into the patient record, so the claim file is complete before the invoice is raised. Accurate, same-day records are also a CQC expectation for independent providers in England.

Pre-authorisation and insurer requirements

Most UK private medical insurers require pre-authorisation before ocular brachytherapy is performed. This reflects the procedure’s specialist oncology classification and its high relative cost within PMI schedules. Without confirmed pre-authorisation, the patient risks bearing the full cost and the practice risks non-payment.

The pre-authorisation process varies by insurer, so check each insurer’s provider portal. Our Bupa CCSD codes guide covers Bupa’s submission requirements in detail. Confirm a code’s descriptor and band in the Bupa code search portal or a published schedule such as Freedom Health Insurance’s Chapter 4 fees.

• Information to submit: the patient’s PMI membership number, the proposed CCSD code (C8654), the ICD-10 diagnosis code, and the treating consultant’s name and GMC number. Add the proposed admission date, the treating facility, and a clinical summary from the referring or treating ophthalmologist.
• Turnaround: pre-authorisation decisions for elective oncology procedures typically take 3 to 10 working days, and urgent cases may be expedited. Confirm the insurer’s stated turnaround in their current provider manual.
• If no pre-authorisation is obtained: submit a after-the-fact authorisation request with a clinical justification as soon as possible after the procedure. Approval is not guaranteed, and the outcome depends on the insurer’s policy and the clinical urgency documented.

How to submit a C8654 claim: step-by-step

A complete CCSD Code C8654 claim needs the procedure code, diagnosis code and supporting references filled in accurately. Skipping any step risks automatic rejection at the insurer’s processing stage.

1. Confirm pre-authorisation: verify the authorisation reference number is active and covers the admission date. Record the reference in the patient file before the procedure.
2. Complete both operative notes: document insertion and removal as described in the documentation section above. Both notes must be in the record before the invoice is raised.
3. Select the ICD-10 diagnosis code: use the most specific applicable code from the indications table, such as C69.3 for choroidal melanoma or C69.2 for retinoblastoma. Avoid unspecified codes unless no specific code applies.
4. Enter CCSD Code C8654: enter the code once per treatment episode. Do not duplicate it for the removal stage.
5. Attach supporting documents: most insurer portals accept PDF attachments. Include the dosimetry record, tumour measurement and MDT summary at submission rather than waiting for a request.
6. Include the pre-authorisation reference: enter it in the right field on the claim form or insurer portal. A missing reference can trigger automatic rejection.
7. Submit via the insurer’s usual channel: most UK PMIs now accept online submission through their provider portal. Some smaller insurers may still require paper, so confirm the current preference with each payer.

Common reasons C8654 claims are rejected

High-value ophthalmic oncology claims attract closer scrutiny than routine outpatient procedures. The usual reasons for rejection are predictable and largely avoidable, and each one below comes with a remediation step.

• Missing pre-authorisation reference: a common cause of automatic rejection. Fix: resubmit with the correct reference number, or submit a after-the-fact authorisation request if pre-authorisation was not obtained.
• Unbundling error (billing insertion and removal as two codes): billing the two stages under separate codes or as two C8654 claims. Fix: cancel the duplicate, resubmit as a single C8654, and include a covering note explaining the correction.
• Incorrect ICD-10 code: a non-specific or mismatched diagnosis code raises a medical necessity query. Fix: resubmit with the most specific applicable ICD-10 code, plus a clinical summary if the diagnosis needs explaining.
• Missing dosimetry record: insurers may request physics planning documentation for radiation-based procedures. Fix: attach the medical physicist’s dosimetry calculation sheet to the appeal or resubmission.
• Procedure performed at an unapproved centre: ocular brachytherapy needs specialist facilities, and some insurers approve only specific centres. Fix: verify centre approval before elective procedures for PMI patients, and request approval if it is not in place.
• Claim submitted outside the insurer’s time limit: each insurer sets its own submission deadline. Fix: check the limit in the provider manual, submit promptly after the procedure, and track unpaid claims in your practice management system.

Finally, check the WPA medical fees portal and each insurer’s own schedule for the fee bands and procedural requirements that apply to C8654.

How Pabau keeps C8654 claims accurate from setup to submission

Many ophthalmology practices still track C8654 fees in a spreadsheet, chase authorisation numbers by email, and assemble claim packs by hand. In fact, each handoff is a chance for a missing reference or a duplicated code. Whatever system you use, these setup steps prevent the rejections above:

• Add the CCSD code to the fee schedule: enter C8654 with the agreed fee for each insurer. The practice and each PMI agree CCSD fees, so never treat published guide prices as contracted rates without confirmation.
• Configure insurer-specific fee bands: Bupa, AXA Health, Aviva, Vitality and others may pay different contracted rates for the same code. The fee schedule should reflect each insurer’s agreement to avoid under- or over-billing.
• Link to the pre-authorisation workflow: make the pre-authorisation reference a required field on the C8654 invoice template, so it cannot be omitted at claim generation.
• Attach documentation at the patient record level: link operative notes, dosimetry records and MDT summaries to the procedure episode before generating the invoice.
• Create an accurate invoice: include the CCSD code, ICD-10 diagnosis code, consultant’s name and GMC number, facility, procedure dates and pre-authorisation reference.

Pabau’s claims management software keeps insurer-specific price lists, so C8654 carries the right fee for each insurer. It checks that membership numbers and authorisation codes are in place before a claim goes out. It then raises the invoice to the correct insurer and sends the claim through Healthcode with the invoice attached.

The result is one C8654 claim per episode, submitted with its reference and supporting records, and fewer resubmissions to chase.

Speed up accurate C8654 claim submissions

Pabau keeps insurer-specific price lists, checks authorisation codes, and submits C8654 claims through Healthcode with the invoice attached.

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Conclusion

Billing C8654 well comes down to one discipline: treat plaque insertion, dwell and removal as a single episode and a single claim. In contrast, splitting it in two is an avoidable error that triggers a rejection and can prompt an audit query.

The practical move is to front-load the work. Confirm pre-authorisation before admission, file both operative notes and the dosimetry record before the invoice goes out, and code the most specific WHO ICD-10 diagnosis. Done in that order, C8654 stops being a claim that gets queried and becomes one that gets paid.

Book a demo to see how Pabau keeps C8654 price lists, authorisation codes and Healthcode submissions in one place for your ophthalmology practice.

Continue your research

Managing Bupa claims in a UK private practice? Bupa CCSD codes guide covers the Bupa procedure code schedule and its submission requirements.

Treating the tumour by removing the eye instead? CCSD code C0122 explains billing enucleation or evisceration with an implant.

Excising a ciliary body tumour rather than irradiating it? CCSD code C5910 covers iridocyclectomy coding, complexity and claims.

Looking to streamline invoicing across UK private insurers? Claims management software shows how Pabau handles insurer price lists and Healthcode submission.

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