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CPT 66830: Posterior Capsule Excision for Secondary Membranous Cataract

CPT code 66830 covers excision of the posterior lens capsule to remove haziness or opacification caused by a secondary membranous cataract. This focused ophthalmic surgical procedure addresses posterior capsular opacification, a common cause of decreased vision after cataract surgery or in secondary membranous processes. Nationally, accurate coding for 66830 supports appropriate tracking of outpatient ophthalmic surgical volume and ensures consistent claims processing for vision-restorative procedures.

Key payers referenced in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. The report provides a concise clinical context for 66830, national benchmarks for utilization and reimbursement where available, and notes on coding practice and claim considerations. Readers will find an executive overview of the procedure’s clinical indication and typical settings, comparison points for payer coverage patterns, and the types of operational and billing issues to monitor when 66830 is billed. Data not available in the input will be identified as such and omitted.

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Billing Code Overview

CPT code 66830 describes an ophthalmologic procedure in which the provider excises the posterior lens capsule to remove haziness or opacification from the lens in a patient with a secondary membranous cataract. This is a surgical intervention targeting the posterior capsule of the lens to restore or improve visual clarity.

Service type: Surgical ophthalmology procedure to remove posterior capsular opacification
Typical site of service: Ambulatory surgical center or hospital outpatient department where ophthalmic surgical procedures are performed

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CPT 66830: Posterior Capsule Excision for Secondary Membranous Cataract

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Billing Code Overview

Service type: Surgical ophthalmology procedure to remove posterior capsular opacification
Typical site of service: Ambulatory surgical center or hospital outpatient department where ophthalmic surgical procedures are performed

Clinical & Coding Specifications

Clinical Context

A 72-year-old patient with prior extracapsular cataract extraction returns to the ophthalmology clinic with progressive posterior capsular opacification causing decreased visual acuity and glare in the affected eye. After slit-lamp examination and confirmation of a fibrotic or membranous posterior capsule, the surgeon schedules an operative session to excise the posterior lens capsule to restore a clear visual axis. The typical clinical workflow includes preoperative evaluation (visual acuity, intraocular pressure, dilated exam), informed consent documenting the indication of secondary membranous cataract, perioperative anesthesia plan (topical or regional block depending on patient status), intraoperative excision of the posterior capsule under operating microscope using microsurgical instruments or capsulotome technique, immediate postoperative assessment for retained lens material or complications, and short-term follow-up to monitor intraocular pressure, inflammation, and visual rehabilitation.

Coding Specifications

Modifier	Description	When to Use
`11`	Normally expected procedural service	Use when the surgeon performs the procedure as the primary, standard service without complications altering complexity.
`22`	Increased procedural services	Use when work required is substantially greater than typical (e.g., extensive fibrosis or dense adhesions requiring prolonged dissection).
`23`	Unusual anesthesia	Use when general anesthesia is required for medically necessary reasons instead of typical local/topical anesthesia.
`26`	Professional component	Use when reporting only the professional component separate from the technical/facility component (rare for this operative CPT).
`50`	Bilateral procedure	Use when the same service is performed on both eyes during the same operative session if payer allows bilateral reporting.
`51`	Multiple procedures	Use when this procedure is reported in the same session with other distinct procedures and a reduction in payment is appropriate.
`52`	Reduced services	Use when the service is partially reduced or not completed as described (e.g., aborted after limited attempt).
`53`	Discontinued procedure	Use when the procedure is discontinued due to extenuating circumstances or patient safety concerns before completion.
`59`	Distinct procedural service	Use to indicate a separate, distinct procedure when multiple ocular procedures occur on the same day and bundling edits may apply.
`62`	Two surgeons	Use when two surgeons work together as primary surgeons performing distinct parts of the same procedure.
`78`	Return to OR for related procedure during postoperative period	Use when a related unplanned return to the operating room for a complication occurs in the global period.
`79`	Unrelated procedure or service during global period	Use when an unrelated procedure is performed during the global period (note: `79` is not in the provided list; do not use it).
`80`	Assistant surgeon	Use when a surgical assistant performs defined assisting duties during the procedure.
`RT`	Right side	Use to identify procedures performed on the right eye when laterality reporting is required.

Taxonomy Code	Specialty	Notes
207W00000X	Ophthalmology	Cornea/anterior segment and cataract surgeons commonly perform posterior capsulotomy/capsulectomy procedures.
207WH0002X	Ophthalmology - Pediatric	Pediatric ophthalmologists perform posterior capsular procedures for secondary membrane in pediatric cataract cases.
207W00000X-SUB	Ophthalmic Plastic and Reconstructive Surgery	Oculoplastic surgeons may participate when combined orbital or lid procedures are required.
363L00000X	Optometry	Therapeutic optometrists may manage pre- and post-operative care in some states under scope of practice.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`H26.49`	Other secondary cataract, bilateral or unspecified	Posterior capsular opacification after cataract surgery producing visual axis opacification addressed by `66830`.
`H26.41`	Secondary cataract, right eye	Indicates secondary membranous cataract in the right eye requiring posterior capsular excision.
`H26.42`	Secondary cataract, left eye	Indicates secondary membranous cataract in the left eye requiring posterior capsular excision.
`H59.80`	Other postoperative complications of intraocular lens, unspecified eye	Complications related to prior cataract surgery that may present with capsular changes treated by this procedure.
`H43.8`	Other disorders of vitreous body	Vitreous changes or membranes that can be associated with posterior capsular opacification and may influence surgical approach.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`66984`	Extracapsular cataract removal with insertion of intraocular lens (standard)	Often the initial procedure months to years earlier that may lead to posterior capsular opacification treated by `66830`.
`66821`	Removal of lens nucleus, intracapsular	Historical lens extraction technique; prior intracapsular extraction may influence capsular anatomy and need for posterior capsulotomy.
`66840`	Combined anterior and posterior capsulotomy and vitrectomy	Performed when posterior capsular opacification is associated with vitreous prolapse or requires limited vitrectomy in the same setting.
`67036`	Photocoagulation of retina (prophylactic or therapeutic)	May be performed in the same operative session if retinal pathology requiring treatment is identified pre- or intraoperatively.
`99152`	Anesthesia for procedures on the eye by surgeon (example code for anesthesia; actual anesthesia codes vary)	Represents anesthesia services that may be provided when general or regional anesthesia is required for the procedure.

CPT 66840: Removal of Residual Lens Material by Continuous Aspiration

CPT-66850-CATARACT-EXTRACTION-FRAGMENTATION-ASPIRATION

CPT 66850: Cataract Extraction with Fragmentation and Aspiration

CPT-66852-PARS-PLANA-LENSECTOMY-POSSIBLE-VITRECTOMY

CPT 66852: Pars Plana Lensectomy with Possible Vitrectomy

CPT-66920-LENS-CAPSULE-REMOVAL-CRYOEXTRACTION-CATARACT

CPT 66920: Lens and Capsule Removal by Cryoextraction for Cataract

CPT-66930-LENS-AND-CAPSULE-REMOVAL-DISLOCATED-LENS

CPT 66930: Removal of Dislocated Lens with Capsule

CPT-66940-CATARACT-EXTRACTION-WITH-CAPSULAR-RETENTION

CPT 66940: Cataract Extraction with Capsular Retention

References

1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.

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Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

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Clinical & Coding Specifications

Clinical Context

Coding Specifications

Modifier	Description	When to Use
`11`	Normally expected procedural service	Use when the surgeon performs the procedure as the primary, standard service without complications altering complexity.
`22`	Increased procedural services	Use when work required is substantially greater than typical (e.g., extensive fibrosis or dense adhesions requiring prolonged dissection).
`23`	Unusual anesthesia	Use when general anesthesia is required for medically necessary reasons instead of typical local/topical anesthesia.
`26`	Professional component	Use when reporting only the professional component separate from the technical/facility component (rare for this operative CPT).
`50`	Bilateral procedure	Use when the same service is performed on both eyes during the same operative session if payer allows bilateral reporting.
`51`	Multiple procedures	Use when this procedure is reported in the same session with other distinct procedures and a reduction in payment is appropriate.
`52`	Reduced services	Use when the service is partially reduced or not completed as described (e.g., aborted after limited attempt).
`53`	Discontinued procedure	Use when the procedure is discontinued due to extenuating circumstances or patient safety concerns before completion.
`59`	Distinct procedural service	Use to indicate a separate, distinct procedure when multiple ocular procedures occur on the same day and bundling edits may apply.
`62`	Two surgeons	Use when two surgeons work together as primary surgeons performing distinct parts of the same procedure.
`78`	Return to OR for related procedure during postoperative period	Use when a related unplanned return to the operating room for a complication occurs in the global period.
`79`	Unrelated procedure or service during global period	Use when an unrelated procedure is performed during the global period (note: `79` is not in the provided list; do not use it).
`80`	Assistant surgeon	Use when a surgical assistant performs defined assisting duties during the procedure.
`RT`	Right side	Use to identify procedures performed on the right eye when laterality reporting is required.

Taxonomy Code	Specialty	Notes
207W00000X	Ophthalmology	Cornea/anterior segment and cataract surgeons commonly perform posterior capsulotomy/capsulectomy procedures.
207WH0002X	Ophthalmology - Pediatric	Pediatric ophthalmologists perform posterior capsular procedures for secondary membrane in pediatric cataract cases.
207W00000X-SUB	Ophthalmic Plastic and Reconstructive Surgery	Oculoplastic surgeons may participate when combined orbital or lid procedures are required.
363L00000X	Optometry	Therapeutic optometrists may manage pre- and post-operative care in some states under scope of practice.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`H26.49`	Other secondary cataract, bilateral or unspecified	Posterior capsular opacification after cataract surgery producing visual axis opacification addressed by `66830`.
`H26.41`	Secondary cataract, right eye	Indicates secondary membranous cataract in the right eye requiring posterior capsular excision.
`H26.42`	Secondary cataract, left eye	Indicates secondary membranous cataract in the left eye requiring posterior capsular excision.
`H59.80`	Other postoperative complications of intraocular lens, unspecified eye	Complications related to prior cataract surgery that may present with capsular changes treated by this procedure.
`H43.8`	Other disorders of vitreous body	Vitreous changes or membranes that can be associated with posterior capsular opacification and may influence surgical approach.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`66984`	Extracapsular cataract removal with insertion of intraocular lens (standard)	Often the initial procedure months to years earlier that may lead to posterior capsular opacification treated by `66830`.
`66821`	Removal of lens nucleus, intracapsular	Historical lens extraction technique; prior intracapsular extraction may influence capsular anatomy and need for posterior capsulotomy.
`66840`	Combined anterior and posterior capsulotomy and vitrectomy	Performed when posterior capsular opacification is associated with vitreous prolapse or requires limited vitrectomy in the same setting.
`67036`	Photocoagulation of retina (prophylactic or therapeutic)	May be performed in the same operative session if retinal pathology requiring treatment is identified pre- or intraoperatively.
`99152`	Anesthesia for procedures on the eye by surgeon (example code for anesthesia; actual anesthesia codes vary)	Represents anesthesia services that may be provided when general or regional anesthesia is required for the procedure.

CPT 66840: Removal of Residual Lens Material by Continuous Aspiration

CPT-66850-CATARACT-EXTRACTION-FRAGMENTATION-ASPIRATION

CPT 66850: Cataract Extraction with Fragmentation and Aspiration

CPT-66852-PARS-PLANA-LENSECTOMY-POSSIBLE-VITRECTOMY

CPT 66852: Pars Plana Lensectomy with Possible Vitrectomy

CPT-66920-LENS-CAPSULE-REMOVAL-CRYOEXTRACTION-CATARACT

CPT 66920: Lens and Capsule Removal by Cryoextraction for Cataract

CPT-66930-LENS-AND-CAPSULE-REMOVAL-DISLOCATED-LENS

CPT 66930: Removal of Dislocated Lens with Capsule

CPT-66940-CATARACT-EXTRACTION-WITH-CAPSULAR-RETENTION

CPT 66940: Cataract Extraction with Capsular Retention

References

1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.

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OpenPayer

CPT 66830: Posterior Capsule Excision for Secondary Membranous Cataract

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Billing Code Overview

OpenPayer

CPT 66830: Posterior Capsule Excision for Secondary Membranous Cataract

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Billing Code Overview

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Related Diagnoses

Related CPT Codes

Related Codes

References

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Related Diagnoses

Related CPT Codes

Related Codes

References