cataract surgery CPT code

Cataract Surgery CPT Code (2022) Description, Guidelines, Reimbursement, Modifiers & Examples

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

Cataract Surgery CPT Code Description

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.

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

The phaco probe incorporates into the eyes after fragmentation, and the cataract retrieves by an irrigation-aspiration examination by the physician. The physician then places the artificial lens after removing all the material. Suture application may require if both capsular and zonular are unable to support or minimally damaged.

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

cataract surgery cpt code 2021

CPT 66989

CPT 66989 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).

It may require devices or techniques not typically used in routine cataract surgery (such as suture support for 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 code for cataract surgery

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 code cataract surgery

CPT 66983

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

CPT 66983

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 66984

CPT 66991

Cataract surgery CPT code 66991 bills for service when the physician performs Extracapsular cataract removal with insertion of intraocular lens prosthesis.

TIP: You can find the complete billing guide for CPT 66991 here.

CPT 66991

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 66988

CPT 66820

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

CPT 66820

CPT 66821

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

CPT 66821

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)

CPT 66830

Cataract Surgery CPT Code Reimbursement

A maximum of one or two-unit can be a bill 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.

The cost of Cataract surgery CPT code 66988 is $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 and 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.

Cataract Surgery CPT Code Modifiers  

The following are the list modifiers applicable with cataract surgery CPT code(s) 66820, 66821, 66830, 66982-66988, and 66991: 

22, 23, 47, 51, 52, 53, 54, 55, 56, 58, 59, 62, 63, 76, 77, 78, 79, 80, 81 82, 99, , AS, CC, CR, ET, EY, GA, GC, GK, GR, GU, GY, GZ, KX, Q5, Q6, QJ, SG, TC, XR, XP, XU, XS, AI, AQ, AR. 

Modifier 47 applies to cataract surgery CPT code(s) 66820, 66821, 66830, 66982-66988, and 66991 when the surgeon administers general or regional anesthesia to the patient. It is not appropriate to report modifier 47 with anesthesia procedures.

Modifier 76 is appropriate with CPT 66820, 66821, 66830, 66982-66988, and 66991 when a similar service performs by the Same Physician on the same service date. 

Modifier 54 is applicable with cataract surgery CPT code(s) 66820, 66821, 66830, 66982-66988, and 66991 when the physician provides surgical care only. In contrast, Modifiers 55 and 56 attach to CPT 66820, 66821, 66830, 66982-66988, and 66991 when the physician performs post-management and preoperative care only. 

Modifier 76 is applicable with CPT 66820, 66821, 66830, 66982-66988, and 66991 when a similar service performs by a different Physician on the same service date. 

Modifier 59 is applicable with CPT 66820, 66821, 66830, 66982-66988, and 66991 when a Distinct service performs by the physician and bundled with another procedure on the same date.   

Modifier X {E, P, S, U} is applicable instead of Modifier 59 with cataract surgery CPT code(s) 66820, 66821, 66830, 66982-66988, and 66991 when service bills to medicare insurance. It divides the modifier into four parts for further specification of the procedure. 

Modifier 53 will be reported with CPT 66820, 66821, 66830, 66982-66988, and 66991 if unsuccessful cataract surgery performs due to unavoidable circumstances like allergic reactions to the substance. 

Modifier 22 applies to CPT 66820, 66821, 66830, 66982-66988, and 66991 when services perform longer than usual and take extra resources during the procedure. 

Modifier 23 is applicable with cataract surgery CPT code(s) 66820, 66821, 66830, 66982-66988, and 66991 when general or local anesthesia administers by the physician and routinely does not require it during the procedure. 

Modifier 52 applies when the physician does not complete the immunization service and terminates due to unavoidable circumstances. 

If physicians believe that Medicare will deny such service, reporting with a GA modifier is appropriate. The beneficiary must sign an Advance Beneficiary Notification (ABN), and CPT 66820, 66821, 66830, 66982-66988, and 66991 must apply the GA modifier to that service.

The cost and RUVS of CPT 66984 are $599.62 and 17.32697 when performed in the facility. In contrast, the reimbursement and RUVS of CPT 66984 are $599.62 and 17.32697 when performed in the non-facility.

The cost and RUVS of cataract surgery CPT code(s) 66991 are $752.68 and 21.74980 when performed in the facility. In contrast, the reimbursement and RUVS of CPT 66991 are $752.68 and 21.74980 when performed in the non-facility.

Cataract Surgery CPT Code Billing Guidelines

Documentation should support the medical necessity of service. It reflects that service is medically necessary and appropriate. 

CPT code 66820, 66821, 66830, 66982-66988, or CPT 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 routinely performed with a retrobulbar injection rather than general anesthesia. 

Cataract surgery CPT code(s) 66820, 66821, 66830, 66982-66988, and 66991 has 90 days global period. If any Evaluation and management (E/M) service perform in conjunction with CPT code 66984, then 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 code 66820, 66821, 66830, 66982-66988, or 66991 separately during the global period time. While modifier 25 will be applicable with CPT codes 66820, 66821, 66830, 66982-66988, and 66991 if the patient saw for an unrelated condition on the same date of the procedure.

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, it is appropriate to report with a different CPT code, 0308T.

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.

Cataract Surgery CPT Code Example

There are the following examples of cataract surgery CPT code(s) 66820, 66821, 66830, 66982-66988, or 66991 bills:

Example 1

A 56-year-old male presents to the ophthalmologist with blurry vision. He complains that he is unable to see anything. The patient restricts at home due to poor visibility. The patient said that visibility is getting tough day by day. 

The physician examined both his eyes and saw cloudiness. The patient also has frequent headaches and denies any other symptoms, such as numbness, digestive and urinary bladder issues, extremity swelling, and dizziness. 

The ophthalmologist suggested extracapsular cataract-removal surgery for the patient. The physician successfully performed surgery, and the patient tolerated the procedure very well. The physician had scheduled an appointment for surgery next week.

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