Summary & Overview
CPT 66982: Complex Cataract Removal with Intraocular Lens Insertion
CPT code 66982 is a nationally recognized billing code for complex extracapsular cataract removal with intraocular lens insertion. This procedure is distinguished from routine cataract surgery by the use of specialized devices or techniques, such as iris expansion devices or suture support for the intraocular lens, and is often required for patients with unique anatomical challenges or in the amblyogenic developmental stage. The code is most commonly billed in ambulatory surgery centers or hospital outpatient departments, reflecting its advanced clinical nature.
Major payers covering this procedure include Aetna, Blue Cross Blue Shield, Cigna Health, Medicare, and UnitedHealthcare. The publication provides a comprehensive overview of payer coverage, clinical context, and policy benchmarks for CPT 66982. Readers will gain insight into the procedural complexity, typical sites of service, and how this code fits within the broader landscape of ophthalmologic surgery billing. The summary also highlights related codes for complex cataract procedures, offering context for coding and reimbursement trends. This resource is designed for healthcare professionals, administrators, and policy analysts seeking up-to-date information on complex cataract surgery billing and coverage.
CPT Code Overview
CPT 66982 represents complex extracapsular cataract removal with insertion of intraocular lens prosthesis. This procedure is performed in a single stage using manual or mechanical techniques, such as irrigation and aspiration or phacoemulsification. It is classified as complex due to the requirement for devices or techniques not generally used in routine cataract surgery, including iris expansion devices, suture support for intraocular lens, or primary posterior capsulorrhexis. The service type is ophthalmologic surgery – cataract complex, and it is typically performed in an Ambulatory Surgery Center (ASC) or hospital outpatient setting.
Clinical & Coding Specifications
Clinical Context
A typical patient scenario involves an adult presenting with a visually significant cataract and additional ocular complexity, such as iris atrophy, iridodialysis, or degeneration of the ciliary body. The patient may have anatomical challenges requiring specialized devices or techniques not used in routine cataract surgery, such as an iris expansion device or suture support for the intraocular lens. The procedure is performed in an ambulatory surgery center or hospital outpatient setting. The clinical workflow includes preoperative assessment, complex extracapsular cataract removal, intraocular lens implantation, and postoperative care, often coordinated among ophthalmology specialists.
Coding Specifications
| Modifier Code | Description | When Used |
|---|---|---|
54 | Surgical care only | Used when the provider performs only the surgical portion of the procedure, not the pre- or post-operative care. |
55 | Postoperative management only | Used when the provider manages only the postoperative care, not the surgery itself. |
25 |