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CPT 66991: Extracapsular Cataract Extraction with IOL and Aqueous Drainage Device
CPT code 66991 represents a combined ophthalmic operation: extracapsular cataract extraction with intraocular lens (IOL) implantation performed in the same session as insertion of one or more anterior segment aqueous drainage devices. This bundled surgical code reflects care for patients who require simultaneous cataract removal and glaucoma pressure-lowering device placement, and it has implications for operative planning, device use, and payer coverage nationally. Key payers examined include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise clinical context explaining when the procedure is used, comparisons to related cataract codes, and the policy and billing considerations that affect authorization and claim processing. The publication outlines typical sites of service, common principal diagnoses associated with the procedure, and the relationship of this code to other cataract and complex cataract codes used in practice. Benchmarks and payer-specific coverage patterns are summarized to inform revenue cycle staff, surgical schedulers, and clinical leaders about authorization expectations, claim adjudication issues, and coding alignment for combined cataract–glaucoma procedures. The brief also highlights coding distinctions to help ensure appropriate reporting of a one-stage cataract removal with concurrent aqueous drainage device implantation in the national payer environment.
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Billing Code Overview
CPT code 66991 describes a combined ophthalmic surgical procedure in which the provider performs an extracapsular cataract extraction and inserts an intraocular lens prosthesis during the same operative session, and also inserts one or more anterior segment aqueous drainage devices to lower intraocular pressure. This is a surgical service for patients who require cataract removal with lens implantation plus concurrent implantation of glaucoma drainage or aqueous outflow devices.
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Service type: Combined cataract extraction with intraocular lens implantation and anterior segment aqueous drainage device insertion
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Typical site of service: Operating room or ambulatory surgical center (ophthalmic surgical setting)
National Reimbursement Benchmarks
Medicare’s mean reimbursement for CPT 66991 sits at $599.20, notably lower than BUCA’s mean commercial benchmark of $2,021.10. This gap highlights a substantial divergence between federal program rates and average commercial contracting for this procedure: Medicare is roughly $1,421.90 below BUCA on average, reflecting typical public-versus-commercial differences in ophthalmic surgical payments.
Dispersion measured by the interquartile range (P75–P25) varies markedly by payer. Blue Cross Blue Shield shows one of the widest IQRs at $1,743.20, followed by UnitedHealth Group at $725.90 and BUCA at $1,273.60, indicating large regional or network variability. Aetna ($470.0) and Cigna ($807.2) are comparatively tighter and looser respectively, with Aetna presenting the tightest IQR among the listed commercial payers at $374.0.