Cataract Surgery CPT Codes | Descriptions, Guidelines & Reimbursement

Cataract surgery CPT code(s) 66820, 66821, 66830, 66982-66988, and 66991 may be used for services when the physician performs cataract surgery to remove the lens and exchange it with an artificial lens if required. 

Introduction

The following are reasons why the physician performs cataract surgery:

• Vision changes
• Blurry vision
• Age-related macular degeneration
• Diabetic retinopathy

The physician creates a tiny incision at the junction where the cornea and sclera meet. The physician then carefully removes the lens by opening the front capsule and removing the lens’s defective, hard center or nucleus.  

The ophthalmologist retrieves the soft lens cortex with a microscope, leaving the capsule in place. The physician then irrigates and aspirates the artificial lens (an intraocular lens IOL)) that is exchanged with the natural lens and placed gently. 

The physician applies the sutures at the incision and eye patch and instills antibiotic ointment. A metal shield is a rap-up with tape to ensure security.

If the lens capsule is intact, the physician may perform the standard phacoemulsification to support sufficient zonular remains. The physician may use capsulorhexis, which breaks the cataract nucleus with an ultrasonic oscillating probe. 

The phaco probe is incorporated into the eyes after fragmentation, and the cataract is retrieved by an irrigation-aspiration examination by the physician. The physician then places the artificial lens after removing all the material. Suture application may be required if both capsular and zonular cannot support or minimally damage.

Descriptions of the Cataract Surgery CPT Codes

Below, we describe the most relevant CPT codes for Cataract Surgery.

CPT 66982

Cataract surgery CPT code 66982 bills for service when the physician performs complex surgery for the removal of the extracapsular cataract, including intraocular lens prosthesis (1-stage procedure) by using the manual or mechanical technique such as irrigation and aspiration or phacoemulsification) requiring devices or techniques not generally used in routine cataract surgery (e.g., iris expansion device, suture support for primary posterior capsulorrhexis, or the intraocular lens furnished on patients in the amblyogenic developmental stage, not including endoscopic cyclophotocoagulation

CPT 66989

CPT 66989 bills for service when the physician performs complex Extracapsular cataract removal with insertion of intraocular lens prosthesis (1-stage procedure) using the manual or mechanical technique (such as aspiration and irrigation or phacoemulsification).

It may require devices or techniques not typically used in routine cataract surgery (such as suture support for the intraocular lens, iris expansion device, or primary posterior capsulorrhexis) or perform on patients in the amblyogenic developmental stage along with the insertion of intraocular such as suprachoroidal anterior segment aqueous drainage device, supraciliary, trabecular meshwork, without extraocular reservoir, internal approach, one or more.

CPT 66987

Cataract surgery CPT code 66987 bills for service when the physician performs complex Extracapsular cataract removal with insertion of intraocular lens prosthesis (1-stage procedure) by using the manual or mechanical technique (such as aspiration and irrigation or phacoemulsification), requiring devices or techniques not generally used in routine cataract surgery (e.g., iris expansion device, suture support for the primary posterior capsulorrhexis) or intraocular lens, or performed on patients in the amblyogenic developmental stage including endoscopic cyclophotocoagulation.

CPT 66983

CPT 66983 bills for service when the physician performs intracapsular cataract extraction with insertion of intraocular lens prosthesis (1-stage procedure)

CPT 66984

CPT 66984 bills for service when the physician performs Extracapsular cataract removal with insertion of intraocular lens prosthesis (1-stage procedure) by using the manual or mechanical technique (e.g., irrigation and aspiration or phacoemulsification) without endoscopic cyclophotocoagulation.

CPT 66991

Cataract surgery CPT code 66991 bills for service when the physician performs Extracapsular cataract removal with insertion of intraocular lens prosthesis (1-stage procedure) by using the manual or mechanical technique (e.g., irrigation and aspiration or phacoemulsification) along with the insertion of intraocular such as supraciliary, suprachoroidal anterior segment aqueous drainage device, not including extraocular reservoir, internal approach, one or more

CPT 66988

CPT 66988 bills for service when the physician performs Extracapsular cataract removal with insertion of intraocular lens prosthesis (1-stage procedure), manual or mechanical technique (e.g., irrigation and aspiration or phacoemulsification), with endoscopic cyclophotocoagulation

CPT 66820

CPT 66820 bills for service when the physician performs Discussion of secondary membranous cataracts (anterior hyaloid and or opacified posterior lens capsule) using stab incision techniques such as Ziegler or Wheeler knife for stage one or more.

CPT 66821

CPT 66821 bills for service when the physician performs the Discission of secondary membranous cataracts (anterior hyaloid and or opacified posterior lens capsule) using laser surgery such as YAG laser for stage 1 or more. 

CPT 66830

Cataract surgery CPT code 66830 bills for service when the physician performs Removal of secondary membranous cataract (opacified posterior lens capsule and or anterior hyaloid) with corneoscleral section, with or without iridectomy (iridocapsulotomy, iridocapsulectomy)

Reimbursement

A maximum of one or two units can be billed on the same service date of cataract surgery CPT code(s) 66982-66988. In contrast, the Two units allow documentation supporting the service’s medical necessity.  

The cost and RUVS of CPT 66982 are $820.49 and 23.70939 when performed in the facility. In contrast, the reimbursement and RUVS of CPT 66982 are $820.49 and 23.70939 when performed in the non-facility.

The cost and RUVS of CPT 66984 will be $599.62 and 17.32697, respectively, when performed in the facility. At the same time, non-facility will be $599.62 and 17.32697.

The cost and RUVS of Cataract surgery CPT code 66989 are $939.63 and 27.15200 when performed in the facility. In contrast, the reimbursement and RUVS of CPT 66989 are $939.63 and 27.15200 when performed in the non-facility.

The cost of CPT 66987 is $3,818 when performed in the facility. In contrast, the reimbursement CPT 66987 is $2,393 when furnished in the non-facility.

Cataract surgery CPT code 66988 costs $3,818 when performed in the facility. In contrast, the reimbursement of CPT 66988 is $2,393 when furnished in the non-facility.

The cost of CPT 66983 is $567.11 when performed in the facility. In contrast, the reimbursement and RUVS of CPT 66983 are $567.11 when performed in the non-facility.

The cost and RUVS of CPT 66820 are 545.13 and 15.75240 when performed in the facility. In contrast, the reimbursement and RUVS of CPT 66820 are 545.13 and 15.75240 when performed in the non-facility.

The cost and RUVS of Cataract surgery CPT code 66821 are $348.94 and 10.08316 when performed in the facility. In contrast, the reimbursement and RUVS of CPT 66821 are $377.81 and 10.91741 when performed in the non-facility.

The cost and RUVS of CPT 66830 are $783.02 and 22.62667 when performed in the facility. In contrast, the reimbursement and RUVS of CPT 66830 are $783.02 and 22.62667 when performed in the non-facility.

Billing Guidelines

CPT code 66820, 66821, 66830, 66982-66988, or 66991 includes Lateral canthotomy, Enzymatic zonulysis, Iridectomy/iridotomy, Anterior or posterior capsulotomy, Subtenon injection, Medications, Subconjunctival injection, and viscoelastic material. Therefore, these services will not be reported separately and will be routinely performed with a retrobulbar injection rather than general anesthesia. 

Cataract surgery CPT code(s) 66820, 66821, 66830, 66982-66988, and 66991 have 90 days global period. If any Evaluation and management (E/M) service is edperforms in conjunction with CPT code 66984, modifier 24 will be reported with E/M service for an unrelated condition.

 Suppose the E/M visit is for post-operative care of prior surgical procedures. It is not appropriate to report the E/M code with CPT codes 66820, 66821, 66830, 66982-66988, or 66991 separately during the global period. While modifier 25 will be applicable with CPT codes 66820, 66821, 66830, 66982-66988, and 66991 if the patient saw an unrelated condition on the exact procedure date.

Suppose extracapsular cataract-removal surgery (cataract surgery CPT code(s) 66820, 66821, 66830, 66982-66988, or 66991) performs in combination with inserting an ocular telescope prosthesis. In that case, reporting with a different CPT code, 0308T is appropriate.

If Secondary fixation (CPT 66682) performs in addition to CPT 66820, 66821, 66830, 66982-66988, or 66991, it is appropriate to report separately.

If Implied material removal from the anterior segment (65920) and cataract surgery CPT code(s) 66820, 66821, 66830, 66982-66988, or 66991, it is appropriate to report separately.