Medicare Reimbursement for Complex Cataract Surgery

A complex cataract surgery may be performed on a patient with pupils that do not dilate because of chronic parasympathomimetic drug use, scarring or trauma.  In such cases, mechanical dilation of the pupil is necessary to enable the surgeon to extract the cataract and place an IOL.

This code may also apply when the surgeon is required to suture the haptics of an IOL, or implant a capsular tension ring.  It may also apply for pediatric patients, or patients with a subluxated lens.  Other procedures requiring additional instrumentation or added steps may also qualify.

This FAQ addresses the following:

1. What CPT codes describes complex cataract surgery?
2. When is cataract surgery considered complex?
3. What types of cataract surgery should not be considered complex?
4. Must complex cataract surgery be preplanned?
5. What diagnosis codes support complex cataract surgery?
6. What does Medicare allow for 66982 and 66987?
7. Is 66982 subject to Medicare’s NCCI edits?
8. Are 66982 and 66987 eligible for HOPD and ASC reimbursement?
9. How frequently is 66982 used?

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