Medicare Reimbursement for Mechanical Pupil Dilation with Malyugin Ring (MicroSurgical Technology)



© Corcoran Consulting Group

Download as PDF

For best results, please view in Mozilla Firefox.


Q  What is the Malyugin Ring™ pupil expander?

A  The Malyugin Ring pupil expander is a one-piece temporary implant to assist the surgeon with mechanical dilation of a small pupil that is refractory to pharmacological dilation.
The Malyugin Ring provides stable mydriasis during cataract surgery with no trauma to the iris tissue and no need for additional paracenteses. The capsulorhexis, hydrodissection, phacoemulsifica-tion, and injection of the IOL may occur with the device in place. At the conclusion of the procedure, the Malyugin Ring is removed from the eye.


Q  What are the indications for use of the Malyugin Ring?

A  Mechanical pupillary stretching is indicated in cases where topical or intracameral mydriatics are inadequate for proper dilation or are contraindicated. Most often these cases involve small pupils with rigid iris tissue due to prior use of miotics, pseudoexfoliation, or posterior synechiae. In some cases of intraoperative floppy-iris syndrome (IFIS), with a constricted pupil, mechanical pupil dilation is necessary.1


Q  Does using the Malyugin Ring qualify as complex cataract surgery?

A  Yes. One aspect of complex cataract surgery is mechanical dilation of a small pupil to enable the surgeon to extract the cataract and implant an IOL 2,3


Q  What CPT codes describe complex cataract surgery?

A  CPT code 66982 is describes as “Extracapsular cataract removal with insertion of intraocular lens prosthesis (1-stage procedure), manual or mechanical technique (eg, irrigation and aspiration or phacoemulsification), complex, requiring devices or techniques not generally used in routine cataract surgery (eg, iris expansion device, suture support for intraocular lens, or primary posterior capsulorrhexis) or performed on patients in the amblyogenic developmental stage; without endoscopic cyclophotocoagulation.”4

Two additional codes describe complex cataract surgery:

  • 66987 – performed in conjunction with endoscopic cyclophotocoagulation (ECP)
  • 66989 – with implantation of an aqueous drainage device (ADD)


Q  What characteristics do not make a procedure complex?

A  Duration of a procedure is not a criteria of complex cataract surgery, so a longer procedure, by itself, isn’t 66982, 66987, or 66989. The type of IOL implanted, monofocal, astigmatism-correcting, or presbyopia-correcting, does not, by itself, render a procedure complex. Vitrectomy or synechialysis at the time of cataract surgery does not, by itself, constitute complex.


Q  What does Medicare allow for complex cataract surgery?

A  In 2022, the national Medicare Physician Fee Schedule allowed amount for the surgeon is $746 for 66982 and $857 for 66989; 66987 is contractor priced and does not have an allowed amount.
Payment rates are adjusted by local wage indices in each area. Other payers set their own rates, which may differ significantly from the Medicare published fee.


Q  Are 66982, 66987 and 66989 eligible for facility reimbursement?

A  Yes. The 2022 hospital outpatient department (HOPD) facility allowed amount for 66982 is $2,121, $4,000 for 66987, and $4,251 for 66989.

The ambulatory surgery center (ASC) rate is $1,063 for 66982, $1,919 for 66987 and $3,246 for 66991. Again, these amounts are adjusted by local indices in each area.


Q  Is there additional payment for the supply of the Malyugin Ring?

A  No. The device is included in the reimbursement for the facility fee, and the HOPD or ASC is precluded from balance billing the beneficiary for it. So, even though the surgeon receives additional reimbursement for complex cataract surgery, the ASC and HOPD do not.


Q  Is complex cataract surgery subject to Medicare’s NCCI edits?

A  Yes. Current National Correct Coding Initiative (NCCI) edits are largely the same as for regular cataract surgery.


Q  What is the frequency of complex cataract surgery?

A  Of all Part B Medicare claims paid during 2018, 66982 was about 9% of all cataract procedures with an IOL. Surgeon utilization rates vary; some perform more than others. 66987 and 66989 are too new to have utilization history.


1 First Coast Health. LCD L38926 Cataract Extraction (Including Complex Cataract Surgery) Rev. eff. 7/11/21. Accessed 12/8/21
2 Noridian Healthcare Solutions. LCD A57196. Cataract Surgery in Adults. Rev eff 01/01/20. Accessed 12/8/21
3 Palmetto GBA. Local Coverage Article A53047. Complex Cataract Surgery: Appropriate Use and Documentation. A53047. Rev eff 10/10/19. Accessed 12/8/21
4 2022 CPT Professional Edition.






Provided Courtesy of MicroSurgical Technology – A Halma Company (888) 279-3323

Last updated January 1, 2022

The reimbursement information is provided by Corcoran Consulting Group based on publicly available information from CMS, the AMA, and other sources. The reader is strongly encouraged to review federal and state laws, regulations, code sets, and official instructions promulgated by Medicare and other payers. This document is not an official source nor is it a complete guide on reimbursement. Although we believe this information is accurate at the time of publication, the reader is reminded that this information, including references and hyperlinks, changes over time, and may be incorrect at any time following publication.

© 2021 Corcoran Consulting Group. All rights reserved. No part of this publication may be reproduced or distributed in any form or by any means, or stored in a retrieval system, without the written permission of the publisher. CPT is a registered trademark of the American Medical Association.

Corcoran Consulting Group (800) 399-6565

Website by MIC