Summary & Overview
HCPCS G8765: Completion of Cataract Quality Measures
HCPCS Level II code G8765 documents that all required quality actions for the cataract measures group have been completed for a patient. As a quality-reporting code, G8765 is used to indicate fulfillment of measure sets tied to cataract care, supporting performance measurement, value-based payment programs, and quality reporting across payers. Nationally, use of a standardized indicator such as G8765 helps align clinical documentation with payer quality frameworks and regulatory reporting requirements.
This analysis covers major national payers including Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of the code’s clinical context in cataract care, typical sites where the code is applied, and what the code signifies for quality reporting workflows. The publication also summarizes common implementation considerations and related coding that organizations typically review when integrating G8765 into quality and billing processes.
The content is intended to inform billing managers, quality leads, and policy analysts about the role of G8765 in cataract quality reporting, clarifying its purpose and the national payer landscape relevant to its use. Data not available in the input is noted where specific payer policy details, modifiers, or related code mappings would normally appear.
Billing Code Overview
HCPCS Level II code G8765 indicates that all quality actions for the applicable measures in the cataract measures group have been performed for this patient. This reflects completion of the specified quality measures tied to cataract care for the reporting period.
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Service type: Quality reporting / performance measurement for cataract care
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Typical site of service: Ambulatory ophthalmology clinics or surgical centers where cataract care and related quality reporting occur
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Clinical & Coding Specifications
Clinical Context
A 72-year-old patient presents to an ophthalmology clinic for routine cataract surgery and perioperative quality measurement reporting. The patient has visually significant age-related cataracts in both eyes causing functional impairment and meets clinical criteria for phacoemulsification with intraocular lens implantation. The clinical workflow includes preoperative evaluation (visual acuity, slit-lamp exam, biometry), informed consent, cataract extraction with intraocular lens placement, and postoperative follow-up visits to assess visual outcomes and complications. Documentation of all required quality actions for the cataract measures group is completed, including baseline visual acuity, appropriate documentation of comorbid eye conditions, reporting of postoperative visual acuity and refractive error when indicated, confirmation of appropriate IOL selection, and completion of patient-reported outcome measures if required. The billing code G8765 is used to indicate that all quality actions for the applicable cataract measures group have been performed for this patient.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
25 | Significant, Separately Identifiable Evaluation and Management Service by the Same Physician on the Same Day of the Procedure | Use when a distinct E/M visit is medically necessary and documented on the same day as cataract surgery-related services. |
| Multiple Procedures | Use when multiple procedures are performed during the same operative session and payer requires modifier for secondary procedures.