HCPCS G8906: Cataract Measures Group Reporting - OpenPayer

Summary & Overview

HCPCS G8906: Cataract Measures Group Reporting

HCPCS Level II code G8906 denotes an intent to report the cataract measures group, a quality-reporting designation used in ophthalmology to track performance on cataract care measures. Nationally, standardized reporting of cataract quality metrics supports benchmarking, quality improvement, and alignment with payer reporting requirements. This code matters because consistent reporting enables comparison across providers and payers and informs payers and regulators about adherence to recognized cataract care processes.

Key payers commonly engaged in cataract quality reporting include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of what HCPCS Level II code G8906 represents, the typical settings where it is used, and which major payers are relevant for national reporting. The publication outlines expected benchmarks, common policy contexts that drive use of quality-reporting codes, and clinical context related to cataract care measures. Where input data is missing, the text notes that specific fields are not available in the input.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareG8906HCPCS Level IIcataract measuresophthalmologyquality reportingoutpatient surgeryambulatory surgical centerquality metrics

Billing Code Overview

HCPCS Level II code G8906 is reported when a provider indicates the intent to report the cataract measures group. This code represents an administrative reporting choice tied to quality measurement for cataract care.

Service type: Quality measure reporting for cataract care
Typical site of service: Ambulatory surgical centers and outpatient ophthalmology clinics

Clinical & Coding Specifications

Clinical Context

A 72-year-old patient presents to an ophthalmology clinic with progressive visual decline attributed to age-related cataract formation of the right eye. Preoperative assessment includes history, visual acuity, slit-lamp examination, measurement of intraocular pressure, biometry (axial length and keratometry) for intraocular lens power calculation, and counseling on risks and benefits of cataract surgery. The clinical workflow typically includes preoperative medical optimization and consent, diagnostic testing (biometry and ocular surface assessment), scheduling for phacoemulsification with intraocular lens implantation in an ambulatory surgical center or hospital outpatient department, intraoperative documentation of laterality and any complications, and postoperative visits for day 1, week 1, and month 1 assessments.

Service Type: Quality reporting for cataract care (cataract measures group reporting).
Typical Site of Service: Ambulatory Surgical Center or Hospital Outpatient Department.
Typical Patient Scenario: Elderly patient with decreased visual acuity from age-related cortical and nuclear sclerotic cataract electing phacoemulsification with posterior chamber intraocular lens implantation; preoperative biometry performed; no significant ocular comorbidity preventing standard cataract surgery.

Coding Specifications

Modifier	Description	When to Use

HCPCS G9771: Peri-Anesthesia Temperature Measurement

HCPCS-G0317-PROLONGED-NURSING-FACILITY-EVALUATION-EM-SERVICE

HCPCS G0317: Prolonged Nursing Facility Evaluation and Management Service

HCPCS-G0494-LPN-OBSERVATION-ASSESSMENT-HOME-HEALTH-HOSPICE

HCPCS G0494: LPN Observation and Assessment, 15-Minute Units

HCPCS-G9323-DOCUMENTATION-NOT-COUNTING-PREVIOUS-CT-CARDIAC-NUCLEAR-STUDIES

HCPCS G9323: Documentation to Exclude Prior CT or Cardiac Nuclear Studies

HCPCS-G9128-MULTIPLE-MYELOMA-DISEASE-STATUS-SMOLDERING-STAGE-I

HCPCS G9128: Multiple Myeloma Disease Status Assessment, Smoldering/Stage I

HCPCS-G9221-PNEUMOCYSTIS-PROPHYLAXIS-PRESCRIBED

HCPCS G9221: Pneumocystis jiroveci Pneumonia Prophylaxis Prescribed

HCPCS-G9642-CURRENT-SMOKER-STATUS-ASSESSMENT

HCPCS G9642: Current Smoker Status Documentation

HCPCS-G9279-PNEUMOCOCCAL-SCREENING-DOCUMENTATION-VACCINATION-PRE-DISCHARGE

HCPCS G9279: Pneumococcal Screening and Vaccination Documented Prior to Discharge

HCPCS-G9282-NSCLC-HISTOLOGY-DOCUMENTATION-REASON-NOT-REPORTED

HCPCS G9282: Documentation for Not Reporting NSCLC Histology

HCPCS-G9232-DEPRESSION-COMORBIDITY-COMMUNICATION-NOT-DOCUMENTED

HCPCS G9232: Non-communication of Comorbid Condition in Major Depressive Disorder

Showing 1–10 of 1996

Taxonomy Code	Specialty	Notes
`207WC0000X`	Ophthalmology	Comprehensive cataract evaluation, surgery, and postoperative care.
`207WX0003X`	Ophthalmic Plastic and Reconstructive Surgery	Manages periocular conditions that may affect cataract surgery planning.
`2080P0222X`	Optometrist	Performs preoperative refraction, postoperative follow-up under co-management agreements.
`261QA1901X`	Ambulatory Surgical Facility	Facility taxonomy for ambulatory surgical centers where cataract procedures are commonly performed.
`261QM0800X`	Hospital Outpatient Department	Facility taxonomy for hospital-based outpatient cataract surgery settings.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`H25.9`	Age-related cataract, unspecified	Most common diagnosis leading to cataract extraction and cataract measures reporting.
`H26.9`	Cataract, unspecified	Used when cataract type is not otherwise specified but cataract surgery is indicated.
`H25.1`	Infantile and juvenile cataract	Relevant when cataract measures are applied to younger patients in specialized cases.
`H28.9`	Disorder of lens, unspecified	Covers lens disorders that may coexist or complicate cataract management.
`H44.2`	Degenerative myopia	May influence preoperative planning and refractive target; associated ocular comorbidity.
`H35.31`	Nonexudative age-related macular degeneration	Important comorbidity affecting visual prognosis and counseling prior to cataract surgery.
`H40.9`	Glaucoma, unspecified	Coexisting glaucoma can alter surgical planning and postoperative monitoring.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`66984`	Extracapsular cataract removal with insertion of intraocular lens (1-stage procedure), manual or phacoemulsification	Primary surgical procedure for age-related cataract; performed during the operative session reported under cataract measures group.
`92136`	Ophthalmic biometry for intraocular lens calculation, using partial coherence interferometry (e.g., IOLMaster)	Preoperative diagnostic measurement used to calculate IOL power prior to cataract extraction.
`92250`	Fundus photography with interpretation and report	Often used preoperatively to document macular or optic nerve status that may affect surgical decision-making and counseling.
`92012`	Ophthalmological services: intermediate, established patient; problem focused follow-up	Preoperative or postoperative office visits for evaluation and management related to cataract surgery.
`66982`	Extracapsular cataract removal with insertion of intraocular lens complicated (e.g., for dense lens, suture removal)	Used when cataract surgery is complex and additional resources or techniques are required.

`25`	Significant, separately identifiable evaluation and management service by the same physician on the day of a procedure	Use when the ophthalmologist performs a distinct E/M visit on the same day as cataract surgery for a separate problem.
`50`	Bilateral procedure	Use when cataract procedures are performed on both eyes during the same operative session (when CPT supports bilateral reporting).
`59`	Distinct procedural service	Use to indicate a procedure or service not normally reported together but appropriate under the circumstances (rare for cataract quality reporting).
`76`	Repeat procedure by same provider	Use when an identical procedure is repeated by the same provider during the postoperative period.
`77`	Repeat procedure by another provider	Use when an identical procedure is repeated by a different provider.
`78`	Return to operating room for a related procedure during global period	Use when the patient requires a repeat operative intervention related to the cataract surgery during the global period.
`79`	Unrelated procedure or service by the same physician during the global period	Use when an unrelated procedure is performed during the cataract surgery global period.
`90`	Reference (outside) laboratory	Use when diagnostic testing related to preoperative evaluation is performed by an external laboratory.
`91`	Repeat clinical diagnostic test/measurement	Use when a diagnostic test (for example, biometry) is repeated on the same day for medical reasons.
`DX`	Data not available in the input.	Data not available in the input.

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